Glove Port Research Articles

Novel Use of Surgical Glove Port to Perform Laparoscopic Total Gastrectomy

Novel Use of Surgical Glove Port to Perform Laparoscopic Total Gastrectomy

AB202. Transumbilical single incision for laparoendoscopic bilateral renal cyst decortication using a homemade glove port device

ObjectiveTransumbilical single incision surgery (TSIS) has recently gained popularity for symptomatic renal cysts. We evaluated the clinical utility and safety of homemade glove port device in bilateral renal cyst decortication patients at our institution.MethodsWe reviewed our series of 42 bilateral symptomatic renal cyst (range, 4–12 cm) decortication performed from November 2010 to December 2013. A homemade port device consisted of two control loops and a glove to form three channels was placed through the umbilical single incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of three trocars with a tie. The homemade port was inserted at the umbilical incision, operation was performed by using a special flexible 30-degree laparoscope and conventional laparoscopic instruments.ResultsAll cases were completed successfully, without conversion to a standard laparoscopic or open approach. The average operative time was 75 min and the estimated blood loss was less than 30 mL, no intraoperative complication occurred. The mean hospital stay was 2.8 d lap[2–5] days, with a median follow-up of 20 months (range, 8–32) there was no recurrence.ConclusionsOur homemade single port device is cost-effective and more flexible to deal with bilateral renal cysts especially ventral lesions than the current multichannel port or traditional laparoscopic surgery.

Glove port, how do we do it? A low-cost alternative to the single-port approach.

The need for cosmetic results in our society and the necessity of an early recovery have promoted the development of minimally invasive techniques, including single-port approach. Some studies have tried to demonstrate the advantages of this access compared with conventional laparoscopic approach. This type of approach requires a high-cost multi-port device, so that some surgeons have tried to create a low-cost homemade device. With this video we intend to show how to build a glove port, a low-cost alternative for the approach by a single port. A glove port is a cost effective approach that could be use instead of multi-port device.

A surgical glove port technique for laparoscopic-assisted ovariohysterectomy for pyometra in the bitch

The objective of the study was to describe the feasibility of a glove port technique for laparoscopic-assisted surgical treatment of canine pyometra. In this retrospective case series, a total of 10 female dogs (median age 7 years, range 5.5–10.5 years; median weight 37.0 kg, range 12.9–64.0 kg) with pyometra were included. A multiaccess port was created from a surgical glove attached to an Alexis wound retractor and placed in the ventral midline between the middle and caudal third of the distance between umbilicus and pubic rim. A vessel sealing device was used for transection of the ovarian pedicle. The port size was selected on the basis of maximum uterine diameter determined by ultrasound. Median incision length was 5.0 cm (range 3.1–7.7 cm) for a maximum uterine diameter of 4.0 cm (range 2.0–7.0 cm). Median surgical time was 57 minutes (range 48–65 minutes). No case had to be converted to open celiotomy. Complications included one case of minor, self-limiting splenic trauma by the endoscope. In eight dogs, the distended uterine horns endangered safe access to the ovarian pedicle, and the vessel sealing device was inserted through a second cannula placed periumbilically. Extension of the original incision was necessary to exteriorize organs in two dogs. All dogs recovered quickly and were discharged either on the day of surgery or 1 day thereafter. In conclusion, a surgical glove port technique in combination with an Alexis wound retractor is feasible for surgical laparoscopic treatment of canine pyometra up to a diameter of 7 cm.

Single-incision laparoscopic appendectomy using homemade glove port at low cost.

PURPOSE:The aim of this study was to report homemade glove port technique for single-incision laparoscopic appendectomy (SILA).MATERIALS AND METHODS:Our homemade glove port was composed of a size 6 latex sterile surgical glove, a sterilized plastic bangle, and three pieces of silicon tube (5 cm in length) that were used as the suction tube. Clinical data were retrospectively collected from those patients who underwent SILA at Bucheon St. Mary's Hospital, Bucheon, Gyeonggi-do, South Korea between February 2014 and June 2014, including patient demographics, and operative and postoperative outcomes. To compare the outcomes, a retrospective review was performed for those patients who underwent conventional laparoscopic appendectomy (CLA) between October 2013 and January 2014. Both SILA and CLA were performed by the same surgical team.RESULTS:The SILA and CLA groups included 37 and 57 patients, respectively. The mean age, weight, body mass index (BMI), operation time, and pathologic diagnosis of gangrenous appendicitis were not significantly different between the two groups. However, the mean hospital stay in the CLA group was significantly (P = 0.018) longer than that in the SILA group (4.2 days vs 3.5 days). There was no conversion to open surgery in both the groups. Of the cases who underwent SILA, 10 (27.0%) needed insertion of additional port and drain. There was one (3.2%) complication of umbilical surgical site infection.CONCLUSION:In this study, SILA, with homemade glove port, was technically feasible and safe at low cost.

