Abstract
Aim. Single-access laparoscopic surgery (SALS) can be effective for benign and malignant diseases of the ileum in both the elective and urgent setting. Methods. Ten consecutive, nonselected patients with ileal disease requiring surgery over a twelve month period were included. All had a preoperative abdominopelvic computerized tomogram. Peritoneal access was achieved via a single transumbilical incision and a “surgical glove port” utilized as our preferred access device. With the pneumoperitoneum established, the relevant ileal loop was located using standard rigid instruments. For ileal resection, anastomosis, or enterotomy, the site of pathology was delivered and addressed extracorporeally. Result. The median (range) age of the patients was 42.5 (22–78) years, and the median body mass index was 22 (20.2–28) kg/m2. Procedures included tru-cut biopsy of an ileal mesenteric mass, loop ileostomy and ileotomy for impacted gallstone extraction as well as ileal (n = 3) and ileocaecal resection (n = 4). Mean (range) incision length was 2.5 (2–5) cm. All convalescences were uncomplicated. Conclusions. These preliminary results show that SALS is an efficient and safe modality for the surgical management of ileal disease with all the advantages of minimal access surgery and without requiring a significant increase in theatre resource or cost or incurring extra patient morbidity.
Highlights
There has been a recent shift in the paradigm of operative access toward minimally invasive approaches for the majority of surgical specialities
single access laparoscopic surgery (SALS) provides the benefits of conventional laparoscopy while reducing the tissue trauma due to the reduction in size and number of ports used
The potential benefits of SALS include reduced postoperative pain, a shorter recovery period, lower morbidity, reduced cost, and superior cosmesis [1]. It obviates trocar-related intra-abdominal injury and port site incisional hernia formation, and may prove superior. This approach is compelling in cases where a 3 cm incision is required anyway for the purposes of specimen extraction or stoma formation and so this wound can be made at the commencement of the surgery and used as the sole site of transabdominal incision before being closed securely under direct vision at procedure end
Summary
There has been a recent shift in the paradigm of operative access toward minimally invasive approaches for the majority of surgical specialities. This has occurred due to the proven benefits of faster recovery times, reduced hospital stay, less wound-related complications, and better cosmesis. The recent development of single access laparoscopic surgery (SALS) represents a natural evolution in progressive practices in order to further improve patient outcomes by minimising operative wounding and reducing access-related complications and the number of ports used. The evidence from the literature to date shows it is a safe and efficient approach that, in the case of malignancy, provides adequate oncologic resection [1,2,3]. SALS has been advocated as an important step in promoting safe live donor organ harvest [2, 4]
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