Preliminary application and efficacy analysis of transumbilical single-incision plus one port robotic total mesorectal excision / 中华胃肠外科杂志

Objective: To investigate the feasibility of transumbilical single-incision plus one port (SIPOP) robotic total mesorectal excision. Methods: Clinical data of a 70-year-old male patient with BMI 22.1 kg/m(2) who successfully underwent transumbilical single-incision plus 1 port robotic total mesorectal resection of upper rectal cancer at the General Surgery Department of Daping Hospital of Army Military Medical University on September 18, 2019 were retrospectively analyzed. Preoperative colonoscopy revealed that the distance of upper rectal cancer to anal edge was 14 cm, and the tumor size was 2.5 cm×1.5 cm×1 cm. Pathological result confirmed rectal moderately differentiated adenocarcinoma. The preoperative abdominal CT showed thickened bowel-wall of upper rectum and the blurred perirectal fat, suggesting tumor infiltration. Results: The operation was successful. There were no conversion to laparotomy or abdominal auxiliary incision, and the mesorectum of the specimen was intact. The operation time was 165 minutes, the blood loss was about 20 ml, and there were no complications such as injury to peripheral organs. Postoperative pathology showed ulcerative moderately differentiated adenocarcinoma of the upper rectum with TNM stage IVA (T4N2b). The postoperative recovery was smooth. Patient ambulated on the 1st day, the catheter was removed on the 7th day, and discharged from the hospital on the 8th day. Conclusion: The transumbilical SIPOP robotic total mesorectal excision is safe, effective and feasible.

Application of single incision plus one port laparoscopic surgery in radical right hemicolon cancer surgery / 中华胃肠外科杂志

Objective: To investigate the feasibility and advantages of the SILS+1 technique in the radical right hemicolectomy, by comparing the short-term efficacy, postoperative recovery of intestinal function, and stress and inflammatory response of patients with right-sided colon cancer undergoing the conventional 5-hole laparoscopic technique or the single incision plus one port laparoscopic surgery (SILS+1). Methods: A retrospective cohort study was performed. Thirty-five patients with right-sided colon cancer undergoing SILS+1 surgery at Department of Gastrointestinal Surgery of Fujian Cancer Hospital from January 2018 to September 2020 were enrolled in the SILS+1 group. Then a total of 44 patients who underwent completely 5-hole laparoscopic right hemicolectomy at the same time were selected as the conventional laparoscopic surgery (CLS) group. The intraoperative observation indexes (operative time, intraoperative blood loss, and incision length) and postoperative observation indexes (time to ambulation after surgery, time to flatus, pain score in the first 3 days after surgery, hospitalization days, number of lymph node dissections, postoperative complication morbidity, and postoperative total protein, albumin and C-reaction protein) were compared between the two groups. Results: There was no conversion to laparotomy or laparoscopic-assisted surgery in both groups. All the patients successfully completed radical right hemicolectomy under total laparoscopy. There were no statistically significant differences in gender, age, body mass index or tumor stage between the two groups (all P>0.05). Compared with the CLS group, the SILS+1 group had shorter incision length [(5.1±0.6) cm vs. (8.5±4.1) cm, t=4.124, P=0.012], shorter time to the first ambulation (median: 27.6 h vs. 49.3 h, Z=4.386, P=0.026), and shorter time to the first flatus (median:42.8 h vs. 63.2 h, Z=13.086, P=0.012), lower postoperative pain score [postoperative 1-d: 2.0 ± 1.1 vs. 3.6 ± 0.9; postoperative 2-d: 1.4 ± 0.2 vs. 2.9±1.4; postoperative 3-d: 1.1 ± 0.1 vs. 2.3±0.3, F=49.128, P=0.003), shorter postoperative hospital stay [(9.1 ± 2.7) d vs. (11.2 ± 2.2) d, t=3.267,P=0.001], which were all statistically significant (all P<0.05). On the second day after surgery, as compared to CLS group, SILS+1 group had higher total protein level [(59.7±18.2) g/L vs. (43.0±12.3) g/L, t=2.214, P=0.003], higher albumin level [(33.6±7.3) g/L vs. (23.7±5.4) g/L, t=5.845, P<0.001], but lower C-reactive protein level [(16.3 ± 3.1) g/L vs. (63.3 ± 4.5) g/L, t=4.961, P<0.001], which were all statistically significant. There were no significant differences in the operative time, intraoperative blood loss, number of harvested lymph node, number of metastatic lymph node, and postoperative complication morbidity (all P>0.05). Conclusions: The SILS+1 technique has good operability and potential for popularization. Under the premise of radical resection, this technology not only reduces incision number and postoperative physical pain, but also speeds up postoperative recovery and shortens hospital stay.