AB190. Transumbilical single incision for laparoendoscopic bilateral renal cyst decortication using a homemade glove port device (video available)

ObjectiveTransumbilical single incision surgery (TSIS) has recently gained popularity for symptomatic renal cysts. We evaluated the clinical utility and safety of homemade glove port device in bilateral renal cyst decortication patients at our institution.MethodsWe reviewed our series of 42 bilateral symptomatic renal cyst (range, 4-12 cm) decortication performed from November 2010 to December 2013. A homemade port device consisted of two control loops and a glove to form three channels was placed through the umbilical single incision. A homemade single port device was made by fixing a size 7 1/2 surgical glove to the retractor outer ring and securing the glove fingers to the end of 3 trocars with a tie. The homemade port was inserted at the umbilical incision; operation was performed by using a special flexible 30-degree laparoscope and conventional laparoscopic instruments.ResultsAll cases were completed successfully, without conversion to a standard laparoscopic or open approach. The average operative time was 75 min and the estimated blood loss was less than 30 mL, no intraoperative complication occurred. The mean hospital stay was 2.8±1.5 (range, 2-5) days, with a median follow-up of 20 (range, 8-32) months, there was no recurrence.ConclusionsOur homemade single port device is cost-effective and more flexible to deal with bilateral renal cysts especially ventral lesions than the current multichannel port or traditional laparoscopic surgery.

A simple transanal technique to complete perineal dissection of a proctectomy when the limits are not visible from above or below.

BACKGROUND An intersphincteric dissection is often used in a proctectomy for benign pathology such as ulcerative colitis, thereby avoiding a large perineal defect. The narrow confines of this approach can make the dissection technically challenging, especially when compounded by body habitus or a narrow pelvis. Transanal minimally invasive surgery (TAMIS) has been developed for both local and extensive resections involving the low and midrectum, usually requiring a single incision laparoscopic surgery port and development of skills to perform extensive transanal resection. A transanal approach using simple theatre equipment to create a single glove port has been reported but is seldom used as an option in difficult cases.

PTU-006 Glove port trans anal excision of rectal tumours

Introduction Transanal glove port excision is a safe minimally invasive procedure for excising rectal tumours that avoids major rectal surgeries and its complications. The aim of this study is to review a single Centre experience with Trans Anal Glove Port excision of rectal tumours. Method Between 2011–2014, 11 patients underwent resection of benign (N = 9) or Malignant (N = 2) rectal tumours, located above the dentate line to 14 cm. The mean follow up period was between 6–12 months. Glove port was constructed using circular anal dilator, standard surgical glove and a wound protector retractor. Results All the patients underwent Glove port transanal excision of rectal tumours. Male: Female ratio was 10:1. Average age of patients was 63 years. None of the patients in the series underwent conversion to radical surgery. Full thickness excision of the tumour was performed in 9 patients and the other two underwent submucosal excision. During the follow up period between 6–12 months, 1 patient had recurrent tubulo villous adenoma, which needed further excision of the adenoma. In two patients who had a planned glove port excision for a presumed benign rectal polyp (Tubulo villous adenoma), The final histology showed an adenocarcinoma on a background of Tubulo-villous adenoma. Both the Patients underwent further staging investigations, one patient had a further chemo-radiotherapy and the other patient did not need any further treatment. Both are under close surveillance with no recurrence. Post-operative complications were only mild which included bleeding and mucus discharge. Conclusion Glove port Trans anal excision is a safe, effective and cheap technique useful in excising rectal tumours with good clearance and full thickness excision of the rectal wall where necessary. It helps avoid major rectal resections with its attendant complications, in many cases. Disclosure of interest None Declared. Reference Alessandro C, Daniela M, Michele M, et al . Glove port technique for transanal endoscopic microsurgery. Int J Surg Oncol . 2012;2012:Article ID 383025,1–4

Single incision glove port laparoscopic colorectal cancer resection.

