Single-incision Laparoscopic Approach Research Articles

Efficacy of Laparoscopic Management of Posterior Urethral Diverticulum in Anorectal Malformations

BackgroundA posterior urethral diverticulum (PUD) is a serious postoperative complication after anorectal malformation correction. Complete resection is technical demanding because of limited retrourethral working space deep in the pelvis. ObjectiveWe pioneered the single-incision laparoscopic approach for PUD excision and evaluated the efficacy. Design, setting, and participantsTwenty-six PUD patients undergoing redo surgeries between June 2011 and June 2021 were reviewed. Surgical procedureA series of transabdominal retraction sutures were placed through the PUD to facilitate dissection. The contents were evacuated to create a working space. Distal PUD dissection was carried along the submucosal layer to prevent injury of the urethra/pelvic nerve complex. The rectal mucosa was peeled off from the junction site for complete PUD excision. The muscular cuff of the distal rectum was then oversewn. MeasurementsOperative time, postoperative recovery, and complications were assessed. Results and limitationsThe mean age of redo surgery was 2.46 yr. The average operative duration was 2.35 h. The mean postoperative hospital stay, resumption of full diet, and bowel movement were 10.23, 2.15, and 1.54 d, respectively. The median follow-up period was 46 mo (12–132 mo). No remnant of PUD, recurrent fistula, or urinary leak was detected. None of the patients had difficulty in urination, urinary dribbling, urinary tract infection, constipation, or soiling. All patients retained morning erection, and two postpubertal patients had ejaculations. ConclusionsOur single-incision laparoscopic redo surgery provides an effective approach for PUD excision. It minimizes complications. It also preserves urinary and bowel continence and sexual function. Patient summaryComplete resection of a posterior urethral diverticulum (PUD) in anorectal malformation is technically demanding because of limited retrourethral working space in the deep pelvis. The outcomes of single-incision laparoscopic PUD excision were satisfactory.

Single incision laparoscopic repair for late-onset congenital diaphragmatic hernia using oval-shaped multichannel port device (E•Z ACCESS oval type)-2months infantile case of Bochdalek hernia.

Late-onset congenital diaphragmatic hernia constitutes 10%-36% of congenital diaphragmatic hernias. They qualify for endoscopic treatment including both thoracoscopic and laparoscopic approaches because this type of patient is in relatively stable condition compared with neonatal cases. However, single incision laparoscopic approach has not been reported. We herein report an infantile case of late-presenting diaphragmatic hernia who underwent single incision laparoscopic repair using an oval-shaped multichannel port device. A 2 month old female infant had sudden onset dyspnea with cyanosis and was diagnosed as having left diaphragmatic hernia (Bochdalek hernia) by chest X-ray. As her respiratory condition became stable under conservative treatment using combination of decompression of the gastrointestinal tract and mild sedation, we electively planned laparoscopic repair. Preoperative enhanced computed tomography imaging found that herniated organs were stomach, spleen, pancreatic tail, small intestine and right colon. The patient also had an umbilical hernia, so we decided to perform single incision repair through this umbilical hernia. Three trocars were introduced using an oval-shaped multichannel port device and herniated organs were reduced by gentle manipulation. The defect of the diaphragm was closed by bi-hand needle driving for upper and lower limb using a stay suture. The umbilical hernia was also repaired. Postoperative course was uneventful and no recurrence was recognized. Wider trocar separation was achieved using the oval-shaped device, making the needle driving easier to perform. By using an oval-shaped multichannel port device and ingenuity of needle driving, single incision repair of infant diaphragmatic hernia was enabled.

Single-Incision Laparoscopic Approach, the New Trend in the Minimal Invasive Surgery - An Overview, Current Status and Correlation with Our Experience in Nobel Medical College Teaching Hospital

