Single-incision Laparoscopic Surgery Research Articles

Stiffness modulation in a 3-DoF pneumatic soft actuator for single-port transvesical prostatectomies

Abstract Soft actuators have demonstrated potential in minimally invasive surgery (MIS), requiring multiple degrees of freedom and stiffness modulation facilitated by pneumatic antagonistic chambers. However, the hollow central passage in these actuators for single-port surgery complicates the internal stress distribution during the inflation of multiple chambers, making stiffness modulation mechanisms difficult to understand. In this study, a finite element analysis model is developed to explore the combined effect of the internal stress distribution and duct structure on the stiffness modulation in soft actuators equipped with multiple pneumatic antagonistic chambers. A prototype is developed to cross-validate the simulation and examine the effects of various antagonistic chambers on the stiffness modulation. The findings confirm that inflating specific chambers alters the internal stress distribution of the actuator by creating bending moments that influence deformation responses to external loads. These moments impact the stiffness and structure of the hollow central duct by modifying its geometrical moment of inertia and affecting the lengths of the tensile and compressive regions during bending, further influencing the stiffness. The effects of bending moments and the geometrical moment of inertia on stiffness modulation vary across different actuator sections owing to the varying lengths of the tensile and compressive regions during bending. These stiffness modulations affect the tip bending, force, and response time. The study findings provide insights into the mechanism of stiffness modulation for the design of soft actuators for complex MIS

Comparative Study of Complications and Incision Esthetic Satisfaction Between Single-Port Laparoscopy and Traditional Laparoscopy in Benign Gynecological Surgery

Objective Single-port laparoscopic surgery (SPLS) is an effective, minimally invasive, feasible, and promising surgical technique for the treatment of various benign and malignant gynecological diseases. This study aimed to evaluate the differences in surgical conditions, complications, and esthetic incisions between SPLS and traditional laparoscopic surgery (TLS) in benign gynecological surgeries. Methods Fifty-one eligible patients were included, and their general information (age, surgical approach), surgical conditions (surgical time, blood loss, postoperative first flatus), postoperative pain, and incision healing were collected. Results There was a significant difference in the results of hysterectomy between the two groups. The surgical time in the SPLS group was significantly shorter than that in the TLS group (p = 0.026). Furthermore, the SPLS group had less blood loss (p < 0.05) and earlier postoperative first flatus (p < 0.05) than the control group. There was no significant difference in postoperative conditions between the two groups. During the follow-up, it was found that the Vancouver Scar Scale score was 8.37 ± 2.30 in the control group and 6.81 ± 2.14 in the study group. The cosmetic effect and satisfaction were better in the SPLS group (p = 0.018). Subgroup analysis showed that in other benign gynecological diseases without uterine lesions, SPLS significantly improved surgical time, intraoperative blood loss, and postoperative first flatus (p < 0.05). Conclusion SPLS demonstrated good clinical efficacy in benign gynecological surgery, with shorter surgical time, less blood loss, earlier postoperative first flatus, fewer complications, and better cosmetic effects of scars.

Successful use of single-port laparoscopic surgery for ovarian cyst removal on postpartum day two after vaginal delivery.

This report describes a single-port laparoscopic approach for giant ovarian cystectomy tailored for postpartum patients. For asymptomatic giant ovarian cysts reaching full term, timely postpartum single-port laparoscopic surgery may confer benefits by utilizing physiological alterations to mitigate risks and enhance surgical outcomes.

Correlation between forceps grasp count and skill proficiency in single-incision laparoscopic percutaneous extraperitoneal closure: A retrospective single-center study.

