The feasibility of single-port laparoscopic appendectomy using a solo approach: a comparative study

PURPOSE: To investigate the feasibility and safety of solo surgery with single-port laparoscopic appendectomy, which is termed herein solo-SPLA (solo-single-port laparoscopic appendectomy). METHODS: This study prospectively collected and retrospectively analyzed data from patients who had undergone either non-solo-SPLA (n = 150) or solo-SPLA (n = 150). Several devices were utilized for complete, skin-to-skin solo-SPSA, including a Lone Star Retractor System and an adjustable mechanical camera holder. RESULTS: Operating times were not significantly different between solo- and non-solo-SPLA (45.0 +/- 21.0 minutes vs. 46.7 +/- 26.1 minutes, P = 0.646). Most postoperative variables were also comparable between groups, including the necessity for intravenous analgesics (0.7 +/- 1.2 ampules [solo-SPLA] vs. 0.9 +/- 1.5 ampules [non-solo-SPLA], P = 0.092), time interval to gas passing (1.3 +/- 1.0 days vs. 1.4 +/- 1.0 days, P = 0.182), and the incidence of postoperative complications (4.0% vs. 8.7%, P = 0.153). Moreover, solo-SPLA effectively lowered the operating cost by reducing surgical personnel expenses. CONCLUSION: Solo-SPLA economized staff numbers and thus lowered hospital costs without lengthening of operating time. Therefore, solo-SPLA could be considered a safe and feasible alternative to non-solo-SPLA.

Bowel Anastomosis in Single Port Laparoscopic Right Hemicolectomy: Comparison of Functional End to End Anastomosis and Isoperistaltic Side to Side Anastomosis

PURPOSE: Colorectal surgeries by single port laparoscopic surgery (SPLS) are increasing. While recent studies have reported results that are similar with the idea of conventional laparoscopy, SPLS is considered superior to conventional laparoscopy with regard to cosmetic aspects. We investigated the question of whether length of incision and postoperative recovery are different depending on the method of anastomosis in patients who underw ent SPLS right hemicolectomy (RHC). METHODS: Data on patients who underwent SPLS RHC from May 2011 to April 2012 at Samsung Medical Center were retrospectively collected. Among 117 patients, 31 received functional end-to-end anastomosis (FEEA) while 86 received isoperistaltic side-to-side anastomosis (ISSA). RESULTS: Operation time was shorter in FEEA compared to ISSA (152+/-42 vs 172+/-35 min, p=0.01). Neither group required an additional port. Although wound extension for specimen delivery tended to be frequent in loop type specimen after FEEA, the result was statistically insignificant (58.1 vs 43.0%, p=0.15). No difference in wound length was observed (4.4+/-1.0 vs 4.5+/-1.5 cm). Length of stay was longer in ISSA compared to FEEA (6.3+/-2.1 vs 7.9+/-4.3 days, p=0.01), and there was no difference in first gas passage (2.5+/-0.9 vs 2.8+/-0.9 days, p=0.26). Although three patients (9.7%) with FEEA and 19 patients (22.1%) with ISSA had postoperative complications, the difference was insignificant. CONCLUSION: Theoretically, delivery of a tube shaped specimen after ISSA is expected to reduce unnecessary wound extension and possible tumor dissemination compared to loop shape specimen after FEEA. However, results of our study showed no advantage in recovery period and wound length. We suggest that future prospective study might reveal more valuable conclusions on the subject.

The application of transumbilica single-port laparoscopic surgery in the treatment of bilateral varicocele / 中国综合临床

Objective To explore the clinical value of transumbilica single-port laparoscopic surgery in the treatment of bilateral varicocele.Methods From Jan. 2010 to Sep. 2010,42 patients with bilateral varicocele underwent laparoscopic high ligation of bilateral spermatic vein.Of these patients,20 were treated with transumbilica single-port laparoscopic surgery,22 with traditional laparoscopic surgery.The two groups of patients were compared for the parameters such as intraoperative blood loss,testicular artery preservation,operating time,time of activities after surgery,time of intestinal function recovery and hospitalization duration.The semen quality 1 year after the surgery was compared with that before treatment.At the out-patient re-examination at 1,3,6months and 1 year after the surgery,the incision,scrotum,spermatic cord,testis were checked for possible complications.The relief of discomfortness in the scrotum was also followed up.Results Both operation procedures were successful,without severe complications.In the single-port laparoscopic surgery produced blood lose ( [ 5 ± 1 ] ml vs.[ 5 ± 1 ] ml,t =- 0.452,P ＞ 0.05 ),the operating time ( [ 41 ± 7 ] min vs.[ 39 ± 3 ] min,t =0.686,P ＞ 0.05 ),postoperative intestinal function recovery time ( [ 11 + 1 ] h vs.[ 11 + 2 ] h,t =- 1.631,P ＞0.05 ) and postoperative hospital stay ( [ 3.1 + 0.7 ] d vs.[ 3.4 + 0.7 ] d,t =- 1.447,P ＞ 0.05 ) which were all comparable to that from conventional laparoscopic surgery.There was significant difference in the population using analgesics,single-port laparoscopic surgery vs.conventional laparoscopic surgery ( 1 case [ 5.0％ ] vs 7case [ 31.8％ ].The difference was statistically significant (x2 =4.886,P ＜ 0.05 ).The single-port laparoscopic surgery produced neglectable scar at the incision.All of the patients were questionaired for their satisfaction with the incision 1 year after the surgery.The difference was statistically significant (x2 =7.636,P ＜ 0.01 )Conclusion Single-port laparoscopic high ligation of bilateral spermatic vein produces comparable outcomes to that of conventional laparoscopic surgery,but it is a more microinvasive procedure producing good aesthetic appearance,representing the trend of laparoscopic technique.