Introduction: The major purpose of the Minimal Access Surgery is to reduce the number and size of scars, decrease pain and rate of infections, reduce complications, and improve cosmetic effect. In order to achieve scarless surgery there was a development of the Natural Orifice Transluminal Endoscopic Surgery (NOTS), which did not gain popularity and induced growing interest to single-incision laparoscopy as a modern technique with minimal visible scars. 
 Objectives: The objective of this study is to correlate worldwide experience with outcomes of Single-Incision Laparoscopic Surgery (SILS) in our institute. 
 Methodology: A retrospective analysis was done for 9141 patients who underwent Laparo-endoscopic single-site surgery between the year 2011-2020 years (AD). The type of surgery, gender, age, operative time, conversion and complication rate were reported. 
 Results: Laparo-endoscopic single-site surgery was performed for 9141 patients, with a mean age of 46.3 years (range=2.5- 90). Out of 9141 patients included in this study, 8668 patients underwent Cholecystectomy, 232 underwent simultaneous, 161 appendectomy, 54 ovarian cystectomy, 11 underwent myomectomy, 8 diagnostic laparoscopy and 7 cases of salpingo-oophorectomy. The mean operating time was 19.5 minutes (range=4-35 min). In our study complicated cases were 0.996%, conversion done for 0.1% and mortality was 0.02%. 
 Conclusion: The advantages of single access surgery include better cosmetic effect, reduced bleeding, infections, herniations and hospital stay.

Laparoscopic-guided versus transincisional rectus sheath block for pediatric single-incision laparoscopic cholecystectomy: A randomized controlled trial

PurposeThe purpose of our study was to compare the effectiveness of transincisional (TI) versus laparoscopic-guided (LG) rectus sheath block (RSB) for pain control following pediatric single-incision laparoscopic cholecystectomy (SILC). MethodsForty-eight patients 10–21 years old presenting to a single institution for SILC from 2015 to 2018 were randomized to TI or LG RSB. Apart from RSB technique, perioperative care protocols were identical between groups. Pain scores were assessed with validated measures upon arrival in the postanesthesia care unit (PACU) and at regular intervals until discharge. The patients and those assessing them were blinded to RSB technique. The primary outcome was pain score 60 min after PACU arrival. Secondary outcomes included pain scores throughout the PACU stay, opioids (reported as morphine milligram equivalents (MME) per kg bodyweight) administered in PACU, length of stay, outpatient pain scores and opioid use, and adverse events. Groups were compared on outcomes using t test and generalized estimating equations for continuous variables and Fisher's exact test for categorical variables with significance at α = 0.05. ResultsMean age of the 48 subjects was 15 years (range = 11–20). The majority (79%) were female. Indications for surgery included symptomatic cholelithiasis (n = 41), acute cholecystitis (n = 4), gallstone pancreatitis (n = 2) and choledocholithiasis (n = 1). Mean (standard deviation) operative time was 61 (±23) min overall. No statistically significant differences in demographics, indication, operative time, or intraoperative analgesia were observed between TI (n = 24) and LG (n = 24) groups. The mean 60-min pain score was 3.4 (±2.6) in the LG group versus 3.8 (±2.1) in the TI group (p = 0.573). No significant differences were detected between groups in overall PACU or outpatient pain scores, PACU or outpatient opioid use, length of stay, or incidence of complications. Overall, mean opioid use was 0.1 MME/kg in the PACU and 0.5 MME/kg in the outpatient setting. Mean postoperative length of stay was 0.2 day. There were no major complications. ConclusionLaparoscopic-guided rectus sheath block is not superior to transincisional rectus sheath block for pain control following pediatric single-incision laparoscopic cholecystectomy. The single-incision laparoscopic approach combined with rectus sheath block resulted in effective pain control, low opioid use, and expedited length of stay with no major complications. Level of evidenceLevel I, treatment study, randomized controlled trial.

Intrahepatic Glissonian approach for single-port laparoscopic left lateral sectionectomy

Background: In the last few years, a novel technique using single-incision laparoscopic approach has been described. There are few reports on single-port liver resection in the literature. The aim of this video is to present a single-port laparoscopic left lateral sectionectomy with intrahepatic Glissonian approach. Methods: A 27 year-old woman with a 6-cm hepatocellular adenoma is referred for surgical treatment. Liver resection is advised and a single-port laparoscopic liver resection using intrahepatic Glissonian approach is proposed. The patient was informed about the advantages and risks of the technique, and she gave consent for its use. A transumbilical incision is performed, and a single-incision platform is introduced. The operation begins with ultrasound examination of the liver. Intrahepatic Glissonian access of the portal pedicle from segments 2 and 3 is performed, and the pedicle is divided with a stapler. The liver is transected, and the left hepatic vein is divided with a stapler. A surgical specimen is retrieved through the single umbilical incision. No drains are left in place. Results: Operative time was 90 minutes and there was minimal bleeding. Recovery was uneventful and patient was discharged on the first postoperative day. Final pathology showed hepatocellular adenoma with no signs of malignancy. Conclusion: Single-port laparoscopic left lateral sectionectomy is feasible and can be safely performed in specialized centers. Intrahepatic approach is a useful tool to control the Glissonian pedicle.