This study aimed to investigate the correlation between forceps grasp count and procedure time in single-incision laparoscopic percutaneous extraperitoneal closure surgeries and the evolution of these metrics with accumulated experience. We retrospectively reviewed 741 procedures performed by surgeons between 2015 and 2023. Surgical videos were analyzed to calculate the procedure time, defined as the time required for suturing around the hernial orifice, and the forceps grasp count. Correlations were evaluated using Spearman's rank correlation coefficients. Changes in experience were assessed using linear regression. Surgeons demonstrated a significantly longer procedure time (585 s vs. 437 s, p < .001) and higher grasp counts (22 times vs. 17 times, p < .001) for surgeries performed on male patients than on female patients. Grasp count was strongly correlated with procedure time (male patients: r = .800; female patients: r = .758, p < .001). With accumulated experience, both procedure time and grasp count decreased, although novice surgeons showed delayed improvement in forceps manipulation compared with improvement in procedure time. Grasp count was strongly correlated with procedure time in single-incision laparoscopic percutaneous extraperitoneal closure. Accumulated experience improved both metrics, with novice surgeons possibly requiring more time to acquire efficient forceps manipulation skills. Efficient forceps manipulation is a valuable metric for evaluating surgical skills.

Innovative Single-Port Approach for Simultaneous Ventral Hernia Repair and Bariatric Surgery: A Retrospective Case Series Study (March 2020 - July 2023)

Background: This retrospective case series study explores the outcomes of single-port bariatric surgery (BS) with ventral hernia repair (VHR) in a simultaneous setting. Through a novel single-port laparoscopic approach, this research emphasizes on operative details, patient selection criteria, and the innovative nature of the technique when repairing ventral hernia in bariatric surgeries. Methods: The research was conducted from February 2021-February 2023 at Al-Noor Specialists Hospital, Makkah, Saudi Arabia. Six patients (5 females and 1 male) underwent simultaneous repair of ventral hernia alongside bariatric surgery through a single-port laparoscopic approach. Results: The study evaluates demographic data, pre-operative parameters, surgical approach, post-operative complications, and post-operative follow-up durations to provide comprehensive insights. Results show the average age of the respondents: 40.5 ± 9.44 years, with a mean BMI of 47 ± 8.25 kg/m2. At post-operative stage, the hospital stay was 48 hours for 50% patients with a mean follow-up duration; 13 ± 3.29 months. At post-surgery, the observed mean weight loss; 33.67 ± 6.66 kg, and the mean excess weight loss was 29.60 ± 5.30%. None of the post-operative complications were reported at the follow-up stage, except minimal seroma. Conclusion: The simultaneous single-port BS and VHR approach provides surgical benefits with lowered complication rates, surgical weight loss, and lesser recurrence of ventral hernia. Single-port bariatric laparoscopy is efficient in treating obese patients. However, further research must advocate for and establish long-term outcomes and broader application of this procedure.

Exploring the Potential of Robotic Single-Port Surgery for Gallbladder Cancer: Initial Insights and Future Prospects.

Robotic surgery has demonstrated outcomes comparable or superior to open and laparoscopic surgeries for extended cholecystectomy.1-8 Despite its advantages, the minimally invasive robotic single-port (SP) system remains underutilized in complex hepatobiliary pancreatic surgery due to instrument limitations and retraction issues.9,10 This study evaluated the feasibility, safety, and effectiveness of the da Vinci SP system in gallbladder cancer surgery. The study was approved by the Ethics Committee of OOO University Hospital (IRB no. DAUH IRB-24-081) and conducted in accordance with the principles of the Declaration of Helsinki. The requirement for informed consent was waived due to the study's retrospective design. A 62-year-old woman with a diagnosis of gallbladder cancer was referred for surgery. Preoperative computed tomography (CT) scans showed no evidence of metastasis (T2N0). Therefore, a robotic SP extended cholecystectomy was planned. Figure 1 shows a 30-mm SP port and a 1-mm assistant port inserted for the procedure. Due to the absence of an energy device for the liver wedge resection, Maryland bipolar forceps were used, mimicking the Kelly clamp crushing technique. A monopolar cautery hook was used for lymph node resection of stations 7, 8, 12, and 13 (Fig. 2). Fig. 1 Port placement for robotic extended cholecystectomy using the da Vinci Xi system Fig. 2 Demonstration of full lymph node dissection RESULTS: The total duration of the operation was 226 min, with an estimated blood loss of 200 ml. The CT scan on day 5 showed no abnormalities, and the patient was discharged routinely on day 7 (Fig. 3). The pathologic examination confirmed adenocarcinoma (T2a) with clear resection, and all six lymph nodes tested negative for malignancy. Fig. 3 The wound 2 weeks after surgery CONCLUSIONS: This study underscores the adequacy of robotic surgeries and emphasizes the potential of the da Vinci SP system in hepatobiliary surgery. Despite current challenges related to instrument limitations, the authors are confident that the SP system will evolve into a crucial asset for hepatobiliary surgical practices in the foreseeable future.