Short-term outcomes of single incision plus one port laparoscopic surgery for colorectal cancer / 中华胃肠外科杂志

Objective: Although single port laparoscopic surgery has achieved good clinical results, many surgeons are discouraged by the difficulties of operation, conflict of instruments, lack of antagonistic traction, and straight-line perspective. Therefore, some surgeons have proposed a single incision plus one hole laparoscopic surgery (SILS+1) surgical method. This study explored the safety and feasibility of SILS+1 for radical resection of colorectal cancer. Methods: A descriptive cohort study was carried out. The clinical data, including the operation, pathology and recovery situation, of 178 patients with colorectal cancer undergoing SILS+1 at Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2018 to January 2019 were prospectively collected and retrospectively analyzed. Clavien-Dindo criteria was used for postoperative complication evaluation and visual analog scale was used for pain standard. Follow-up studies were conducted through outpatient service or telephone and the follow-up period was up to May 2019. Results: A total of 178 patients with colorectal cancer underwent SILS+1, including 111 male patients (62.4%) with an average age of 59 years. Eleven (6.2%) patients received added 1-3 operation ports during operation, and 1 patient was converted to open surgery due to ileocolic artery hemorrhage. The operative time was (135.2±42.3) minutes. The intraoperative blood loss was (34.6±35.5) ml. The number of harvested lymph nodes was 33.1±17.6. The distal margin was (4.7±17.8) cm. The proximal margin was (10.2±5.3) cm. Operation-related complications were observed in 16 patients (9.0%) within 30 days after the operation, of whom 6 had Clavien-Dindo III complications (3.4%). The postoperative pain scores were lower than 3. The average postoperative hospital stay was (5.6±2.6) days. Three patients (1.7%) returned to hospital within 30 days after operation due to intestinal obstruction and infection around stoma. The cosmetic evaluation of all the patients was basically satisfied. Conclusion: SILS+1 is safe and feasible in the treatment of colorectal cancer, and can reduce the postoperative pain.

Managing intraocular lens dislocation with one-port pars plana vitrectomy under direct vision with microscope illumination / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To describe a technique of managing intraocular lens(IOL)with deep dislocation in the vitreous cavity by performing pars plana vitrectomy(PPV)with only one pars plana incision under the direct illumination of the surgical microscope.<p>METHODS: Patients who had in-the-bag or out-of-the-bag(spontaneous)IOL dislocation after uneventful phacoemulsification cataract extractions, with the dislocated IOL or IOL-capsular bag complex dropping completely into the vitreous since 2013 were included in our studies. The postoperative patients were followed up for 6mo. Detailed description of technique and retrospective description of eight typical cases were demonstrated in this study.<p>RESULTS:A total of 40 surgeries were conducted using this technique. The main possible predisposing conditions included: post-vitrectomy, posterior capsule rupture or broken zonules, a history of ocular trauma, long axial length, secondary IOL implantation, chronic uveitis, retinitis pigmentosa and post-glaucoma surgery. In all eyes, the IOLs were successfully removed. No intraoperative or postoperative complications related to the procedures occurred. The preoperative corrected distance visual acuity(CDVA)ranged from 20/133 to 20/25, and at 6mo postoperatively, the CDVA was similar or the same. The intraocular pressure was all within the normal range.<p>CONCLUSION: One-port PPV under direct vision with microscope illumination is a simple and safe surgical technique to managing IOL dislocation, which shortens the surgical time, and largely avoids surgical complications.