Single-incision laparoscopic approach for linea alba hernia in children.

Objective:The aim of this study is to describe the technique and to evaluate the outcome of single-incision laparoscopic (SILC) approach for linea alba hernia in children.Materials and Methods:A 2 cm vertical umbilical incision was made and stretched horizontally. A 5-mm trocar was inserted through middle port for the telescope. Another extra-long 5-mm 30° trocar was inserted through the lateral port, 5 mm beside the middle port. The extraperitoneal fat was removed, and the defect of linea alba was repaired after hernial sac was excised. The peritoneum was reconstructed with interrupted suture.Results:From May 2014 to May 2015, eight children with linea alba hernia underwent SILC. Pre-operative abdominal ultrasound showed the average diameter of hernia ring was 3.2 ± 0.7 cm. Mean operation time was 32.5 min (range = 30–45 min). Oral intake was resumed during anaesthesia recovery period. All could endure pain and discharge on the post-operative 12 h. There was no post-operative wound infection. The follow-up period was 1–12 months, no recurrence and other complications occurred.Conclusions:SILC approach for linea alba hernia is a safe and effective, minimally invasive new technology. The linea alba hernia could be repaired with a cosmetic outcome.

Single incision laparoscopic approach to inflammatory bowel diseases: Not only a technical detail

Introduction: Patients affected by chronic inflammatory bowel diseases (IBD) may require numerous surgical procedures during lifetime. The Single Incision Laparoscopic technique (SILS) is the ultimate challenge and a further step compared to conventional video assisted therapies. We report our recent experience with the application of SILS technique in IBD patients.

Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique.

Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II. Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient. Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5±65.5min. The stone clearance rate was 100%. The postoperative length of hospital stay was 5.1±2.2days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2%) and one superficial wound infection (9.1%). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1months. LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.

High rectal tumor resection using single-incision laparoscopic approach (with video)

High rectal tumor resection using single-incision laparoscopic approach (with video)

Laparoscopic Distal Pancreatectomy Using Single-Port Platform: Technique, Safety, and Feasibility in a Clinical Case Series

A novel technique using a single-incision laparoscopic approach has been described for several laparoscopic procedures. The aim of this article is to describe our experience with an alternative technique for laparoscopic distal pancreatectomies using a single-port platform. We have performed this procedure on 20 patients with pancreatic tumors in the pancreatic body or tail. A transumbilical incision is performed, and a single-incision platform is introduced. The stomach is sutured to the abdominal wall to expose the pancreas. This technique uses an additional 5-mm trocar in the left quadrant, ultimately used for drainage after the end of the procedure. The median operative time was 176 minutes, and the hospital stay was 2 days. Mortality was 0%, and morbidity was 20%; 4 patients developed grade A pancreatic fistula. During follow-up (median, 11 months), no patient developed an incisional hernia. The cosmetic appearance of the incision was excellent in all cases. Laparoscopic distal pancreatectomy using a single-port platform is feasible and can be successfully performed by surgeons with experience in pancreatic and advanced laparoscopic surgery.

Single-incision laparoscopic surgery for colon cancer in patient with situs inversus totalis: report of a case.

A preliminary experience with single-incision laparoscopic colectomy for colon cancer with situs inversus totalis (SIT) is reported. An 87-year-old man was admitted because of a fecal occult blood. A colonoscopy revealed cecal cancer. An air-barium and a computed tomography contrast enema showed the right-sided descending colon and the left-sided ascending colon and cecum. The surgical procedures were as follows: First, a Lap protector was inserted through a 2.5-cm transumbilical incision. Three 5-mm ports were placed in the Lap protector. We successfully performed ileocolectomy with lymph node dissection by using a single-incision laparoscopic approach without any technical problems. The operative time was 125min, and blood loss was negligible. Postoperative follow-up did not reveal any umbilical wound complications and recurrences.

