Additional Trocars Research Articles

Laparoscopic single-port Burch colposuspension with an extraperitoneal approach and standard instruments for stress urinary incontinence: Early results from a series of 15 patients

Objective:We aimed to investigate the use of single-port laparoscopy in a series of patients undergoing Burch colposuspension with an extraperitoneal approach as an alternative treatment for scarless surgery in stress urinary incontinence. Material and methods: From September 2010 to May 2011 we performed single-port extraperitoneal laparoscopic Burch colposuspension for stress incontinence in 15 patients. Fifteen women who were diagnosed with urodynamic stress incontinence were included in the study. Demographic and clinical data, intraoperative findings, and postoperative course were recorded. Results:The mean age was 45,80 ± 9,91 years (range: 38–70 years). The mean body mass index was 25,67 ± 4.06 kg/m2 (range: 22.23–35.38 kg/m2). The mean operation time and mean blood loss were 40.80 ± 5.94 minutes (range: 30–50 minutes) and 30.67 ± 11.00 cc (range: 10–50 cc), respectively. The single-port laparoscopic operations were technically completed successfully without placement of additional trocars and there were no complications. The cure and improvement rates following laparoscopic Burch colposuspension via single port were 73.3 % and 20 % respectively. Conclusion: Single-port laparoscopic Burch can be an alternative treatment for scarless surgery in stress incontinence. Single-incision laparoscopic Burch colposuspension can offer suitable, effective and safe treatment in women with stress incontinence.

Single Trocar Skin Puncture Laparoscopic Orchidopexy

To assess the outcomes of a modified technique for pediatric laparoscopic orchidopexy performed without instrument trocars. A retrospective cohort study, for all laparoscopic orchidopexy performed without instrument trocars, was performed. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. All patients undergoing this procedure had a single trocar placed to insufflate and introduce the laparoscope. Skin punctures were used without trocars to introduce 3-mm instrumentation for laparoscopic orchidopexy. Initial follow-up visits were performed 2 to 4 weeks after surgery. Subsequent follow-up visits were performed at 6 to 12 months after surgery to reassess position and size of the testes. A total of 22 patients with 27 undescended testes (20 right, 7 left) were identified. Median age was 1.3 years old (range, 5 months-7 years). Median operative time was 61 minutes (range, 42-81 minutes) for primary unilateral procedures (18 patients). Median operative time was 84 minutes (range, 75-90 minutes) for bilateral procedures (3 patients). All procedures were performed without additional trocars. There were no intraoperative complications. Patients were followed for 1 year and discharged. No patients were lost in follow-up. Postoperatively, 26 of 27 (96%) laparoscopic orchidopexy were successful. One patient developed atrophy with subsequent orchiectomy 6 months after the initial procedure. Using skin punctures without trocars for laparoscopic orchidopexy is a safe and effective modification of standard laparoscopic orchidopexy. Further studies are warranted to compare the morbidity, ergonomics, cosmesis, costs, and reproducibility of outcomes for various options of pediatric minimally invasive surgery for intra-abdominal testes.

Single‐fulcrum laparoscopic cholecystectomy: a single‐incision and multi‐port technique

Single-incision laparoscopic cholecystectomy (LC) is still technically demanding and usually requires specially designed instruments. This article describes our own technique, a single-fulcrum LC using only standard ports and instruments. Between March 2009 and December 2010, 130 consecutive patients, all scheduled to undergo elective LC, underwent this single-fulcrum LC for benign gallbladder disease. Perioperative surgical outcomes were retrospectively evaluated. One hundred and ten patients (84.6%) underwent successful single-fulcrum LC, and 20 patients (15.4%) were converted to conventional surgery (n= 18) or required additional trocars (n= 2) during the procedure because of umbilical hernia (n= 3), severe inflammation or adhesion (n= 9), impacted cystic duct stone (n= 3), anatomical anomaly (n= 3) and iatrogenic injury (n= 2). Two intraoperative complications (iatrogenic injury) were securely managed using additional trocars and there was no post-operative morbidity or mortality. This single-fulcrum LC could be performed with comparable cost to conventional LC, and the sequential operative time showed reasonable learning curve. Single-fulcrum LC is feasible, safe and quite reproducible. The surgical wound can be dramatically reduced at a similar cost to conventional LC. It may be an alternative procedure for most uncomplicated benign gallbladder disease.

