Concept of Reduced Port Laparoscopic Surgery

Abstract

Since the first report of single-incision laparoscopic surgery (SLS) for gallbladder removal by Navarra in 1997, a number of approaches have been reported in the literature. Nevertheless, SLS failed to attract the wide attention of surgeons, because it violated a basic principle known as “triangular formation” resulting in a clashing problem between the scope and instruments. Surgical maneuver became technically demanding with these approaches. A new proposal for SLS with a new accessing device (SILS™ port (Covidien, New Haven, CT, USA)) and bendable forceps (Roticulator™ (Covidien)) was successful, and it reminded surgeons of the promise of SLS, and again proposed it as a viable next-generation surgical technique. Needle-scopic surgery was invented around the same time (1996) and evolved gradually. After the introduction of SLS, many surgeons took note of the pros and cons of SLS and needle-scopic surgery and that they are complementary to each other and the mixed use of the two techniques drastically mitigates the difficulty in SLS. Surgeons started using needle instruments as an active forceps. These approaches are collectively called reduced port laparoscopic surgery (RPLS). Robot and natural orifices translumenal endoscopic surgery (NOTES) devices have reportedly been used as tools of RPLS. The most appropriate combination of these tools would suggest the future shape of minimally invasive surgery.