Multiport Laparoscopy Research Articles

Design of a Box Trainer for Objective Assessment of Technical Skills in Single-port Surgery

Laparoscopic single-port (SP) surgery uses only a single entry point for all instruments. The approach of SP has been applied in multiple laparoscopic disciplines owing to its improved cosmetic result. However, in SP surgery, instrument movements are further restricted, resulting in increased instrument collisions compared with standard multiport (MP) laparoscopy. Our goal was to develop a trainer that can quantitatively measure task time, force and motion data during both MP and SP training to investigate the influence of instrument configuration on performance. Custom-made abdominal force sensors and accelerometers were integrated into a new training box that can be used in an SP and an MP configuration. This new box trainer measures forces, acceleration, and tilt angles during training of SP and MP laparoscopy. With the new trainer, 13 novices performed a tissue manipulation task to test whether significant differences exist between MP and SP in maximum abdominal force, maximum tissue manipulation force, maximum acceleration, and tilt angles of the handles. The results show that the task time (SP-145s, standard deviation (SD) = 103 vs MP-61s SD = 16), maximum abdominal force (SP-8.4N, SD = 2.0 vs MP-left (L)-3.3N, SD = 0.8 and MP-right (R)-5.8N, SD = 2.1), tissue manipulation force (SP-10.4N, SD = 3.6 and MP-5.6N, SD = 1.3), maximum acceleration (MP-L-9m/s(2), SD = 5 vs SP-L-14m/s(2), SD = 7), and tilt angles of the left handle are significantly higher in SP. This study shows that the new trainer can be used to find the most important differences in instrument and tissue handling, which is an important step toward the assessment of surgical skills needed for safe SP surgery depending on force and motion-based parameters.

Simultaneous Transvesical Laparoendoscopic Single-Port Diverticulectomy and Cystolithotripsy

Introduction: Transvesical laparoendoscopic single-site surgery (T-LESS) is a novel minimally invasive approach that has been introduced to decrease the morbidity related to laparoscopic multiport placement and to improve cosmetic results. This technique was first used for foreign body removal from the bladder.1 We previously described a practical application of this method for bladder diverticulectomy.2 A potentially significant role of T-LESS has been noticed by other investigators.3 We present a video of the use of this approach for simultaneous bladder diverticulectomy and cystolithotripsy.4 Materials and Methods: A total of 10 patients underwent the T-LESS diverticulectomies. In two patients, additional procedures (ureteral reimplantation or cystolithotripsy) were carried out simultaneously, using the same access. In this video, we present the T-LESS diverticulectomy and cystolithotripsy in a 58-year-old male patient found to have a symptomatic diverticulum and intradiverticular multiple calculi, up to 2 cm in diameter. The following operative steps were employed: (1) introduction of the TriPort+ (Olympus) into the bladder; (2) establishing the pneumovesicum; (3) removal of the calculi either intact or after cystolithotripsy with the lithoclast probe; (4) dissection of the diverticulum with standard laparoscopic instruments; and (5) closure of the bladder wall defect with the V-Loc suture. An 18F Foley catheter was placed in the bladder for 7 days. Results: The procedure was completed effectively, without blood loss or any complications. No extra port was added. The operative time was 115 minutes, and the hospital stay was 2 days. In a 6-month follow-up, no bladder diverticulum or stones were observed, and the patient confirmed a significant reduction in preoperative symptoms. Conclusion: The T-LESS technique for the simultaneous removal of the bladder diverticulum and stones is a feasible and safe procedure. This combination of already existing techniques can be a valuable method for the treatment of more complex pathologies of the lower urinary tract. Nevertheless, further development of applicable instruments is needed. The authors have nothing to disclose. Runtime of video: 7 mins 48 secs

Does single port improve results of laparoscopic colorectal surgery? A propensity score adjustment analysis.