Feasibility of Single-Incision Pediatric Endosurgery for Treatment of Appendicitis in 415 Children

Single-incision pediatric endosurgery (SIPES) has gained popularity for ablative procedures such as appendectomy in many pediatric surgical centers. This study evaluates the outcome of SIPES for treatment of appendicitis in our institution. After Institutional Review Board approval was obtained, data were prospectively collected on all patients undergoing SIPES appendectomy in our hospital from March 2009 through October 2011. The surgical techniques, operative times, complications, conversion rates, and outcomes were recorded. SIPES appendectomy was attempted in 415 children (mean age, 10.9 years; age range, 1.4-17.9 years; 266 males, 149 females; median weight, 43 kg; weight range, 9.8-146 kg). Intraoperatively, acute appendicitis was found in 298 cases and perforated appendicitis in 79 cases. Thirty-eight patients underwent interval appendectomy. Appendectomy was carried out solely as SIPES in 397 cases (96%). Median operative time was 40±16 minutes (37±16 minutes for fellows [n=284] and 46±15 minutes for residents [n=131]). There were three intraoperative complications, which could be handled during the procedure. Pathologic reports revealed inflammatory changes of the appendix (n=386), other pathology (n=11), and no pathologic change (n=18). Overall, 24 patients (5.8%) were readmitted for intra-abdominal abscess (n=14), umbilical wound infection (n=3), and other reasons (n=7). Twelve patients (2.9%) underwent reoperation: drainage of intra-abdominal abscess (n=8) (3 by the surgeon, 5 by the interventional radiologist), wound drainage (n=3), and right hemicolectomy for carcinoid (n=1). In perforated appendicitis the postoperative intra-abdominal abscess rate was 10 of 79 cases (12.7%), which is similar to the previous report with conventional laparoscopic appendectomy from our institution (13.6%). The wound infection rate (5 of 79 cases [6.3%]) was also similar to the previously report (6.8%) with conventional laparoscopic appendectomy for perforated appendicitis. Appendectomy can be accomplished successfully and safely using single-incision endosurgery in children with acceptable operative times without leaving any appreciable scar. Additional trocars are infrequently necessary. So far, the intraoperative and postoperative complication rates are comparable to those of triangulated laparoscopic appendectomy.

Retroperitoneal Laparoendoscopic Single-Site Adrenalectomy: Our Initial Technical Experience

We performed retroperitoneal laparoendoscopic single-site (LESS) adrenalectomy using a homemade multi-access platform to evaluate the feasibility and safety of this technique and to share our initial experiences. Since March 2011, 40 patients underwent retroperitoneal LESS adrenalectomy. A single incision of 2.5-3 cm was made under the 12th rib on the midaxillary line on the affected side. Next, a homemade multi-access platform was inserted through that incision, and a combination of lengthened curved and conventional rigid instruments was used for handling. The procedure was performed mainly according to the procedure for conventional laparoscopic retroperitoneal adrenalectomy. For 1 patient with pheochromocytoma, one additional trocar was used because the peritoneum was damaged. Surgery was successfully completed in all other patients without conversion to conventional laparoscopic or open surgery. Retroperitoneal LESS adrenalectomy is feasible; although initial technical adjustments are inevitable, some useful techniques are effective in simplifying the procedure.

Single-Port Laparoscopic Floppy Nissen Fundoplication: A Novel Technique with the Aid of the Cerrahpasa Retractor®