The advantages of single port surgery remain controversial. This study was designed to evaluate the safety and feasibility of single incision glove port colon resections using a diathermy hook, reusable ports and standard laparoscopic straight instrumentation. Between June 2012 and February 2014, 70 consecutive patients (30 women) underwent a colonic resection using a wound retractor and glove port. Forty patients underwent a right hemicolectomy through the umbilicus and thirty underwent attempted single port resection via an incision in the right rectus sheath (14 high anterior resection, 13 low anterior resection, 3 abdominoperineal resection). Sixty-two procedures (89%) were completed without conversion to open or multiport techniques. Four procedures had to be converted and additional ports were needed in four other patients. The postoperative mortality rate was 0%. Complications occurred in six patients (9%). Two cases were R1 while the remainder were R0 with a median nodal harvest of 20 (range: 9-48). The median length of hospital stay was 5 days (range: 3-25 days) (right hemicolectomy: 5 days (range: 3-12 days), left sided resection: 6 days (range: 4-25 days). At a median follow-up of 14 months, no port site hernias were observed. Single incision glove port surgery is an appropriate technique for different colorectal cancer resections and has the advantage of being less expensive than surgery with commercial single incision ports.

In memoriam: Robert Emmons Kissling (1923–2013).

In memoriam: Robert Emmons Kissling (1923–2013).

Laparoendoscopic Single-Site Surgery Using Conventional Laparoscopic Instruments and Glove Port Technique in Gynecology: A Single Surgeon's Experience

Study ObjectiveTo report a single surgeon's experience with 120 laparoendoscopic single-site surgery (LESS) procedures using conventional laparoscopic instruments and a homemade glove port system to treat benign gynecologic diseases. DesignRetrospective chart analysis (Canadian Task Force classification III). SettingEulji University Hospital. PatientsOne hundred twenty patients who underwent LESS performed by a single surgeon to treat benign gynecologic diseases between November 2010 and November 2012. InterventionLESS using conventional instrumentation was performed using our specialized glove port technique, which consists of the combination of the homemade glove port system designed to minimalize collision of the trocar on the tip of the finger of the surgical glove, a sufficient rectus fasciotomy, the surgeon's position at the patient's head, and adequate positioning of the instruments. Measurements and Main ResultsThe LESS procedures performed were laparoscopically assisted vaginal hysterectomy (n = 50), ovarian cystectomy (n = 25), myomectomy (n = 14), oophorectomy (n = 11), salpingectomy (n = 9), fimbrioplasty or neosalpingstomy (n = 7), and adhesiolysis only (n = 4). Median patient age was 40 years, and median body mass index was 23. Median operative time was 100 minutes (range, 50–145 minutes) for laparoscopically assisted vaginal hysterectomy, 70 minutes (range, 30–150 minutes) for ovarian cystectomy, 107 minutes (range, 65–180 minutes) for myomectomy, 55 minutes (range, 25–130 minutes) for oophorectomy, 85 minutes (range, 35–110 minutes) for salpingectomy, 70 minutes (range, 25–140 minutes) for neosalpingostomy or fimbrioplasty, and 35 minutes (range, 30–60-minutes) for adhesiolysis only. All procedures were completed successfully without the need for additional ports or conversion to the standard laparoscopic approach. One perioperative complication occurred. The complication rate was 83% (1 of 120). Other postoperative complications were not observed at follow-up. ConclusionOur experience shows that LESS using conventional laparoscopic instruments and our glove port technique is a feasible and safe technique for the surgical management of various gynecologic conditions. Therefore, our homemade glove port laparoscopic system used in our specialized technique provides a simple, cost-effective approach to LESS and would probably make laparoscopic procedures using conventional instruments easier.