The impact of single-port robotic surgery: a survey among urology residents and fellows in the United States.

Our aim was to investigate the perception and future expectations of Single-Port (SP) surgery among urology trainees in the United States. A 34-item online survey was distributed to urological residency and fellowship programs across the US, covering demographic profiles, SP training opportunities, perceived educational impact, and future perspectives. Descriptive analysis and multivariable linear regression were used to assess predictors of SP adoption. 201 surveys were completed (28.6% completion rate). Among institutions with an SP platform, about 50% have used it regularly for over 2 years, though often in less than 50% of procedures. While robotic simulators are commonly available, only 17% offer both multi-port and SP simulators, and structured pre-clinical SP training is limited. Approximately 30% of respondents expressed concerns over limited hands-on experience and a steeper learning curve with SP. Around 40% felt that their robotic surgery exposure was negatively impacted by SP's introduction. SP surgery's benefits are seen mostly in the immediate post-operative period and a significant number of respondents foresee a major role for SP in urology. However, proficiency in SP surgery is not seen as crucial for career advancement or job opportunities. Academic job aspirations, SP platform availability, and SP surgery workload are predictors of future SP implementation. Trainees increasingly recognize the clinical benefits of SP procedures but express concerns about the potential negative impact on hands-on experience. Training programs should more systematically integrate SP technology into curricula. There is a correlation between training in high-volume SP centers and future SP adoption.

Evaluation of the da Vinci single-port system in colorectal cancer surgery: a scoping review.

Minimally invasive surgery for the treatment of colon and rectal cancer has gained popularity due to its association with reduced postoperative pain, shorter hospital stays, and quicker recovery. The Da Vinci Single-Port (SP) System combines single-port laparoscopy with robotic assistance. This scoping review aims to evaluate the safety and short-term postoperative outcomes of utilizing the Da Vinci SP platform in colorectal cancer surgery. A scoping review was conducted adhering to the PRISMA-ScR guidelines. Data were collected from PubMed, Embase, and the Web of Science Library as of December 22, 2023. Studies were screened and selected based on predefined criteria, focusing on the application of the SP robotic system in colorectal procedures. Data extraction included demographics, surgical details, intraoperative and postoperative outcomes. A narrative summary of the results was provided due to the heterogeneity in study designs. From an initial 2312 articles, 22 studies were selected for analysis, encompassing 465 patients undergoing robotic SP colorectal surgeries. Of these, 384 (82.6%) had a cancer diagnosis. The median age was 65years, with approximately 60% being male. The median operative time was 225min, with docking times averaging 12-20min. Conversion to multi-port laparoscopy occurred in 4.2% of cases, with no conversions to open surgery. Mean intraoperative blood loss ranged from 50 to 150ml. The mean number of lymph nodes retrieved ranged from 15 to 28. A diverting ileostomy was constructed in 20.3% of patients. Median times to flatus and soft diet were 2.5 and 3days, respectively, with hospital stays ranging from 3 to 11days. Perioperative complications occurred in 15.1% of patients, including wound infections (5.1%), anastomotic leakage (3.7%), and postoperative ileus (2.8%). Negative margin status (R0 resection) was achieved in 95% of cases. The Da Vinci SP robotic platform demonstrates promising safety and effectiveness in colorectal cancer surgery. It achieves high rates of successful oncological resection, adequate lymph node retrieval, and minimal intraoperative blood loss. Postoperative outcomes indicate quicker recovery times and manageable complication rates. However, longer follow-up studies are necessary to fully assess recurrence rates and long-term survival benefits associated with this innovative surgical approach.

Is single-port laparoscopy or vaginal natural orifice transluminal endoscopic surgery the better option for salpingo-oophorectomy?