Introduction: The retraction of the left lobe of the liver in the laparoscopic upper gastrointestinal procedures is a critical maneuver with its added possible complications. In our study, we utilized the Cerrahpasa retractor® for the retraction of the left liver with a different concept other than utilizing a suturing or silk lace techniques described in previous studies. We present a video of a laparoscopic floppy Nissen fundoplication (LFNF) performed through a single port with the aid of the Cerrahpasa retractor. Materials and Methods: We performed single-port LFNF on 22 patients with symptomatic gastroesophageal reflux disease between September 2009 and April 2011. One 12-mm and two 5-mm trocars were utilized through the SILS™ (Covidien AG, Norwalk, CT) port. The next step was the introduction of a hand-made needle liver retractor (Cerrahpasa retractor, trademark pending), from the midline just below the xiphoid process. The retractor is composed of two parts: the head and the wire. The wire is introduced through a hand-made Seldinger-type needle. The head is introduced through the SILS port, and the two parts are mounted together intracorporeally. Main steps of the operation were dissection of the hepatogastric and Laimer's ligament, dissection and closure of the hiatus, and construction of the short, floppy Nissen fundoplication. The short gastric vessels were not divided. In our technique, we do not fix the fundoplication. Results and Conclusions: All the procedures were performed without any perioperative complications. The mean duration of the operations was initially 110 minutes (initial five operations) and reduced to 60 minutes (last five operations) throughout the 8-month period. No drains were used. The postoperative period was uneventful. All the patients were given oral fluids 12 hours postoperatively and discharged after 24 hours. On the basis of the short term of follow-up, there are no postoperative complications encountered. Until now, the procedures described for retraction in single-port surgery utilize more or less a suturing or silk lace techniques1–3 that potentially could tear the liver or other anatomical structures easily. Alternative technique utilizing anything other than suturing or silk lace technique was described by Gianni et al,4 where the authors used Veress needle for the retraction of the liver. A publication similar to our technique was reported by Cuesta et al5 in 2008. In their study authors performed transumbilical laparoscopic cholecystectomy with the aid of a 1-mm Kirschner wire. The wire was used for gallbladder traction. The Cerrahpasa retractor utilized in this study to elevate the liver was 1 mm in diameter and made of stainless steel. For the use of this needle-retractor, no additional trocar was employed. In our technique, the potential of tearing the liver or other anatomical structures is minimal. We believe that, with the aid of our Cerrahpasa retractor, the problem of liver retraction in single-port laparoscopic surgeries is being solved by a simple and safe technique. No competing financial interests exist. Runtime of video: 5 mins 30 secs The first three cases of this technique were presented in the 17th Turkish National Surgical Congress on May 26–29, 2010, in Ankara, Turkey. This technique is being presented in SAGES TV since SAGES Annual Meeting in San Antonio, TX, March 30–April 2, 2011.

A Prospective Controlled Trial Comparing Single-incision and Conventional Laparoscopic Cholecystectomy

To evaluate the safety and feasibility of single-incision laparoscopic cholecystectomy (SILS-C) compared with conventional laparoscopic cholecystectomy (CLC). Sixty-five patients (SILS-C: 35, CLC: 30) were prospectively enrolled and operated with conventional straight instruments. The postoperative pain scores at 6, 24 hours, and 1 week, nausea, vomiting, commencement of oral intake, hospital stay, resumption of normal activities and work and satisfaction levels were noted. Twenty-eight percent (10/35) SILS-C patients required introduction of additional trocars to complete the procedure. No patient required conversion to open. All the morbidity parameters were similar in both the groups, except that the seroma formation in the wound was significantly higher in the SILS-C group [SILS-C: 17% (6/35)/CLC: 0%, P=0.038]. One patient in SILS-C had a major bile duct injury. SILS-C is safe and feasible with conventional instruments. However, caution needs to be exercised in view of a major bile duct injury and a higher rate of seroma formation in the wound.

Scarless Pyeloplasty in the Pediatric Population

To assess the outcomes of a modified technique for pediatric laparoscopic pyeloplasty (LP) performed without instrument trocars. A retrospective cohort study for all LPs performed without instrument trocars was performed. Patient demographics, surgical technique, complications, and clinical outcomes were reviewed. All patients undergoing this procedure had a single trocar placed to insufflate and introduce the laparoscope. Skin punctures were used without trocars to introduce 3-mm instrumentation for LP. Nine patients with 10 procedures were identified. Median age was 8 months old (range 3-190). Median weight was 8.3 kg (range 5.9-70.5). Median operative time was 229 minutes (range 145-387). All procedures were performed without additional trocars. There were no open conversions. Median hospital stay was 1 day (range 1-4). Median narcotic use was 0.1 mg/kg/d of intravenous morphine equivalent. There were no intraoperative complications. Median follow-up was 36 months (range 18-45). Follow-up renal ultrasound evaluation has demonstrated improved hydronephrosis in all patients. No reoperative pyeloplasty was performed. Subjective assessment of cosmesis has shown excellent outcome with almost imperceptible evidence of operative intervention. LP without instrument trocars can be safely and effectively performed without compromise of the surgical procedure, with minimal use of narcotics, and with a short hospital stay. Intermediate-term follow-up indicates encouraging results for achieving scarless surgery.