The benefit of single-incision laparoscopy (SIL) over conventional multiport laparoscopy (ML) is not demonstrated in colorectal surgery, mainly because of potentially biased reports. The objective of this study was to compare SIL to ML for colorectal resection, using a propensity score (PS) adjusted analysis. From July 2009 to April 2013, 764 patients who underwent 799 colorectal resections by SIL or ML were analyzed. PS was estimated using a logistic regression model. Eighty-four colorectal resections were performed using SIL: 43 ileocolic resections, 15 right-sided colectomies, 14 left-sided colectomies, 5 rectal resections, 4 subtotal colectomies, and 3 total proctocolectomies. Intra-operative complications occurred in 3 procedures (4%), and conversion laparotomy in 10 (12%). Postoperative mortality was nil and overall morbidity rate was 25%, including 7% of major complications. Mean postoperative length of hospital stay was 8±6 (4-47) days. Outcomes of SIL, when compared to those of 715 ML and after PS adjustment, showed no difference in terms of intra-operative complication (p=0.315), conversion to open surgery (p=0.387), overall morbidity (p=0.393), major morbidity (p=0.381), or length of postoperative hospital stay (p=0.080). However, the length of hospital stay was significantly shorter after SIL in the right colectomy subgroup (p=0.001). In colorectal surgery, SIL appears to be safe and effective as compared to ML. It can also reduce hospital stay after right colectomy. These results, if confirmed by randomized trials, would validate SIL in colorectal surgery.

The Influence of Training Levels and Surgical Experience on Outcomes after Single-Incision Laparoscopic Appendectomy

Background: Single-incision laparoscopic appendectomy (SILA) has become an accepted alternative to conventional multiport laparoscopic appendectomy. Yet, little is known about the impact of operations performed by residents on the outcome of SILA. The aim of the present study was to evaluate the safety and efficacy of SILA performed by younger surgeons. Methods: All SILA's at a single institution were reviewed and grouped according to the educational level of the operating surgeon: group 1 included residents with no experience in single-incision laparoscopic surgery (SILS) and little experience in multiport laparoscopy, group 2 comprised fellows with experience in multiport laparoscopy but with no experience in SILS, and group 3 consisted of senior surgeons, all of whom were experienced in performing SILS. Results: A total of 176 patients were included. The patients had been operated on by residents (n=62), fellows (n=21), or senior surgeons (n=93). Senior surgeons performed the operation in less time than fellows or residents (48.7 vs. 55.4 vs. 53.6 minutes, respectively; p=0.108). Six patients required conversion to multiport laparoscopy while no patient required conversion to the open procedure. The overall postoperative morbidity was 9.1%, with no significant difference between the three groups (p=0.536). The surgeon's level of surgical education was no statistical risk factor for developing postoperative complications after SILA. Conclusion: Although operating times were longer for residents and fellows compared to senior surgeons, less surgical experience did not correlate with a greater need for conversion to multiport laparoscopy and was not associated with a higher rate of postoperative complications.

Review of single incision laparoscopic surgery in colorectal surgery.

As surgical techniques continue to move towards less invasive techniques, single incision laparoscopic surgery (SILS), a hybrid between traditional multiport laparoscopy and natural orifice transluminal endoscopic surgery, was introduced to further the enhanced outcomes of multiport laparoscopy. The safety and feasibility of SILS for both benign and malignant colorectal disease has been proven. SILS provides the potential for improved cosmesis, postoperative pain, recovery time, and quality of life at the drawback of higher technical skill required. In this article, we review the history, describe the available technology and techniques, and evaluate the benefits and limitations of SILS for colorectal surgery in the published literature.

Single-Incision Single-Instrument Adnexal Surgery in Pediatric Patients.

Introduction. Pediatric surgeons often practice pediatric gynecology. The single-incision single-instrument (SISI) technique used for appendectomy is applicable in gynecologic surgery. Methods. We retrospectively analyzed the records of patients undergoing pelvic surgery from 2008 to 2013. SISI utilized a 12 mm transumbilical trocar and an operating endoscope. The adnexa can be detorsed intracorporeally or extracorporealized via the umbilicus for lesion removal. Results. We performed 271 ovarian or paraovarian surgeries in 258 patients. In 147 (54%), the initial approach was SISI; 75 cases (51%) were completed in patients aged from 1 day to 19.9 years and weighing 4.7 to 117 kg. Conversion to standard laparoscopy was due to contralateral oophoropexy, solid mass, inability to mobilize the adnexa, large mass, bleeding, adhesions, or better visualization. When SISI surgery was converted to Pfannenstiel, the principal reason was a solid mass. SISI surgery was significantly shorter than standard laparoscopy. There were no major complications and the overall cohort had an 11% minor complication rate. Conclusion. SISI adnexal surgery is safe, quick, inexpensive, and effective in pediatric patients. SISI was successful in over half the patients in whom it was attempted and offers a scarless result. If unsuccessful, the majority of cases can be completed with standard multiport laparoscopy.