To compare postoperative pain and recovery in patients undergoing oophorectomy with single-port laparoscopic surgery (SPLS) versus vaginal natural orifice transluminal endoscopic surgery (vNOTES). Patients who underwent salpingo-oophorectomy with SPLS or vNOTES between 2016 and 2023 were analyzed retrospectively. Oophorectomy was performed based on the presence of an adnexal mass or breast cancer susceptibility gene mutation. Fifty-two patients underwent oophorectomy with SPLS and 35 underwent vNOTES. Although the mean mass size was slightly larger in the SPLS group than in the vNOTES group (8.0 ± 4.1 vs. 6.8 ± 3.3 cm), the difference was not significant. There was no difference in operating times between SPLS and vNOTES. The mean visual analog scale and faces pain scale scores 2 and 6 h postoperatively were lower in the vNOTES group. The mean quality of recovery-40 (QoR-40) score was higher in the vNOTES group (156 ± 14 vs. 148 ± 11; p = 0.009). This analysis identified vNOTES as an independent predictor of a high QoR-40 score. The vNOTES group experienced less pain during the early postoperative period than the SPLS group. Although the operating and removal times were similar, the port setup time was longer for the vNOTES group.

Robot-Assisted Nerve-Sparing Eradication of Deep Endometriosis Using the da Vinci SP

ObjectiveThe evolution of nerve-sparing surgery has been supported by a growing body of literature on anatomic details, dissection techniques, and functional outcomes, suggesting that nerve-sparing surgery for deep endometriosis (DE) reduces postoperative pelvic organ dysfunction, including voiding and rectal dysfunction [1]. Recently, newer single-port robotic systems (da Vinci SP) have become available with articulating instruments and cameras that allow for intracorporeal triangulation, which may overcome some of the weaknesses of conventional single-port laparoscopic surgery [2]. Although such systems are believed to allow more complex surgeries than conventional single-port laparoscopic surgery, the scope of application remains unexplored. The objective of this video is therefore to demonstrate the anatomical and technical highlights of a complex intrapelvic procedure, nerve-sparing modified radical hysterectomy and complete removal of DE using the da Vinci SP (SP). SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 47-year-old woman who presented with chronic pelvic pain resistant to pharmacotherapy. Magnetic resonance imaging showed uterine adenomyosis and bilateral ovarian endometrioma with DE, involving the uterosacral ligament and surface of the rectum, with complete cul-de-sac obliteration. InterventionsThe surgical steps were completely identical to conventional multiport laparoscopic robotic surgery [3,4]. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. These advantages allow us to comfortably perform meticulous dissection and suturing even in difficult situations such as DE. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder or rectal dysfunction [5]. She was very satisfied with the invisible operative scar and low degree of postoperative pain. ConclusionNerve-sparing eradication of DE using SP is technically safe and feasible, with cosmetic advantages and less pain.

Comparison of different types of single-port laparoscopic surgery in posterior uterine fibroid resection

This study aims to objectively assess the effect of three surgical approaches for posterior uterine fibroid resection: transumbilical laparoendoscopic single-site surgery (LESS), vaginal natural orifice transluminal endoscopic surgery (vNOTES) in prone position (vNOTES-P), and vNOTES in the lithotomy position (vNOTES-L). A retrospective analysis was conducted on data pertaining to all patients who underwent vNOTES and LESS for single posterior fibroids at our institution from January 2023 to July 2023. Patients were categorized into three groups based on the surgical approach: vNOTES-P group (n = 30), vNOTES-L group (n = 17), and LESS group (n = 32). Comparative analysis was performed on the demographic characteristics and perioperative outcomes among the three groups of patients. All 79 patients underwent surgery without the need for conversion to laparotomy. There were no statistically significant differences among the LESS group, vNOTES-P group, and vNOTES-L group in terms of operative time, intraoperative blood loss, and perioperative complication rates. In the vNOTES-L group, two patients required conversion to LESS during surgery. Patients had faster return of bowel function (less time to flatus) in the vNOTES group compared to the LESS group (P < 0.05). However, three cases of postoperative infection occurred in the vNOTES group, while none were reported in the LESS group. Compared to LESS, vNOTES demonstrates significant advantages in alleviating postoperative pain, shortening time to passage of flatus, speeding recovery and enhancing cosmetic outcomes. Particularly, vNOTES-P for posterior uterine fibroid resection, as an emerging surgical approach, offers certain advantages in facilitating surgical maneuverability and reducing operative time, rendering it more suitable for posterior uterine fibroid resection.