Routine single-port sleeve gastrectomy: a study of 60 consecutive patients

BackgroundSingle-port surgery has been developed for many digestive procedures, such as cholecystectomy and colectomy. Our objective was to present our preliminary results for laparoscopic single-port sleeve gastrectomy (SPSG), performed in our department for the treatment of morbid obesity, at Antoine Beclere Hospital and Paris XI University. MethodsFrom July 2010 to February 2011, all patients evaluated by our multidisciplinary team for morbid obesity and eligible for sleeve gastrectomy underwent SPSG. The data were collected prospectively. ResultsSixty consecutive patients underwent SPSG. The median age was 40.1 years; 6 patients were men and 48 were white. The median body mass index was 46.5 kg/m2. The co-morbidities included diabetes in 12, essential hypertension in 31, sleep apnea in 39, dyslipidemia in 33, and coronary artery disease in 9. Of the 60 patients, 9 had previously undergone laparotomy and 5 had undergone bariatric surgery. The median operating time was 86 minutes. All procedures were achieved laparoscopically, with 10 patients requiring a second trocar and 3 patients 2 additional trocars. No conversion to open surgery was required. One leak was reported, and 1 patient experienced cubital nerve compression. The median hospital stay was 4 days. During a median follow-up of 8 months, most preoperative co-morbidities resolved, and the Bariatric Analysis and Reporting Outcome System score for care efficacy was 6.8 of 9. ConclusionSPSG is feasible in routine bariatric surgery. The results for weight loss and co-morbidity resolution seem to be equivalent to those with “multiple port” laparoscopy. New instruments and specific training are required. We believe that this technique is a natural evolution of minimally invasive surgery requiring additional investigation in prospective studies.

Single-Incision Laparoscopic Surgery—Hype or Reality: A Historical Control Study

Single-incision laparoscopic surgery (SILS) is a "new" method to perform "old" operations. Though SILS has been referred to by many names, for the sake of this paper, any procedure done laparoscopically through one incision (regardless of the number of ports or working channels) will be considered a SILS procedure. This brief review will discuss the history of SILS, current applications, and potential pitfalls. To explore the outcomes of SILS cholestectomy in a community setting, we conducted a historical control study comparing, through retrospective review, 50 laparoscopic cholecystectomies to 50 SILS cholecystectomies, all performed by one of the authors (DT). Of the 50 patients selected, 12 patients had cholangiograms performed at the same time. The mean operative time for all cases was 50.4 minutes (range 31 minutes to 108 minutes). For the noncholangiogram group, the mean operative time was 48 minutes whereas it was 57.7 minutes for patients requiring a cholangiogram. Mean estimated blood loss was 28 mL. There was a 20% "conversion" rate (n = 10): 4 with an additional trocar, 5 with a 4-port technique, 1 with an open procedure. We conclude that, although SILS is a relatively new procedure for general surgery, we feel it is here to stay. Although the only documented benefit is cosmetic, SILS is equivalent to conventional laparoscopy in all other respects.