Physical and mental workload in single-incision laparoscopic surgery and conventional laparoscopy.

The aim of the present study is to evaluate mental workload and fatigue in fingers, hand, arm, shoulder in single-incision laparoscopic surgery (SILS) and multiport laparoscopy. Volunteers performed chosen tasks by standard laparoscopy and SILS. Time to complete tasks and finger and hand strength were evaluated. Lateral, tripod, and pulp pinch strengths were measured. Hand dexterity was determined by pegboard. Electromyography recordings were taken from biceps and deltoid muscles of both extremities. The main outcome measurement was median frequency (MF) slope. NASA-TLX was used for mental workload. Time to complete laparoscopic tasks were longer in the SILS group (P < .05). Decrease of strength in fingers and hand were similar in SILS and standard laparoscopy. Pegboard time was increased in both hands after SILS (P < .05). MF slope of biceps muscle and deltoid muscle in SILS was far away from the reference slope. MF slope of biceps muscle and deltoid muscle in standard laparoscopy was close to reference slope, indicating there was more fatigue in biceps and deltoid muscles of both upper extremities in SILS group. NASA-TLX score was 73 ± 13.3 and 42 ± 19.5 in SILS and multiport laparoscopy, respectively (P < .01). Mental demand, physical demand, temporal demand, performance, effort, and frustration were, respectively, scored 10.7 ± 3.8, 11.7 ± 3.5, 12.2 ± 2.7, 11 ± 3, 13.6 ± 2.7, and 13.5 ± 2.8 in SILS and 6.3 ± 3.1, 6.6 ± 3.3, 7.3 ± 3.3, 7.1 ± 4.1, 7.9 ± 3.9, and 6.6 ± 3.8 in standard laparoscopy (P < .01). SILS is mentally and physically demanding, particularly on arms and shoulders. Fatigue of big muscles, effort, and frustration were major challenges of SILS. Ergonomic intervention of instruments are needed to decrease mental and physical workload.

Single-Site Hysterectomy: Robotic Versus Laparoscopic

This study evaluated the feasibility and safety of robotic single port hysterectomy and laparoscopic single port hysterectomy, and to compare the perioperative parameters of the two systems. Twenty patients underwent robotic single port hysterectomy and 25 patients underwent laparoscopic single port hysterectomy. All hysterectomies were successfully performed via a single port and there were no conversions to conventional multi-port laparoscopy, multi-port robotic, open surgery, or vaginal surgery. The median operative time and hysterectomy time in robotic and laparoscopic groups were 90 vs. 90 min (P 0.74), 57.5 vs. 60 min (P 0.17), respectively. The median estimated blood loss was 40 ml in the robotic group and 50 ml in the laparoscopic group (P 0.77). No operative and post-operative complications were observed in the two groups. The median time to discharge from the hospital was one day for both techniques (P 0.17). Robotic and laparoscopic single port systems are feasible and safe for hysterectomy operation in terms of operative time, conversion to laparotomy or multiport laparoscopy/robotic rates, complication rates, and postoperative results in the hands of experienced surgeons. The possible benefits of robotic single port surgery compared with conventional laparoscopy should be evaluated in further randomized controlled studies.

Minimal access laparoscopic surgery for treatment of ulcerative colitis and familial adenomatous polyposis coli in children and adolescents.