Single‐incision laparoscopic ileorectal anastomosis

Minimally invasive approaches for stoma closure offer considerable benefits for patients. Single port access via an end ileostomy site after stoma take-down in patients with prior total colectomy and a rectal stump remnant could allow restoration of ileorectal continuity by anastomosis but has not been detailed previously. After mobilisation of the end ileostomy, the anvil of a circular stapler is secured into the open end of the distal ileum and the intestine returned into the abdominal cavity. A single port access device (in this description, a 'surgical glove port') is placed then into the stoma site and full laparoscopy performed. Once the rectal stump is identified and prepared, an intracorporeal anastomosis can be constructed in a tension-free manner using a Knight-Griffin technique. Leak-testing can also be performed and the operation concluded with closure of the solitary incision. In selected cases, adhesiolysis and anastomosis can be safely performed in toto. If the peritoneal environment is challenging, access can be escalated to multiport laparoscopy or even laparotomy. Initiation of ileorectal anastomosis construction by single port laparoscopy at least allows peritoneal assessment but can provide for the operation's completion. This can confer maximum patient benefit for the most minimally invasive option.

Standardized technique for single port laparoscopic ileostomy and colostomy

Single site laparoscopic techniques and technology exploit maximum usefulness from confined incisions. The formation of an ileostomy or colostomy seems very applicable for this modality as the stoma occupies the solitary incision obviating any additional wounds. Here we detail the principles of our approach to defunctioning loop stoma formation using single port laparoscopic access in a stepwise and standardized fashion along with the salient specifics of five illustrative patients. No specialized instrumentation is required and the single access platform is established table-side using the 'glove port' technique. The approach has the intra-operative advantage of excellent visualization of the correct intestinal segment for exteriorization along with direct visual control of its extraction to avoid twisting. Postoperatively, abdominal wall trauma has been minimal allowing convalescence and stoma care education with only one parietal incision. Single incision stoma siting proves a ready, robust and reliable technique for diversion ileostomy and colostomy with a minimum of operative trauma for the patient.

A systematic review of transanal minimally invasive surgery (TAMIS) from 2010 to 2013.

Transanal minimally invasive surgery (TAMIS) was introduced as an alternative to transanal endoscopic microsurgery in 2010. Over the past 4years, considerable international experience has been gained with this approach. Most published reports focus on TAMIS for local excision of rectal neoplasia, but there are other important applications such as transanal mesorectal excision for rectal cancer. This comprehensive review details the progress with TAMIS since its inception. Robotic transanal surgery is a natural evolution of TAMIS still in its early infancy, which is also reviewed. A comprehensive search of PubMed, EMBASE, the Cochrane Library, and Web of Knowledge was performed. Since the inception of TAMIS in 2009, 33 retrospective studies and case reports, and 3 abstracts have been published on TAMIS for local excision of rectal neoplasms, which represents a combined n=390 TAMIS procedures performed worldwide using eight different types of TAMIS platforms. A total of 152 lesions were excised for benign disease including adenomas and high-grade dysplasias (39%), 209 for malignancy for carcinomas in situ and adenocarcinomas (53.5%). Twenty-nine (7.5%) of TAMIS resections were for other pathology, of which the majority (23/29) were neuroendocrine lesions. The remaining resections were for mucocele, gastrointestinal stromal tumor, melanoma, and fibrosis. Robotic-TAMIS has also been reported, however, data are extremely limited as there are only 7 case reports (combined n=11) in the published literature. Success with Robotic-TAMIS has been demonstrated with various patient positions and by use of a special glove port. Transanal total mesorectal excision using the TAMIS platform has also been demonstrated is several small series, and the feasibility of performing pure transanal total mesorectal excision has also been reported. Combined, n=78 cases of transanal total mesorectal excision have been performed using TAMIS. The advantages of TAMIS-assisted transanal total mesorectal excision are discussed.

Transanal endoscopic microsurgery by transanal glove port combined with colonoscopy for excision of rectal tumors

To evaluate the feasibility and efficacy of transanal endoscopic microsurgery (TEM) by transanal glove port combined with colonoscopy for excision of rectal tumors. Eight patients with rectal cancer eligible for local resection were chosen to receive a procedure performed via a "glove TEM port" from October 2012 to March 2013. This device was constructed on-table using a circular anal dilator (CAD), standard surgical glove, colonoscopy instruments and straight laparoscopic instruments. Procedures of all the patients were completed successfully by glove TEM. The median (range) diameter of tumor was 2.6(1.5-3.5) cm, the median (range) operative time was 55.6(30-110) min. Postoperative pathology included villous adenomas (n=3), tubular adenomas (n=2), tubulovillous adenomas (n=2), serrated adenoma (n=1), low-grade intraepithelial neoplasia (n=2), and high-grade intraepithelial neoplasia (n=1). All resection margins were negative. Two patients presented with postoperative minor bleeding. There were no serious intraoperative complications. No cancer recurrence was found during a follow-up of 1-5 (median 3.1) months. Transanal endoscopic microsurgery by transanal glove port combined with colonoscopy in the treatment of early rectal cancer is easy and safe.