Single-Incision Laparoscopic Surgery for Ileocolic Resection in Crohn's Disease

Single-incision laparoscopic surgery is a development in the field of minimally invasive surgery that is being increasingly used for colorectal procedures. We report on the short-term results of single-port laparoscopic ileocolic resection in patients with ileocecal Crohn's disease. This investigation is a retrospective matched-pair control study. Data were obtained from a prospectively maintained single-institution inflammatory bowel disease database. This study was conducted at a tertiary care university hospital. Twenty consecutive patients receiving elective single-port ileocolic resection between April 2010 and May 2011 were included (6 male, 14 female; age, 31.6 ± 10.8 years; BMI, 21.5 ± 2.6 kg/m). Their data were compared with the data of 20 individually matched patients who had undergone standard 3-trocar laparoscopic-assisted ileocolic resection between 2007 and 2010 (6 male, 14 female; age, 31.7 ± 10.7 years; BMI, 21.2 ± 2.5 kg/m). All patients had medically refractory stenosis of the terminal ileum in histologically confirmed Crohn's disease. Single-port laparoscopic-assisted or standard laparoscopic-assisted ileocolic resection was performed. The primary outcomes measured were the surgical details and early outcome. : The mean length of the paraumbilical single-port incision was 3.8 cm (range, 2.5-5.0 cm). Conversion rates were similar in both groups (1/20 vs 2/20, p = 0.55). Additional strictureplasties or short-segment small-bowel resections were performed in both groups. The overall complication rate was 20% (4/20) in both groups. There were no observed differences in postoperative pain scores and hospital stay duration. The limitations of this study were as follows: this study was a comparison of 2 different time points with possible selection bias, there was no prestudy power calculation, and the study might be underpowered. Single-port ileocolic resection is a safe procedure for the surgical treatment of stenotizing Crohn's disease of the terminal ileum. Avoidance of additional trocars was the only identified benefit.

Transumbilical multiple-port laparoscopic cholecystectomy using standard laparoscopic instruments

Introduction: As a complement to standard laparoscopy, single incision laparoscopic cholecystectomy (SILS) is gaining popularity. We report our technique and our initial experience with transumbilical multi-port laparoscopic cholecystectomy (TUMP-LC) without an access device, with standard laparoscopic instruments, and report the clinical outcomes. Material and methods: Twenty-five (23 F: 2 M) consecutive patients with symptomatic cholelithiasis were included. The surgical outcomes such as length of stay, complications and perioperative morbidity were analyzed. For evaluation of surgical stress preoperative and postoperative C-reactive protein (CRP) values at 6 h and 24 h were measured. Postoperative pain was evaluated using a standard 10-point visual analogue scale (VAS). Results: The mean duration of the surgery was 44.56 minutes (range, 18–110). Additional trocars were needed in two (8%) cases. Mean pain scores post-operatively at 4 h, 12 h and 24 h were 4 ± 1.19, 3.64 ± 1.03 and 2.24 ± 0.96, respectively (p < 0.0001). Plasma CRP values increased at 6 h and started to decrease at 24 h (p < 0.0001). None of the cases were converted to open surgery and no major complications occurred. Discussion: TUMP-LC using standard laparoscopic instrumentation without an access device is an effective alternative to standard four-incision laparoscopic cholecystectomy. Our technique maintains the principles of the conventional procedure and the instrumentation, but also improves the access.

A Comparison between Laparoendoscopic Single-Site and Conventional Laparoscopic Renal Stone Removal Surgery: A Study of Application in Two Cases

Aim: To present our initial experience of applying laparoendoscopic single-site surgery (LESS) nephrolithotomy in the treatment of renal calculi. Methods: In August 2010 and April 2012, the LESS nephrolithotomy technique was applied to treat two patients with a renal calculus. One patient had a calculus measuring 5 × 3 cm, and the second patient's measured 3 × 3 cm. Both patients underwent general anesthesia. The operations were performed through a retroperitoneal approach with a single-port instrument inserted through the retroperitoneal incision. The standard laparoscopic retroperitoneal technique was performed, and the calculi were removed by incising the area of the thin renal cortex and the renal pelvis, respectively. The operating time, estimated blood loss, intraoperative complications, other complications, drainage time, and post-operative hospital stay were recorded. Results: Both procedures were completed successfully. No additional trocars were added. No conversion to standard laparoscopic or open surgery was needed. The operating times were 130 min and 120 min, and the estimated blood losses were 40 mL and 30 mL. There were no intraoperative complications. The wound drainage times were 3 d and 2 d, respectively and the post-operative hospital stays were 8 d and 7 d, respectively. There was no secondary bleeding or wound infection. Follow-up times were 2 years and 3 months, respectively. No incidence of hydronephrosis was recorded. Conclusions: LESS nephrolithotomy is safe and feasible for treating kidney calculi. It can be applied in patients with large renal calculi and regionally thin renal parenchyma.