Transumbilical single-incision plus one-port laparoscopic surgery for colorectal cancer: A feasibility study / 中国肿瘤临床

To explore the safety and feasibility of single-incision plus one-port laparoscopic surgery (SILS+1) for colorectal cancer. Methods: The clinical data of 8 patients with colorectal cancer who were admitted to hospital for transumbilical SILS+1 between October 2017 and November 2019 were retrospectively analyzed. Results: The procedure was successfully performed in all 8 cases, without needing to convert to open surgery or increase the number of punch holes. The mean operating time was 107 minutes (range: 95 to 124 minutes). Blood loss ranged from 10 to 80 mL (median: 33 mL). Two patients had a fever postoperatively. Postoperative heat absorption was considered, and the fever reduced after the third day. The other patients had no obvious surgical complications. Gastrointestinal function was restored 1 to 3 days after the operation, and the abdominal drainage tube was removed after 3 to 5 days. The average hospital stay was 9.3 days (range: 7 to 11 days). Postoperative pathology confirmed colorectal adenocarcinoma in all patients. The average number of lymph nodes detected was 13.6 (range: 11-16). No perioperative complications or deaths occurred. Patients were followed up for 3-24 months (average: 10 months), and no local recurrence or distant metastases were found. Conclusions: Although SILS+1 for colorectal cancer appears to be safe and feasible, with minimal trauma and satisfactory cosmetic effect, the long-term effects require further observation.

Colecistectomía laparoscópica a través de un puerto único / Single-port access laparoscopic cholecystectomy

Introducción: la cirugía laparoscópica a través de un puerto único se realiza básicamente a través de una única incisión (15 a 18mm), en la cual se colocan varios trócares o un dispositivo multi-puerto. La mayoría de estos procedimientos tienen dos grandes limitaciones: la aglomeración e interferencia del instrumental y la disminución de la calidad de la triangulación y exposición del área quirúrgica. Objetivo: describir la técnica operatoria y evaluar los resultados iniciales de una nueva modalidad de colecistectomía laparoscópica a través de un puerto único. Métodos: se detalla la técnica operatoria desarrollada por los autores, la cual se basa en el uso de: un laparoscopio con canal de trabajo, nuevos instrumentos laparoscópicos y un sistema de retracción basado en dos retractores de 1.2mm especialmente diseñados. El estudio fue conducido entre Diciembre del 2010 y Agosto del 2012. Fueron incluidos 29 pacientes seleccionados. Los criterios de inclusión fueron: enfermedad sintomática no complicada, Índice de Masa Corporal no mayor de 30 y no más de tres cálculos con diámetro no mayor de 20mm. Resultados: el procedimiento fue realizado satisfactoriamente (visión crítica) en el 93.1 por ciento de los casos. El 86 por ciento fueron mujeres, la edad promedio fue 36 años (rango, 17-57), el IMC promedio fue de 24.4 (rango, 21.9-27.5) y el tiempo quirúrgico promedio fue 62 minutos (rango, 41-80). Se reportó una ruptura de la pared vesicular durante la extracción sin consecuencias en el seguimiento. Conclusiones: la técnica propuesta evita la aglomeración e interferencia del instrumental y optimiza la calidad de exposición. Puede realizarse con seguridad en pacientes seleccionados aunque demanda de una mayor experiencia quirúrgica(AU)

Introduction: single-port access laparoscopic surgery is basically performed through one incision (15-18mm) in which several trocars or a multi-port device are placed. Most of these procedures have two main limitations: accumulation and interference of surgical instruments and the reduction of the triangulation quality and of the surgical area exposure. Objectives: to describe the surgical technique and to evaluate the initial results of a new modality of laparoscopic cholecystectomuy through a single-port access. Methods: the surgical technique developed by the authors was detailed, which is based in the use of a laparoscope with working channel, new laparoscopic instruments and a retraction system supported on two specially designed 1.2mm retractors. The study was conducted from December 2010 through August 2012 and included 29 selected patients. The inclusion criteria were uncomplicated symptomatic disease, body mass index lower than 30 and not more than three calculi with less than 20mm diameter. Results: the procedure was performed satisfactorily (critical view) in 93.1 percent of cases. Eighty six percent were women, the average age was 36 years (range, 17-57), the average body mass index was 24.4 (range, 21.9-27.5) and the average surgical time was 62 minutes (range, 41-80). The rupture of a vesicular wall was reported during extraction but no consequences occurred during follow-up. Conclusions: the suggested technique avoids accumulation and interference of the surgical instruments and optimizes the quality of the surgical area exposure. It may be safely performed in selected patients, although it demands more surgical experience from the surgeon(AU)