Incision-less reversal of Hartmann’s procedure

After taking down the colostomy in a patient who has previously undergone a Hartmann's operation, it is possible to restore bowel continuity using the single-port technique via the colostomy site itself. This study presents our experience of this approach using the glove port and standard laparoscopic instrumentation. Between October 2010 and October 2013, 14 patients [median age 62years (range 42-83years); median body mass index 25.2kg/m(2) (range 22.7-34.9)kg/m(2)] underwent attempted single-port (via colostomy site) reversal of Hartmann's. All but one patient had had a laparotomy for their primary surgery. The glove port was used with a camera and two working ports. Additional remote access was needed in 3 (21%) patients [1×5mm port (two patients); 2×5-mm ports ; 2×5-mm ports and Pfannenstiel]. Median operative time was 150min (range 75-270min). Mortality was nil. One patient required reoperation and a stoma. Median hospital stay was 5days (range 2-36days). Glove port reversal of Hartmann's is technically possible, though challenging if extensive adhesions are present. Outcomes are variable. Further studies will be needed to assess whether this is a safe technique.

Robotic transanal minimally invasive surgery for local excision of rectal neoplasms

Robotic transanal minimally invasive surgery (TAMIS) may be an option for rectum-preserving excision of neoplasms. Recent cadaveric studies showed improved vision, control and manoeuvrability compared with use of laparoscopic instruments. This study reports the clinical application. Consecutive patients eligible for transanal endoscopic microsurgery (TEM) or TAMIS in three participating centres were operated on using a robotic platform and transanal glove port. Patient demographics, lesion characteristics, perioperative data, complications and follow-up of all patients were recorded prospectively. Sixteen patients underwent robotic TAMIS for rectal lesions with a median (range) distance from the anal verge of 8 (range 3-10) cm. The median size of the resected specimen was 5·3 (0·5-21) cm(2) . The median docking time and duration of operation were 36 (18-75) and 108 (40-180) min respectively. One conversion to regular (non-robotic) TAMIS was needed owing to difficulties accessing the rectum. Glove puncture necessitated replacement in four procedures, an unstable pneumorectum arose during one operation and one patient developed a pneumoperitoneum. One patient required catheterization for urinary retention. The median hospital stay was 1·3 (0-4) days. The additional cost of the robotic approach was approximately €1000 per procedure (excluding the capital expenditure on the robotic system and its maintenance). Robotic TAMIS is feasible in patients with rectal lesions. Potential advantages over TEM and non-robotic TAMIS will need to be balanced against the cost of the robotic system.

Single port laparoscopic surgery for patients with complex and recurrent Crohn's disease

BackgroundSingle port laparoscopic surgery (SPLS) is a modified access technique allowing grouping of instruments at a single parietal site. It is intuitively appealing specifically for patients with Crohn's disease (CD) as its minimal invasiveness favors cosmesis and facilitates any future (re)operation. MethodsConsecutive patients presenting either electively or urgently for resectional surgery for CD over a 36month period were considered for SPLS using, by preference, a transumbilical ‘Surgical Glove Port’. Standard, straight laparoscopic instrumentation was used without additional resources. ResultsOf 33 consecutive, unselected patients, 28 (92%) had their procedure initiated by SPLS including those needing urgent intervention (n=15) and those with prior abdominal operation (n=8), obstruction (n=7), mass (n=6), fistula (n=6) and/or abscess (n=4). The median (range) age and BMI of the patients were 31 (17–69) years and 21.3 (18.6–28) kg/m2 respectively. 31 had ileocolonic resection (6 with recurrent disease) while two underwent segmental colectomy. No-one suffered intraoperative or anastomotic complication. Both conversion (15%) and postoperative complication (13 Clavian–Dindo complications — I: 8; II: 2; IIIa: 3) rates were predominantly reflective of patient and disease complexity. Median (range) postoperative day of discharge was 6 (3–33) overall and 5 (3–18) in those completed by SPLS. There was one early readmission (for infectiouscolitis) and median follow-up is now 21months. ConclusionsComplex and recurrent Crohn's resections can be performed by SPLS in the majority of patients presenting elective or urgently for surgery. The Surgical Glove Port performs capably and, by minimizing cost, can facilitate broad embrace of this approach.