Transumbilical Single-Incision Laparoscopic Wedge Resection for Gastric Submucosal Tumors: Technical Challenges Encountered in Initial Experience

PurposeTo report the initial clinical experience with single-incision laparoscopic gastric wedge resection for submucosal tumors.Materials and MethodsThe medical records of 10 patients who underwent single-incision laparoscopic gastric wedge resection between July 2009 and March 2011 were reviewed retrospectively. The demographic data, clinicopathologic and surgical outcomes were assessed.ResultsThe mean tumor size was 2.5 cm (range, 1.2~5.0 cm), and the tumors were mostly located on the anterior wall (4/10) or along the greater curvature (4/10), of the stomach. Nine of ten procedures were performed successfully, without the use of additional trocars, or conversion to laparotomy. One patient underwent conversion to multiport laparoscopic surgery, to get simultaneous cholecystectomy safely. The mean operating time was 66.5 minutes (range, 24~132 minutes), and the mean postoperative hospital stay was 5 days (range, 4~7 days). No serious perioperative complications were observed. Of the 10 submucosal tumors, the final pathologic report revealed 5 gastrointestinal stromal tumors, 4 schwannomas, and 1 heterotopic pancreas.ConclusionsSingle-incision laparoscopic gastric wedge resection for gastric submucosal tumors is feasible and safe, when performed by experienced laparoscopic surgeons. This technique provides favorable cosmetic results, and also short hospital stay and low morbidity, in carefully selected candidates.

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG). One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis, respectively. A retrospective review was performed not only between SILC for AIG and non-AIG, but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period. Comparison between SILC for AIG and non-AIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min, P = 0.03). The open conversion rate (2/26 vs 2/84, P = 0.24) and complication rate (1/26 vs 3/84, P = 1.00) showed no differences, but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82, P = 0.01). Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis. Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.

Magnetic-Assisted Single-Port Sleeve Gastrectomy

Sleeve gastrectomy is a recent, purely restrictive procedure in bariatric surgery that has shown results similar to gastric bypass over the short and middle term. At the same time, single-port access surgery has fostered the development of new techniques and methods seeking better cosmetic results and less postoperative pain, while maintaining the satisfactory results obtained by the standard laparoscopic approach. One of the problems associated to single-access surgery is the lack of traction and the difficulties to retract the liver. The authors' aim was to try to avoid additional trocars or sutures in order to perform pure single-incision surgery, using 2 magnetic forceps. The authors present the case of a 51-year-old morbidly obese female (body mass index = 44.82) who underwent a pure single-access laparoscopic sleeve gastrectomy with no additional trocars or sutures and assisted by 2 neodymium magnetic forceps: one to retract the liver and the other to retract the stomach in order to provide sufficient triangulation for adequate exposure of the surgical field during dissection. The procedure was completed in 120 minutes. No preoperative or postoperative complications were recorded, and the patient was discharged 2 days after surgery. Single-port access sleeve gastrectomy assisted by magnetic forceps is feasible and safe in the hands of experienced laparoscopic surgeons, solving one of the problems associated to this type of surgery, that is, the need for an additional trocar and needles or sutures to retract the liver and stomach in order to perform the operation.

Single-site laparoscopic herniorrhaphy using needle instruments for inguinal hernias in children: a novel technique

We describe our new technique for laparoscopic herniorrhaphy with subumbilical single-site access to treat inguinal hernias in children. First, we inserted a transparent 3-mm trocar and a 2-mm minitrocar at the umbilicus. We then inserted a 3-mm 45° camera through the 3-mm trocar and needle-grasping forceps through the 2-mm trocar. We closed the hernia defect by using a 19-gauge hooked injection needle with a nonabsorbable suture. We treated 11 consecutive female children with inguinal hernia using this operation. The mean operating time was 26.7 min (range 21-36 min) and the procedure was technically successful, without the need for additional trocars, in all 11 patients. There were no intraoperative complications and all the patients were discharged on the same day after the surgery. Single-site laparoscopic herniorrhaphy using needle instruments is feasible and seems to be safe. Further studies are required to determine whether this approach would benefit patient compared with standard laparoscopic herniorrhaphy.

