Single-incision Laparoscopic Procedures Research Articles

Transumbilical laparoscopy-assisted Malone procedure for fecal incontinence in children

Transumbilical laparoscopy-assisted Malone procedure (TULAM) is a single-incision laparoscopic procedure in which the appendicostomy is made at umbilicus. The aim of this study is to evaluate the outcomes of TULAM. With IRB approval, the medical records of the patients who underwent TULAM were retrospectively reviewed between July 2013 and December 2018. The data collected included ages, gender, underlying diseases, operative techniques, complications, stoma continence, parental satisfaction and follow-up duration. Fifteen patients underwent TULAM at the median age of 5.0 years (2.9-10.7 years). There were 4 girls and 11 boys. Thirteen patients had anorectal malformations or cloaca; the other two patients had spina bifida. All patients presented with fecal incontinence; 9 of them had concomitant constipation. TULAM was successfully accomplished in 14 patients; one patient required conversion to the three-port procedure. The median follow-up period was 1.7 years (0.5-3.2 years). One patient required tube replacement under endoscopy guidance in the operation room. One patient required surgical revision because the appendix was disrupted after an episode of enterocolitis. All patients were socially continent with antegrade enemas. 12 patients were stoma continent, and 3 patients had minor leaking less than once a month. The stoma cosmesis was satisfactory. All parents expressed satisfaction with TULAM. TULAM is effective in the management of fecal incontinence and constipation, and provides a continent stoma with excellent cosmesis.

Comparison of Clinical Outcomes of Single-Incision Versus Conventional Multiport Laparoscopic Distal Pancreatectomy: A Single Institution Experience.

Objectives:Single-incision laparoscopic procedures have been gaining popularity in recent years due to their minimal incisional morbidity and improved cosmetic outcomes. Herein, we will compare the feasibility and outcomes of single-incision and conventional multiport laparoscopic distal pancreatectomy.Methods:This study involves consecutive patients who underwent either single-incision or conventional multiport laparoscopic distal pancreatectomy from March 2007 to February 2014. The patients were divided into two groups, based on the surgical approach: single-incision laparoscopic surgery (Group 1) and conventional multiport laparoscopic surgery (Group 2). The parameters evaluated included estimated blood loss, operative time, postoperative pain, duration of hospital stay, complications, conversion, and final pathology.Results:There were a total of 20 patients, 10 in each study group. Baseline characteristics were similar, and there was no mortality in either of the groups. The low-flow pancreatic fistula was the most commonly seen morbidity, but it was ceased spontaneously in each group by a ratio of 30%. The operative time was significantly shorter in Group 2, with a mean of 116 minutes versus a mean of 180 minutes for Group 1 (p<0.001). One of the procedures in Group 2 was converted to open surgery due to peroperative bleeding. The median follow-up periods of the patients were 22 months and 56 months. The spleen was preserved in only 1 patient from Group 1, whereas in Group 2, the spleen preservation was achieved in 5 patients.Conclusion:The single-incision laparoscopic technique is a safe and effective alternative to standard laparoscopic distal pancreatectomy.

Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION).

Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive. We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals(CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size. Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p=0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive. Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.

Differences in mental workload between traditional and single-incision laparoscopic procedures measured with a secondary task

IntroThe mental workload associated with laparoscopic suturing can be assessed with a secondary task that requires the same visual-spatial attentional resources. The purpose of this study was to use a secondary task to measure the incremental workload demands of single-incision laparoscopic surgery (SILS) procedures versus traditional laparoscopic procedures. Method12 surgery residents and surgical assistants who had met FLS criteria on an FLS and SILS simulator performed one trial each of peg transfer, cutting, and intracorporeal suturing tasks simultaneously with the secondary task and provided subjective workload ratings using the NASA-TLX. ResultsSILS procedures resulted in lower primary and secondary task scores, p < 0.001 and higher workload ratings, p < 0.0001. Suturing resulted in lower primary (p < 0.003) and secondary task scores (p < 0.017) and higher workload ratings (p < 0.017) compared to the other tasks. ConclusionsSILS procedures were significantly more mentally demanding than traditional laparoscopic procedures corroborated by primary and secondary tasks scores and subjective ratings.

Design and Implementation of a Less Invasive Gastrostimulator.

Gastrointestinal stimulator implants have recently shown positive results in helping obese patients lose weight. However, to place the implant, the patient currently needs to undergo an invasive surgical procedure. Our team is aiming for a less invasive procedure to stimulate the stomach with a gastrostimulator. Attempts covered fully endoscopic implantation and, more recently, we have focussed on a single incision laparoscopic procedure. Whatever the chosen implantation solution, the electronic design of the implant system shares many challenges. This paper covers the work achieved to meet these.

Laparoscopic Splenectomy and Azygoportal Disconnection: a Systematic Review.