Laparoscopic restorative proctocolectomy is standard surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis coli (FAP). Scar burden can be minimized by reducing the number of laparoscopic ports. The aim of this study is to review the authors' experience with reduced-port laparoscopy in this setting and to compare it with conventional laparoscopy using multiple ports. Charts of pediatric patients undergoing colectomy for UC or FAP between 2009 and 2012 were retrospectively reviewed. Patients who had the operation performed through one or two multichannel ports were assigned to the minimal access (MA) study group. Patients who had four or five single-channel ports with or without an additional small laparotomy were assigned to the LAP group. Twenty-two patients were identified. Ages at first operation were 2-18 years (median, 13.5 years). There were no conversions to laparotomy and no mortality. Mean operative times for the MA and LAP groups, respectively, were 250 and 284 minutes for abdominal colectomy with end ileostomy (P=.15), 198 and 301 minutes for completion proctectomy with diverting loop ileostomy (DLI) (P=.26), and 455 and 414 minutes for proctocolectomy with ileal pouch-anal anastomosis and DLI (P=.72). A major complication requiring laparotomy occurred in 1 patient (9%) in the MA group and in 2 patients (18%) in the LAP group. Minimal access laparoscopic surgery for UC and FAP is safe and feasible. A slightly larger incision at the ostomy site facilitates extraction of the specimen and extracorporeal construction of a J-pouch. Operative times and hospital stay are comparable to those with multiport laparoscopy.

Contained power morcellation within an insufflated isolation bag.

To describe a technique for contained power morcellation within an insufflated isolation bag at the time of uterine specimen removal during minimally invasive gynecologic procedures. Over the study period of January 2013 to April 2014, 73 patients underwent morcellation of the uterus or myomas within an insufflated isolation bag at the time of minimally invasive hysterectomy or myomectomy. This technique involves placing the specimen into a large plastic bag within the abdomen, exteriorizing the opening of the bag, insufflating the bag within the peritoneal cavity, and then using a power morcellator within the bag to remove the specimen in a contained fashion. Procedures were performed at four institutions and included multiport laparoscopy, single-site laparoscopy, multiport robot-assisted laparoscopy, or single-site robot-assisted laparoscopy. Demographic and perioperative characteristics were collected for the cases. Surgical specimen morcellation within an insufflated isolation bag was successfully used in all cases. The median operative time was 114 minutes (range 32-380 minutes), median estimated blood loss was 50 mL (range 10-500 mL), and the median specimen weight was 257 g (range 53-1,481 g). There were no complications related to the contained morcellation technique nor was there visual evidence of tissue dissemination outside of the isolation bag. Morcellation within an insufflated isolation bag is a feasible technique. Methods for morcellating uterine tissue in a contained manner may provide an option to minimize the risks of open power morcellation while preserving the benefits of minimally invasive surgery. II.

Single-port and multi-port laparoscopic left lateral liver sectionectomy for treating benign liver diseases: a prospective, randomized, controlled study.

The use of single-port laparoscopy for left-lateral liver sectionectomy (LLLS) has been reported in the literature, but the effectiveness and safety of LLLS has not been validated in randomized, controlled trials. This prospective randomized controlled trial compared the effectiveness and safety of single-port and multi-port laparoscopic LLLS for the surgical treatment of benign liver disease. Altogether, 38 patients aged 17-65 years (16 men, 22 women) with benign liver diseases were hospitalized for elective laparoscopic LLLS between January 2010 and December 2012. Patients were randomly assigned to either single-port (n = 19) or multi-port (n = 19) laparoscopic LLLS. Main outcome measures were operative time, volume of intraoperative blood loss, complication rates, and postoperative hospitalization. Baseline characteristics of the two groups were comparable. Single-port and multi-port laparoscopies were successfully completed in all but one patient (1/19, 5.3 %) who required conversion from a single-port to a multi-port procedure. The two groups had similar mean operative times and volumes of intraoperative blood loss. There were no clinically significant postoperative complications or deaths. The single-port group had a significantly shorter postoperative hospitalization than the multi-port group (2.5 ± 1.7 vs. 4.0 ± 2.1 days; p < 0.05). Single-port laparoscopic LLLS is a technically feasible, effective, safe alternative to multi-port laparoscopy for the treatment of benign liver diseases in cautiously selected patients.