Single-Incision Laparoscopic Ladd's Procedure for Intestinal Malrotation

The potential of single-incision laparoscopic surgery (SILS) as a less invasive and more cosmetically appealing technique has prompted the expansion of its adoption. SILS has been shown to be a safe and feasible alternative to traditional multiport cholecystectomy, appendectomy, colectomy, and many other laparoscopic procedures. The objective of this study is to provide an initial report of the feasibility of correcting intestinal malrotation via a single-incision laparoscopic transumbilical approach. A 29-year-old woman presented with symptomatic congenital intestinal malrotation. She elected to undergo a Ladd's procedure using a single-incision laparoscopic approach with a SILS port and standard laparoscopic instruments. The procedure was accomplished without additional ports or conversion to laparotomy, and no intraoperative or postoperative complications were noted. Total operative time was 106 minutes. The patient had minimal postoperative pain and was satisfied with the cosmetic outcome. When performed by a surgeon experienced in the SILS technique, single-incision laparoscopic Ladd's procedure for symptomatic intestinal malrotation in an adult is feasible and safe, with minimal postoperative pain and favorable cosmetic outcome.

A Ruptured Left Gastroepiploic Artery Aneurysm Successfully Treated with a Single-incision Laparoscopic Approach: A Case Report

A Ruptured Left Gastroepiploic Artery Aneurysm Successfully Treated with a Single-incision Laparoscopic Approach: A Case Report

Single‐incision laparoscopic hepatic resection in patients with previous hepatic resections: A mini case series

Single-incision laparoscopic hepatic resection has been attracting increased attention from the surgical community in recent years. While there have been reports and studies on this procedure, none has suggested the possibility of doing repeated hepatic resections via a single incision. This report on three such cases aims to determine the feasibility and safety of this approach for such patients. Three patients who had previously had liver resections underwent single-incision laparoscopic hepatic resection in our center. Patient demographics, type of port and instruments used, operating time, complications and incision length were collected. The operating time in each case was less than 230 min. The incision length for the single-port device was 3.5 cm or less. The length of hospital stay was less than 5 days in each case. Intra-operative blood loss was limited to 250 mL in each case. There were no immediate postoperative complications related to hepatic resection. Single-incision laparoscopic hepatic resection is feasible for selected patients who have had previous hepatic resections. Because the port entry site for the single-incision laparoscopic approach is usually slightly larger than that for the conventional approach, it is safer in re-resection cases where there may be adhesions from previous surgery. Other possible benefits, such as cosmesis and reduced port-associated morbidity, are mainly related to the use of only one small incision.

FIRST SINGLE-PORT LAPAROSCOPIC PANCREATECTOMY IN BRAZIL

Pancreatic surgery is an extremely challenging field, and the management of pancreatic diseases continues to evolve. In the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique with a single-incision laparoscopic approach has been described for several laparoscopic procedures. We present a single-port laparoscopic spleen-preserving distal pancreatectomy. To our knowledge, this is the first single-port pancreatic resection in Brazil and Latin America. A 33-year-old woman with neuroendocrine tumor underwent spleen-preserving distal pancreatectomy via single-port approach. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector was used. Operative time was 174 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Single-port laparoscopic spleen-preserving distal pancreatectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

Hepatectomia laparoscópica com portal único: experiência pioneira no Brasil

Since the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the laparoscopic ports . A novel technique with a single-incision laparoscopic approach has been recently described. To describe the single-port technique for laparoscopic liver resection. A transumbilical 3-cm skin incision is performed and a single-incision advanced access platform is introduced. Operation began with exploration of the abdominal cavity and ultrasound examination of the liver. Intrahepatic Glissonian access for retrieval of portal pedicles from segments 2 and 3 is performed. Vascular endoscopic stapler is used to divide segments 2 and 3 Glissonian pedicle. Liver is transected with harmonic scalpel and left hepatic vein is divided with stapler. Procedure is completed. Surgical specimen is retrieved through the single umbilical incision. No drains are left in place. Single port laparoscopic left lateral segmentectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