Early experience with single-site laparoscopic surgery for complicated ileocolic Crohn’s disease at a tertiary-referral center

The role of single-site laparoscopy (SSL) for the treatment of ileocolic Crohn's disease complicated by an abscess, a phlegmon, or fistulizing disease has not been thoroughly assessed. A prospectively maintained database of SSL surgeries performed between October 2010 and March 2011 was reviewed. Consecutive patients with ileocolic Crohn's disease complicated by a paracolic abscess, a phlegmon, or a fistula were included for analysis. Data recorded included demographic information, body mass index (BMI), estimated blood loss (EBL), length of surgery, rate of conversion to standard laparoscopic surgery or open surgery, length of hospital stay, and rate of complications. A total of six patients were identified. Complications from Crohn's disease included four (66%) patients who developed a paracolic abscess that required drainage upon admission, one (16%) patient who developed a phlegmon, and one (16%) patient who developed an enterocutaneous fistula. Mean age of the study population was 25 years, with a mean BMI of 21 and a mean ASA score of 3. Five (83%) of the patients were immunosuppressed with high-dose steroids. Mean operative time was 160 min, with a median EBL of 60 mL. One patient required the insertion of an additional trocar, whereas there were no conversions to laparotomy. Four (66%) patients required diversion with a loop ileostomy. Median time to flatus was 1 day. All patients tolerated a diet on the day of surgery, with a median length of stay of 3 days. There were no deaths and no complications related to bleeding, organ injury, surgical site infections, or anastomotic leaks. A single-site laparoscopic approach for complicated ileocolic Crohn's disease can be performed safely, with short lengths of hospital stay and with a low rate of complications. A multicenter study would be beneficial to validate these findings.

Single-Incision Laparoscopic Approach to Management of Splenic Pathology in Children: An Early Experience

Certain splenic conditions in children require surgical interventions, the majority of which are approached via standard laparoscopy with multiple incisions. The single-incision laparoscopic (SIL) technique is gaining popularity. The aim of this study is to review our institutional experience using the SIL technique to surgically manage different splenic pathology in the pediatric population. A retrospective review was performed of the patients who underwent SIL splenic procedures at Miller Children's Hospital (Long Beach, CA) from January 2009 to December 2010. Seven patients underwent a SIL technique for different splenic diseases. Five patients underwent splenectomy, 1 patient underwent a splenic cystectomy and omental patching, and 1 patient underwent reduction of splenic torsion and splenopexy. There were no conversions to open. Six procedures were successfully performed without the need for an additional trocar. However, 1 patient required an additional grasper through a separate stab incision. There were no intraoperative complications. One patient had a superficial wound infection at 2-week postoperative follow-up, which resolved with local wound care. Our preliminary experience shows the SIL technique for the management of splenic pathology in children is safe and feasible.

Single-incision transabdominal preperitoneal and totally extraperitoneal repair for inguinal hernia: Early experience from a single center in Asia

Laparoscopic inguinal hernia repair is currently one of the most commonly performed minimally invasive surgical procedures. In recent years, single-incision operations have been developed to further reduce the invasiveness of the surgery. Herein, we report our early experience with single-incision laparoscopic inguinal hernia repair in Asia, with both the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches. This is a retrospective review of prospectively collected data on a cohort of consecutive patients with inguinal hernia who underwent single-incision laparoscopic inguinal hernia repair in a minimal access surgical center in Hong Kong between January 2010 and January 2011. Our cohort consists of 15 patients who underwent single-incision laparoscopic inguinal hernia; 13 were unilateral and two were bilateral hernias. The mean age was 59.8 years old (range, 28-74 years). The overall mean operative time was 59.53 min (range, 25-120 min). For unilateral hernia repair, the mean operative time was 56 min (range, 25-75 min) and 48.5 min (range, 41-55 min) for TAPP and TEP, respectively. In all cases single-incision laparoscopic hernia repair was successfully performed, no additional trocars were required, and there were no conversions to conventional laparoscopic or open inguinal hernia repair. All patients were discharged on the same day as the procedure. Single-incision laparoscopic inguinal hernia is feasible in both TEP and TAPP approaches. The procedure should be performed by laparoscopic surgeons with a high level of experience in single-incision surgery. Further randomized trials should be performed to evaluate the full potential and clinical application of single-incision TAPP and TEP.