Natural Orifice Transluminal Endoscopic Surgery-assisted Versus Single-port Laparoscopic-assisted Vaginal Hysterectomy: A Case-matched Study

ObjectiveNatural orifice transluminal endoscopic surgery (NOTES) is currently a very important procedure for surgeons. This study aimed to describe the initial clinical experience of NOTES-assisted vaginal hysterectomy (NAVH) and to investigate its feasibility and surgical outcomes compared with single-port laparoscopic-assisted vaginal hysterectomy (SP-LAVH). DesignRetrospective chart analysis (Canadian Task Force classification II-1). SettingOne university-affiliated hospital. PatientsWomen undergoing NAVH or SP-LAVH for benign uterine diseases. InterventionNAVH using a novel homemade NOTES system comprised a glove-wound retractor NOTES port or SP-LAVH using conventional laparoscopic instruments and an umbilical glove port. Measurements and Main ResultsSince July 2012, 16 patients with benign uterine disease have undergone NAVH. Another 32 paired, SP-LAVH patients from the registered database were used to compare these 2 modalities of laparoscopic-assisted techniques for vaginal hysterectomy. All NAVHs were completed successfully without the need of an additional port or conversion to the standard laparoscopic approach. Intraoperative and postoperative surgical outcomes were assessed in both groups of patients. There was also no significant difference between both groups in perioperative outcomes such as estimated blood loss, decrease in hemoglobin on postoperative day 1, amount of analgesic drugs used, postoperative visual analog scale pain score, and febrile complications, except for operative time and length of postoperative hospital stay. The mean operative time was 70.6 ± 12.8 minutes for NAVH and 93.2 ± 21.4 minutes for SP-LAVH (p < .001). The median postoperative hospital stay was 3.5 days (range, 3–5) for NAVH and 4 days (range, 3–6) for SP-LAVH (p < .001). ConclusionThe findings show that NAVH is a feasible and safe surgical technique and has a short operative time and postoperative hospital stay compared with SP-LAVH. This new technique at least offers similar surgical outcomes and superior cosmesis in our opinion compared with SP-LAVH. However, prospective studies are needed to determine its full clinical application.

Outcomes of a Single-Port Laparoscopic Appendectomy Using a Glove Port With a Percutaneous Organ-Holding Device and Commercially-Available Multichannel Single-Port Device

PurposeA laparoscopic appendectomy is now commonly performed. The push in recent years toward reducing the number of ports required to perform this surgery has led to the development of a single-port laparoscopic appendectomy (SPA). We compared postoperative pain after an SPA using a glove port with a percutaneous organ-holding device (group 1) with that of an SPA using a commercially-available multichannel single-port device (group 2).MethodsBetween March 2010 and July 2011, a retrospective study was conducted of a total of 77 patients who underwent an SPA by three surgeons at department of surgery, Kangbuk Samsung Medical Center. Thirty-eight patients received an SPA using a glove port with a percutaneous organ-holding device. The other 39 patients received an SPA using a commercially-available multichannel single port (Octo-Port or SILS Port). Operative details and postoperative outcomes were collected and evaluated.ResultsThere were no differences in the mean operative times, times to pass gas, postoperative hospital stays, or cosmetic satisfaction scores between the two groups. The pain score in the first 24 hours after surgery was higher in group 2 than group 1 patients (P < 0.001). Furthermore, the trocar used in group 2 was more expensive than that used in group 1.ConclusionAn SPA using a glove port with a percutaneous organ-holding device was associated with a lower pain score during the first 24 hours after surgery because of the shorter fascia incision length and a cheaper cost than an SPA using a commercially-available multichannel single-port device.