Single Port Laparoscopic Surgery and Transanal Specimen Retrieval for Sigmoid Colon Cancer

Transumbilical single-port laparoscopic surgery (SPLS) is a newly emerged and rapidly evolving, minimally invasive treatment method. Transumbilical SPLS produces minimal parietal injury and can achieve cosmetic advantages by reducing additional trocar placement. The in-line or chopstick arrangement of laparoscopic instruments can make the operative procedures somewhat strange and inconvenient at first, but experienced laparoscopic surgeons can achieve the same coverage as conventional laparoscopic surgery with time. Here, we report the first case of transumbilical SPLS anterior resection (SPLS-AR) with transanal retrieval of aspecimen and intracorporeal single stapling anastomosis. The operating time was 270 min. There were no intraoperative or postoperative complications. Transumbilical SPLS resulted in a 1.5-cm wound with early recovery. Transumbilical SPLS-AR with transanal retrieval and intracorporeal anastomosis for sigmoid colon cancer is feasible by experienced laparoscopic colorectal surgeons based on careful evaluation and selection of patients. This operation fulfills both oncological principles and cosmetic demand.

Early Experience of Single-Port Laparoscopic Anterior Resection for Colon Cancer / 대한내시경복강경외과학회지

PURPOSE: Single-port laparoscopic surgery (SPLS) has recently emerged as a method to improve the morbidity and cosmetic benefit of conventional laparoscopic surgery. We describe our experience of SPLS for an anterior resection (AR). The results of a prospective series of single-port laparoscopic anterior resection procedures are presented. METHODS: Anterior resections were performed on 16 cases using a single-port laparoscopic technique between March 2009 and March 2010. The surgical and oncologic outcomes were recorded on a prospective database. RESULTS: Sixteen (8 women) unselected patients (eight males, eight females), aged 43~82 years (median 66.5 years), underwent a SPLS anterior resection for sigmoid colon cancers (median 16 cm above AV, range 13~27). All patients were alive at 30 days. The surgery time ranged from 150~415 min (median 242 min) and the median wound incision length was 2.4 cm (range 1.5~4.0 cm). The median hospital stay was 7.5 days. Pathological reports from the resected specimens revealed adenocarcinoma in 15 patients and mucinous carcinoma in one. There was one case of an anastomotic leak that required reanastomosis. The median number of lymph nodes harvested was 27.5 (range 10~56). CONCLUSION: SPLS is a possible approach to an anterior resection with the potential for minimal access. A SPLS anterior resection is feasible and safe when performed by an experienced laparoscopic surgeon and team. On the other hand, the technique and oncologic safety warrants further prospective randomized studies.

Heterotopic Pancreas of the Jejunum Identified by Capsule Endoscopy / 대한소화기내시경학회지

Heterotopic pancreas is an uncommon condition that commonly occurs in the gastrointestinal tract such as the stomach and small bowel. It is defined as the presence of pancreatic tissue outside its usual location and lacking anatomical and vascular continuity with the pancreas. A heterotopic pancreas is usually found incidentally and is mostly silent; however, it rarely causes abdominal pain, weight loss, bleeding, or ileus. A 49-year-old male presented with intermittent abdominal pain for 4 weeks. We report a case with submucosal features of a jejunal heterotopic pancreas with the aid of capsule endoscopy and a histological confirmation through a single port laparoscopic segmental jejunectomy.

Clincal study of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection for treatment of chyluria / 中华泌尿外科杂志

Objective To evaluate the feasibility and efficacy of laparoscopic single-port transumbilical renal pedicle lymphatic disconnection (TRPLD) for treatment of chyluria. Methods Nine cases of chyluria underwent laparoscopic single-port TRPLD. In all cases a 2-3 cm single inverted Ushaped supraumbilical incision was made, two 5-mm and one 12-mm trocars were inserted, and a medical rubber glove was sutured surrounding the three trocars and incision was made for gas proofing.Conventional straight and flexible instruments were used for dissection. Results All laparoscopic operations were successfully completed without conversion to open surgery. The mean operative time was 135 (96-178) minutes, and the mean estimated blood loss was 126 (50-250) ml. Chyluria disappeared in all patients after operation and did not reoccur during the follow-up (1 - 6 months).Conclusions Laparoscopic single-port transumbilical TRPLD represents a feasible and novel mini-invasive option for patients with chyluria.

Single port laparoscopic surgery

Minimally invasive surgery and laparoscopic surgery have been used for more than 30 years, and are now popular even for some malignant diseases. There have been two developments in technology; one is robotic surgery and the other is less minimally invasive surgery like natural orifice transluminal endoscopic surgery (NOTES) and single port laparoscopic surgery. NOTES, using the current platform of a conventional fiberscope and side channel instruments for surgery, suffers many limitations, including image quality, flexibility of the fiberscope, size of the side channel, and difficulty of closing the opening. Due to the above-mentioned limitations, single port laparoscopic surgery has many advantages over. This review aims to define single port laparoscopic surgery and describe its terminology and technology. To perform single port laparoscopic surgery efficiently, new instruments (e.g., a laparoscopic camera, ports, laparoscopic instruments) and combining other innovative methods into surgery are both helpful. Even though there have been many developments in laparoscopic cameras, ports, and laparoscopic instruments to enhance single port laparoscopic surgery, further improvements are needed. Motorized instruments or using a robotic platform in combination with single port laparoscopic surgery will be another way to overcome the limitations of current single port laparoscopic surgery. Single port laparoscopic surgery is a technique that has recently emerged, but will be performed in a wider range of surgical procedures based on developments in laparoscopic cameras, ports and laparoscopic instrument technology.