Editorial Comment

Laparoendoscopic single site surgery (LESS) and natural orifice translumenal endoscopic surgery (NOTES) emerged as promising techniques that aim to continue evolution of minimally invasive surgery by attempting to further reduce pain and improve cosmesis of multiport laparoscopy. Recently there seems to be a relative waning of the otherwise heightened enthusiasm with these procedures just a few years ago. LESS/NOTES are still remaining procedures performed by experienced experts in referral centers, used more frequently for extirpative procedures in carefully selected patients. 1 Merseburger A.S. Herrmann T.R. Shariat S.F. et al. EAU guidelines on robotic and single-site surgery in urology. Eur Urol. 2013; 64: 277-291 Abstract Full Text Full Text PDF PubMed Scopus (109) Google Scholar Although there has been improvement to the design of the instruments (longer, prebent and articulated instruments and cameras) that facilitate LESS/NOTES procedures, they are still relatively laborious with suboptimal ergonomics. Continuing refinement of instrumentation and, most importantly, development of purpose-specific robotic platforms may overcome current limitations of LESS/NOTES due to the lack of the triangulation. These may help wider adoption of LESS/NOTES that remain promising techniques waiting for a suitable technology. Hybrid Transvaginal Nephrectomy: Development of Our TechniqueUrologyVol. 84Issue 1PreviewTo evaluate the development of natural orifice transluminal endoscopic surgery (NOTES) transvaginal nephrectomy and present the initial experience. Full-Text PDF ReplyUrologyVol. 84Issue 1PreviewThe technical difficulty of laparoendoscopic single-site surgery (LESS) and natural orifice transluminal surgery (NOTES) hinders their wide acceptance. The development and adoption of new instrument designs have not yet overcome these technical issues. Even the specially designed LESS instruments for robot-assisted LESS face technical problems.1 Nevertheless, the introduction of the special instrumentation for LESS and NOTES may represent one of the greatest contributions of these approaches to minimally invasive surgery. Full-Text PDF

1130 Laparoendoscopic single site surgery for the treatment of renal masses: Comparative study with multiport laparoscopy

1130 Laparoendoscopic single site surgery for the treatment of renal masses: Comparative study with multiport laparoscopy

526 Comparative study between laparoendoscopic single site through the umbilicus, multiport laparoscopy and open retropubic approaches for radical prostatectomy

526 Comparative study between laparoendoscopic single site through the umbilicus, multiport laparoscopy and open retropubic approaches for radical prostatectomy

Single‐incision laparoscopy: A review of the indications, techniques and results after more than 700 procedures

Single-incision laparoscopy (SIL) gained in popularity in the last 5-7 years, as a new philosophy has emerged to reduce the invasiveness of minimally invasive surgery. Various abdominal procedures using fewer and smaller trocars in order to obtain pure SIL have been described. To overcome some known problems of SIL, such as establishing the conventional multiport laparoscopic working triangulation, the non-ergonomic positioning of the surgeon, and the increased cost of each procedure, a particular SIL technique has been developed. The technique involves reusable trocars along with specially designed DAPRI curved reusable instruments introduced through the same incision but laterally to the optical system. Hence, the main principle of conventional multiport laparoscopy--working in an appropriate triangulation while maintaining the scope in the center--is respected. The final scar is 15 mm and the cost of the procedure remains unchanged because reusable materials are used. All the abdominal procedures, including upper and lower gastrointestinal, colorectal, hepatobiliopancreatic, solid organs, gynecologic and abdominal wall hernia repair, are here reported, as are the indications for and the results after 740 procedures. In conclusion, SIL has to be considered as one of the most attractive techniques of the new minimally invasive era.