Background and Objectives:Given the technical difficulty of laparoscopic splenectomy and azygoportal disconnection (LSD), data are limited that compare the laparoscopic to the open procedure. As the technique becomes more widespread, questions regarding its safety, feasibility, and reproducibility must be addressed. This review assesses the current status of LSD.Methods:We conducted our literature review with a search of the PubMed database. All published series of 5 or more laparoscopic splenectomy and azygoportal disconnection procedures were examined. The demographic, intraoperative, and postoperative data analyzed included number of ports, conversion rate, operative duration, estimated intraoperative blood loss, postoperative hospital stay, and complications.Results:Fifteen articles met the review criteria. Of 412 laparoscopic procedures, traditional laparoscopic splenectomy and azygoportal disconnection (TLSD) was used in 322 patients (78.2%), a modified laparoscopic procedure (MLSD) in 79 (19.2%), and a single-incision laparoscopic procedure (SLSD) in 11 (2.7%). Compared with the traditional and single-incision laparoscopic procedures, the MLSD procedure was associated with shorter operative duration and less blood loss. Furthermore, although the incidence of postoperative portal vein system thrombosis was higher in the laparoscopic than in the open splenectomy with azygoportal disconnection (OSD) procedure, the LSD procedure was associated with less pulmonary infection and pleural effusion and fewer incisional and overall complications than the open procedure. The rate of conversion to an open procedure was 5.4%.Conclusions:LSD is feasible and safe for selected patients when performed by an expert laparoscopic surgeon. It has perioperative advantages over OSD, but studies with longer follow-up periods and larger samples of patients are needed.

Single-incision Laparoscopic Surgery for Stage IV Colon Cancer

: The safety and efficacy of single-incision laparoscopic resections for patients with stage IV colorectal cancer have not been examined explicitly. This article describes our experience with single-incision laparoscopic procedures for patients with stage IV colorectal cancer. Seventy-seven patients who underwent single-incision laparoscopic colectomy between August 2010 and January 2012 were investigated retrospectively. Eleven patients were in clinical stage IV (ST4 group) and were compared with 66 patients in clinical stages 0 to III (control group). There were no differences in the intraoperative and the postoperative complications, the 30-day mortality rate, the number of the lymph nodes harvested, and the duration of postoperative hospital stay between the 2 groups. Our initial experiences suggested that single-incision laparoscopic colectomy is feasible for stage IV colon cancer patients. This is a good start comparing the outcomes of single-incision colectomy in stage IV patients with open and traditional laparoscopic colectomy.

Immersive training: breaking the bubble and measuring the heat

Minimal access surgery and, lately, single-incision laparoscopic procedures are challenging and demanding with regard to the skills of the surgeon performing the procedures. This article presents the results of an investigation of the performance and attention focus of 21 medical interns and surgical residents training in an immersive context. That is, training 'in situation', representing more realistically the demands imposed on the surgeons during minimal access surgery. Twenty-one medical interns and surgical residents participated in simulation trainings in an integrated operating room for laparoscopic surgery. Various physiological measures of body heat expenditure were gathered as indicators of mental strain and attention focus. The results of the Mann-Whitney test indicated that participants with a poor performance in the two laparoscopic cholecystectomy cases had a significantly (U = 3, p = 0.038) higher heat flux at the start of the procedure (mean 107.08, standard deviation [SD] 24.34) than those who excelled in the two cases (mean 62.64, SD 23.41). Also, the average frontal head temperature of the participants who failed at the task was significantly lower (mean 33.27, SD 0.52) than those who performed well (mean 33.92, SD 0.27). Surgeons cannot operate in a bubble; thus, they should not be trained in one. Combining heat flux and frontal head temperature could be a good measure of deep involvement and attentional focus during performance of simulated surgical tasks.

Wound Complications in 1145 Consecutive Transumbilical Single-Incision Laparoscopic Procedures

To evaluate the wound complication rate in patients undergoing transumbilical single-incision laparoscopic (SIL) surgery. SIL surgery claims to be less invasive than conventional laparoscopy. Small SIL series have raised concerns toward a higher wound complication rate related to the transumbilical incision. In a 44-month period, 1145 consecutive SIL procedures were included. The outcomes were assessed according to the intention-to-treat analysis principle. All procedures were followed for a minimum of 6 months postoperatively, and wound complications were recorded as bleeding, infection (superficial/deep), or hernia. Patients were classified as having a wound complication or not. For all comparisons, significance level was set at P<0.05. Pure transumbilical SIL surgery was completed in 92.84%, and additional trocars were used in 7.16%. After a median follow-up of 22.1 (range, 7.67-41.11) months, 29 wound complications (2.53%) had occurred [bleeding 0%/infection 1.05% (superficial 0.9%/deep 0.17%)/early-onset hernia 0.09%/late-onset hernia 1.40%, respectively]. Factors associated with complications were higher patient body mass index (28.16±4.73 vs 26.40±4.68 kg/m; P=0.029), longer skin incisions (3.77±1.62 vs 2.96±1.06 cm; P=0.012), and multiport SIL versus single-port SIL (8.47% vs 2.38%; P=0.019) in complicated versus uncomplicated procedures. Furthermore, a learning curve effect was noted after 500 procedures (P=0.015). With transumbilical SIL surgery, the incidence of wound complications is acceptable low and is further reduced once the learning curve has been passed.