Patient Scar Assessment After Single-Incision Versus Four-Port Laparoscopic Cholecystectomy: Long-Term Follow-Up from a Prospective Randomized Trial

The single-incision laparoscopic approach for cholecystectomy has been reported to be cosmetically superior in the traditional four-port technique in several case series; however, prospective comparative data are lacking. We conducted a 60-patient, prospective, randomized trial comparing single-incision laparoscopic cholecystectomy with standard four-port cholecystectomy, including validated scar assessment evaluation around 6 weeks and 18 months after the operation in an effort to determine if a cosmetic advantage existed. Patients over 12 years of age and parents of patients under 12 years of age enrolled in the trial were asked to complete the validated Patient Scar Assessment Questionnaire (PSAQ). The PSAQ consists of four subscales: Appearance, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms. The Symptoms subscale is omitted from analysis per PSAQ instructions because of insufficient reliability. Each subscale is a set of items with 4-point categorical responses (from 1=most favorable to 4=least favorable). The sum of the questions quantifies each subscale. Data are expressed as mean±standard deviation values. Eighteen single-site patients and 8 four-port patients completed early questionnaires, in which there was no difference in overall scar assessment (P=.17). Telephone follow-up was accomplished for 17 single-site patients and 24 four-port patients and revealed that the overall scar assessment significantly favored the single-site approach (P=.04). Patients or parents of patients do not identify an overall superior scar assessment at early follow-up after single-site laparoscopic versus four-port cholecystectomy. However, they do perceive a superior scar assessment at long-term follow-up, suggesting that there is a cosmetic benefit favoring the single-site approach.

Single-incision laparoscopic resection of ovarian masses in children: a preliminary report

Ovarian masses in the pediatric population are commonly resected with a three or four port laparoscopic approach. Single-incision laparoscopic (SIL) resection is an alternative approach. However, there is limited experience with this modality in ovarian mass resection. We reviewed SIL ovarian mass resections performed by our group from 2010 to 2012. We evaluated patient demographics, surgery statistics, and hospital course. Six patients were identified with mean age of 14years. Imaging studies showed cystic masses ranging 4-6cm in five patients, and 20cm in one patient. One patient presented with recurrent teratoma. Pathology revealed four benign teratomas, one benign cyst, and one serous cystadenoma. Average operating time was 75min. All patients had an ovarian-preserving resection. Three patients had cyst spillage, including the one who presented with recurrence (this was the only patient with a subsequent recurrence). Hospital stay averaged 37h. Narcotic use averaged 9.9mg of morphine daily. All patients had excellent cosmetic results, and no postoperative complications. Ovarian cystic mass excision using the SIL approach carries a higher risk of tumor spillage. Although the incidence of malignancy is low, they cannot be conclusively excluded with our current preoperative evaluations. At this time, we recommend SIL resection only for simple cysts with low malignant potential; however, further experience with this procedure will likely improve the risk of tumor spillage in the future.

Use of the SAND balloon catheter in single‐incision laparoscopic cholecystectomy for acute cholecystitis

SILS for acute cholecystitis is technically challenging because of the difficulties in obtaining optical surgical field. A 2-cm incision was made through the umbilicus, a single port and trocars were introduced, and the abdomen was then insufflated. A 5-mm SAND balloon punctured the abdominal wall and then the gallbladder wall. The distal and proximal balloons were inflated to prevent bile leakage, and the bile was aspirated. The collapsed gallbladder was then retracted cephalad, the critical structures were exposed, and the cystic artery and duct were divided. The gallbladder was dissected and removed through the umbilicus, and the abdomen was closed. We performed this procedure in three cases with acute cholecystitis. Operative times were 95, 133 and 244 min, blood loss was 5, 10 and 43 mL, and postoperative hospital stay was 2, 2 and 3 days, respectively. The single-incision laparoscopic approach with the SAND balloon is a feasible technique for acute cholecystitis.

Single Incision Supracervical Hysterectomy with Resection of a Pararectal Space Mass

There was noted to be an undiagnosed cystic pararectal space mass noted at time of scheduled single incision supracervical hysterectomy. This is video illustrates our management of the mass. The patient's history was significant for a uterine artery embolization. The mass was determined to be a degenerated fibroid. The mass was successfully resected with the single incision laparoscopic approach without complications.