Comparison of Single Incision and Three Port Laparoscopic Cholecystectomy

PURPOSE: Laparoscopic surgery is a minimally invasive surgery which has been widely used in abdominal surgery, such as appendectomy and cholecystectomy. There were several strong points in single incision laparoscopic cholecystectomy (SILC). However, no definite study comparing SILC with three port laparoscopic cholecystectomy (TPLC) has been reported. Therefore, this study focused on feasibility and safety of SILC in comparison with conventional TPLC. METHODS: This study included 86 cases of SILC and 230 cases of TPLC from April, 2010 to February, 2011. The patients were divided into two groups according to the surgical procedure, group 1 was SILC and group 2 was TPLC. All operations were performed by a single surgeon, and the retrograde approach was the fundamental surgical procedure used in both groups. RESULTS: Eighty five patients in group 1 underwent SILC and 229 patients in group 2 underwent TPLC. In comparison of preoperative data, statistical significance regarding age, gender, and preoperative PTGBD insertion was observed between the two groups. In comparison of intraoperative data, the average operation time and average hospital day did not show any statistical significance. Intraoperative multiple port conversion was performed in group 1 to TPLC due to cystic artery bleeding, and in group 2, TPLC was changed into a four port operation due to the same reason. CONCLUSION: In this study, no significant difference in operation result, time, and acute complication was observed between SILC and conventional TPLC. Besides the cancers, SILC could definitely be applied without exclusion criteria mentioned above if improvement of instruments and accumulation of surgeon's experience were satisfied.

Feasibility of laparoscopic salpingectomy using one port in tubal pregnancy / 대한산부인과내시경학회지

OBJECTIVE: To evaluate the feasibility of laparoscopic salpingectomy using one-port in tubal pregnancy compared to conventional laparoscopic surgery. METHODS: From June 2008 to June 2011, 63 women were treated with laparoscopic salpingectomy due to tubal pregnancy, which was diagnosed by ultrasonography. These patients were divided into two groups. Of these 63 patients, 32 women were treated with conventional laparoscopic salpingectomy (CLS) in group I, 31 women underwent laparoscopic salpingectomy using one port (OPLS) in group II. In group I, rigid 0degrees or 30degrees, 10 mm laparoscope, rigid instruments were used. In group II, 30degrees, 10 mm laparoscope, rigid or flexible angulated tip instruments were used during the surgery. We reviewed and compared clinical characteristics, clinical outcomes of these patients. RESULTS: Patients in Group I were compatible with the patients in group II in clinical characteristics. Clinical outcomes were not different between two groups in terms of Hemoglobin change (g/dL), hospital stay (days), hemoperitoneum (mL), transfusion. Mean operative time was significantly longer in group II (59.7+/-15.7 min vs. 46.5+/-15.0 min, p=0.001). The mean length of skin incision was obviously shorter in group II; the difference was highly statistically significant (15.5+/-3.0 mm vs 23.5+/-3.0 mm, p<0.001). CONCLUSION: It seems that OPLS is feasible alternative to CLS to treat hemodynamically stable patients without complications. Additionally, this technique also results in better cosmetic outcomes than CLS. Randomized prospective clinical studies with larger scale are necessary in the future to confirm these results.

Clinical Analysis of Single-Port Laparoscopic Cholecystectomies: Early Experience

PURPOSE: Single-port laparoscopic cholecystectomy (SPLC) is a technique under development in the field of minimally-invasive surgery. We have considered the feasibility of SPLC based on the advantages or restrictions compared with multi-port procedures. METHODS: Two hundred seventeen patients with benign gallbladder disease who underwent SPLC or multi-port laparoscopic cholecystectomy (MPLC) during the most recent 10 months were retrospectively reviewed. RESULTS: Patients were divided into two or three groups based on the operative period and disease. The mean age and ASA scale were different between the three groups. The intra-operative bile leakage and post-operative hospital stay were significantly less in the SPLC group; however, the blood loss and operative time was greater in the SPLC group. When patients with empyema of the gallbladder were excluded and all patients were reassigned into two groups based on the operative method, the incidence of bile leakage and post-operative hospital stay were similar between the two groups. The mean blood loss and operative time were higher in the patients who underwent SPLC. The mean numeric rating scale (NRS) and requirement for opioid analgesics were similar in the two groups. CONCLUSION: With the exception of increased intra-operative hemorrhage and a longer operative time, the risks associated with SPLC were not greater than MPLC. With adequate analgesics, advances in laparoscopic instruments, and surgical experience, SPLC is expected to gain acceptance amongst physicians.