Management of benign ovarian cysts by a novel, gasless, single-incision laparoscopic technique: keyless abdominal rope-lifting surgery (KARS)

To find the most efficacious method to minimize the side effects and maximize the advantages of laparoscopic surgery, this study aimed to define and document a gasless, single-incision abdominal access technique for the management of benign ovarian cysts. During a 1½ year period, 55 women underwent surgery for a benign ovarian cyst. Conventional carbon dioxide (CO(2)) laparoscopy was used for 33 of the women, and 22 of the women underwent a novel, gasless, single-incision laparoscopic surgery. An abdominal access pathway through a single intraabdominal incision was used to place transabdominal sutures that elevated the abdominal wall, and the operations were performed through the intra-umbilical entry without the use of trocars. Thus, the new technique was called keyless abdominal rope-lifting surgery (KARS). Two operative groups were compared to assess the feasibility of the new technique. All the operations could be performed by KARS without conversion to CO(2) laparoscopy or laparotomy. However, for two patients in the conventional laparoscopy group, minilaparotomy had to be performed for tissue retrieval. Although the two techniques had many similar results, the total operative times and the abdominal access times in the KARS group were significantly longer than in the conventional laparoscopy group (p < 0.05). Simple oral analgesics were adequate for postoperative pain relief in both groups. The KARS technique is a gasless, single-incision laparoscopic procedure that can be performed safely and effectively in terms of cosmesis, postoperative pain, and fertility preservation for the management of benign adnexal pathologies.

Magnetic instrumentation and other applications of magnets in NOTES.

Modern surgery is developing towards a minimally invasive approach. To minimize the trauma the number of ports is either limited as in single incision laparoscopic procedures or ports are introduced through natural orifices as in natural orifice translumenal endoscopic surgery (NOTES). To provide surgeons with appropriate instrumentation novel technologies are employed involving magnets. This article summarizes the theoretical background, technology and currently developed magnetic instrumentation for NOTES, laparoscopic surgery and endoscopy. Moreover, current limitations and future goals are addressed to outline the prospects for use of magnetic instrumentation in the surgery of tomorrow.

Single-Incision Laparoscopic Hepatectomy

Single-incision laparoscopic procedures are reported to be accessible comprehensively for abdominal surgeries. Herein, we report 1 case of partial hepatectomy in which the single-incision laparoscopic surgery (SILS) technique or the laparoendoscopic single-site surgery was conducted. One 53-year-old woman diagnosed with hepatic multicystis (the largest one had a diameter of 5 cm) underwent single-incision laparoscopic partial hepatectomy on January 1, 2010. The entire procedure was completed in 105 minutes without any complications. The patient went out of bed for mobilization 8 hours after surgery and was discharged on the fifth postoperative day. Single-incision laparoscopic procedures are available for many abdominal surgeries, whereas trials reported to perform partial hepatectomy using SILS are fewer. Therefore, our success in the case of partial hepatectomy by SILS provides another optional approach to liver surgeries.

Single-Incision Laparoscopic Takedown of a Hartmann's Colostomy

This video describes the steps necessary to perform single-incision laparoscopic (SIL) takedown of a Hartmann's colostomy. The SIL approach seems particularly suited for this procedure, because an incision of at least 3 cm is usually created around the end colostomy. Because of this, there is less limitation of instrument mobility than standard SIL procedures such as cholecystectomy, which is usually done through an incision of less than 2 cm. Nonetheless, because of the larger incision required, a gelport is probably required to create a seal so that pneumoperitoneum can be obtained. The benefits of SIL Hartmann Takedown include avoidance of repeat exploratory laparotomy; as a result, larger studies may show decreased length of hospital stay and earlier return to work. No competing financial interests exist. Runtime of video: 6 mins

Early Experience with Laparoendoscopic Single-Site Surgery in the Pediatric Urology Patient Population

To present our initial experience with single-incision laparoscopy in the pediatric urologic population. Four patients underwent eight single-incision laparoscopic procedures. One patient underwent bilateral nephrectomies, a hernia repair, and an orchiectomy. The remaining three patients underwent unilateral nephrectomies. All procedures were performed in children using the Covidien SILS port system via an umbilical incision. Procedures in three of four patients, representing seven of eight cases, were successfully performed via a single incision. Operative times ranged from 114 minutes to 360 minutes. There were no conversions to traditional laparoscopy. One nephrectomy was converted to an open procedure secondary to bleeding. There were no complications postoperatively, and at follow-up, all wounds were well healed. Single-incision laparoscopic urologic surgery is safe and feasible in the pediatric population. The umbilical (trans or peri) approach confers improved cosmesis over traditional laparoscopy, and the scar is essentially concealed.