Single-Incision Versus Standard Multiple-Incision Laparoscopic Cholecystectomy

The advantages of single-incision surgery for the treatment of gallstone disease is debated. Previous meta-analyses comparing single-incision laparoscopic cholecystectomy (SILC) and standard laparoscopic multiport cholecystectomy (SLMC) included few and underpowered trials. To overcome this limitation, we performed a meta-analysis of randomized and nonrandomized studies. A MEDLINE, EMBASE, and Cochrane Library literature search of studies published in and comparing SILC with SLMC was performed. The primary outcome was safety of SILC as measured by the overall rate of postoperative complications and biliary spillage. Feasibility was another primary outcome as measured by the conversion and operative time. Postoperative pain, length of hospital stay, perioperative blood loss, time to return to normal activity, and cosmetic satisfaction were secondary outcomes. We identified 43 studies of which 30 were observational reports and 13 experimental trials, for a total of 7489 patients (2090 SILC and 5389 SLMC). The overall rate of complications was comparable between groups (relative risk [RR] = 1.08; 95% CI = 0.87-1.35; P = .46), as were the rates of biliary spillage (RR = 1.16; 95% CI = 0.73-1.84; P = .53) and conversion rate (RR = 0.88; 95% CI = 0.53-1.46; P = .62). Operative time was in favor of SLMC (weighted mean difference = 0.73; 95% CI = 0.67-0.79; P < .0001). Secondary outcomes favored SILC, but with marginal advantages. SILC is a feasible technique but without any significant advantage over SLMC for relevant end points. Although secondary outcomes favored SILC, the small magnitude of the advantage and the low quality of assessment methods question the clinical significance of these benefits.

A Prospective, Randomized Controlled Trial of Single-Incision Laparoscopic vs Conventional 3-Port Laparoscopic Appendectomy for Treatment of Acute Appendicitis

Proponents of single-incision laparoscopic surgery (SILS) claim patients have less pain, faster recovery, and better long-term cosmetic results than patients who undergo multiport laparoscopy. However, randomized comparisons are lacking. This study presents the results of a prospective randomized trial of SILS or 3-port laparoscopic appendectomy. Adults with uncomplicated acute appendicitis were randomized 1:1 to either SILS or 3-port laparoscopic appendectomy. The primary end point was early postoperative pain (measured by opiate usage and pain score in the first 12 hours). Secondary end points were operative time, complication rate (including conversions), and recovery time (days of oral opiate usage and return to work). After 6 months, body image and cosmetic appearance were assessed using a validated survey. The trial was planned for 150 patients, but was halted after 75 patients when planned interim analysis showed that SILS patients had more postoperative pain (pain score: 4.4 ± 1.6 vs 3.5 ± 1.5; p = 0.01) and higher inpatient opiate usage (hydromorphone use: 3.9 ± 1.9 mg vs 2.8 ± 1.7 mg; p = 0.01) than 3-port laparoscopy. Operative time for SILS averaged 40% longer (54 ± 17 minutes vs 38 ± 11 minutes; p < 0.01). Only 1 SILS case was converted to 3-port. There were no significant differences in length of stay, complications, oral pain medication usage after discharge, or return to work. After 6 months, body image and cosmetic appearance were excellent for both groups and indistinguishable by most measures. However, 3-port patients reported better physical attractiveness (4.0 ± 0.4 vs 3.8 ± 0.4; p = 0.04) and SILS patients reported better scars (score 18.4 ± 2.7 vs 16.4 ± 3.0; p < 0.01). Results are reported as mean ± SD. Single-incision laparoscopic surgery appendectomy resulted in more pain and longer operative times without improving short-term recovery or complications. Long-term body image and cosmetic appearance were excellent in both groups.

Umbilical laparoendoscopic urological surgery with a novel reusable device

Objective.The aims of this study were to present cumulative experience with umbilical laparoendoscopic urological surgery using a reusable device and to evaluate outcomes and complications in the first 100 patients. Material and methods. Patients undergoing umbilical surgery with the KeyPort system and DuoRotate instruments (Richard Wolf, Knittlingen, Germany) were evaluated prospectively. Demographic, intraoperative and postoperative data were assessed. Results.Between October 2011 and July 2012, 79 pelvic (66 radical prostatectomy, 10 radical cystectomy, one diverticulectomy, one bilateral orchiectomy, one ureter reimplantation) and 21 renal (seven radical nephrectomy, six partial nephrectomy, five nephroureterectomy, two pyeloplasty, one pyelolithotomy) surgeries were performed through the umbilicus using this platform. Follow-up was 56.7 ± 12.6 weeks (mean ± SD). Mean age was 64.3 ± 10.3 years, body mass index 29 ± 4.6 kg/m2, operative time 232 ± 106 min and estimated blood loss 260 ± 95 ml. Conversion to standard multiport laparoscopy was not necessary. An accessory port was used in 87 cases to facilitate suturing and conduct drainage extraction. Postoperative complications occurred in 24 cases (six Clavien grade I, 12 grade II, one grade IIIa, two grade IIIb, two grade IVa, one grade IVb). Mean hospital stay was 4.2 ± 4 days. Total transfusion rate was 10%. Mean visual analogue pain scale at day 2 was 2.1 ± 1.3 (0–10). Visual analogue wound satisfaction scale at month 1 was 9.2 ± 0.6 (0–10). No cancer-related events occurred during follow-up. Late complications (4%) were not related to the surgical approach. Conclusions.Umbilical KeyPort surgery is technically feasible for a great variety of procedures, both ablative and reconstructive. This access offers adequate surgical outcomes, scarce postoperative pain and security for the patient in the short term. Its reusable nature implies a noticeable economic advantage.

Single-Site Laparoscopic Surgery for Inflammatory Bowel Disease

Background and Objectives:Single-site laparoscopic colorectal surgery has been firmly established; however, few reports addressing this technique in the inflammatory bowel disease population exist.Methods:We conducted a case-matched retrospective review of 20 patients who underwent single-site laparoscopic procedures for inflammatory bowel disease compared with 20 matched patients undergoing multiport laparoscopic procedures. Data regarding these patients were tabulated in the following categories: demographic characteristics, operative parameters, and perioperative outcomes.Results:A wide range of cases were completed: 9 ileocolic resections, 7 cases of proctocolectomy with end ileostomy or ileal pouch anal anastomosis, 2 cases of proctectomy with ileal pouch anal anastomosis, and 2 total abdominal colectomies with end ileostomy were all matched to equivalent multiport laparoscopic cases. No single-incision cases were converted to multiport laparoscopy, and 2 single-incision cases (10%) were converted to an open approach. For single-incision cases, the mean length of stay was 7.7 days, the mean time to oral intake was 3.3 days, and the mean period of intravenous analgesic use was 5.0 days. There were no statistically significant differences between single-site and multiport cases.Conclusions:Single-site laparoscopic surgery is technically feasible in inflammatory bowel disease. The length of stay and period of intravenous analgesic use (in days) appear to be higher than those in comparable series examining outcomes of single-site laparoscopic colorectal surgery, and the outcomes are comparable with those of multiport laparoscopy. This may be because of the nature of inflammatory bowel disease, limiting the benefits of a single-site approach in this population.

The voice of Holland: Dutch public and patient's opinion favours single-port laparoscopy.

INTRODUCTION:Single-port laparoscopy is prospected as the future of minimal invasive surgery. It is hypothesised to cause less post operative pain, with a shorter hospitalisation period and improved cosmetic results. Population- and patient-based opinion is important for the adaptation of new techniques. This study aimed to assess the opinion and perception of a healthy population and a patient population on single-port laparoscopy compared with conventional laparoscopy.MATERIALS AND METHODS:An anonymous 33-item questionnaire, describing conventional and single-port laparoscopy, was given to 101 patients and 104 healthy volunteers. The survey participants (median age 44 years; range 17-82 years) were asked questions about their personal situation and their expectations and perceptions of the two different surgical techniques; conventional multi-port laparoscopy and single-port laparoscopy.RESULTS:A total of 72% of the participants had never heard of single-port laparoscopy before. The most important concern in both groups was the risk of surgical complications. When complication risks remain similar, 80% prefers single-port laparoscopy to conventional laparoscopy. When the risk of complications increases from 1% to 10%, 43% of all participants prefer single-port laparoscopy. A total of 70% of the participants are prepared to receive treatment in another hospital if single-port surgery is not performed in their hometown hospital. The preference for single-port approach was higher in the female population.CONCLUSION:Although cure and safety remain the main concerns, the population and patients group have a favourable perception of single-port surgery. The impact of public opinion and patient perception towards innovative techniques is undeniable. If the safety of the two different procedures is similar, this study shows a positive attitude of both participant groups in favour of single-port laparoscopy. However, solid scientific proof for the safety and feasibility of this new surgical technique needs to be obtained before this procedure can be implemented into everyday practice.