Can a Continuous Wound Infiltration System Replace Intravenous Patient-Controlled Analgesia for Postoperative Pain Management after a Single-Port Access Laparoscopy?

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

Robotic and Laparoscopic Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy, Multicenter Study From Saudi Arabia.

Peritoneal metastasis (PM) is a common evolution of abdominal tumors. Without aggressive multimodal treatment, it is associated with a poor prognosis. The aim of this study is to present a multicenter results from Saudi Arabia on minimally invasive CRS and HIIPEC. A retrospective analysis of a prospective maintained multicenter database was queried for all patients treated with laparoscopic or robotic CRS and HIPEC between 2019 and 2024 in Saudi Arabia. Surgical and oncological outcome was analyzed. Eleven consecutive patients underwent minimally invasive CRS and HIPEC between 2019 and 2024. Eight patients (72.7%) were operated by laparoscopy, one of them by single port access and three patients (27.3%) were operated robotically. Six patients (54.5%) were female. Median age was 42 (29-64). Primary tumor was PMP from the appendix, colon, and MCM in 6 (54.5%), 4 (36.4%), and 1 (9.1%) respectively. The median duration to complete the surgical procedure for all patients was 330 (230-580) min and for robotic CRS the median docking time was 570 (330-580) min. Median PCI was 2 (1-7) and completeness Cytoreduction (CC score 0) was achieved in the all patients (100%). Median hospital stay was 8 days (3-20). Four patients had one night postoperative ICU stay. Major morbidity (CTCAE) 3 and 4 occurred in three patients (27.3%) (Port site hernia, bleeding, and wound infection). No readmission to the hospital and no 90 days mortalities. The minimally invasive approach by laparoscopy or robot is a feasible and promising option for CRS and HIPEC. It reduces the hospital stay, early return to intended oncological treatment (RIOT). Further prospective clinical studies are needed to evaluate this approach.

Application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents

ObjectiveTo investigate the clinical efficacy of transumbilical single-incision laparoscopic surgery in the treatment of complicated appendicitis in overweight/obese adolescents.MethodsA retrospective analysis was conducted on the clinical data of 226 adolescent patients with complicated appendicitis who were admitted to our hospital from January 2014 to June 2022. Among them, 102 cases underwent transumbilical single-incision laparoscopic appendectomy as the observation group, and another 124 cases underwent conventional three-port laparoscopic appendectomy as the control group. The surgical time, intraoperative blood loss, duration of incisional pain, postoperative flatus time, length of hospital stay, surgical site infection (SSI), satisfaction with cosmetic result, and occurrence of postoperative complications were compared between the two groups.ResultsBoth groups completed the surgery smoothly, and there were no statistically significant differences in gender, age, BMI, duration of illness, white blood cell count, and preoperative CRP value between the two groups (P > 0.05). There were no statistically significant differences in surgical time and intraoperative blood loss between the two groups (P > 0.05). However, the observation group had shorter hospital stays, shorter duration of incisional pain, shorter postoperative time to flatus, and lower overall postoperative complication rates compared to the control group, with statistically significant differences (P < 0.05). The observation group had higher satisfaction with cosmetic result compared to the control group, with statistically significant differences (P < 0.05). Both groups were followed up for one year postoperatively, and there were no occurrences of residual appendicitis or severe adhesive intestinal obstruction.ConclusionWhen proficiently mastered, the application of transumbilical single-incision laparoscopy in the treatment of complicated appendicitis in overweight/obese adolescents offers advantages such as minimal trauma, rapid recovery, fewer complications, and improved aesthetic outcomes.

WP2.16 - Hartman’s Reversal; A comparison of conventional vs minimally invasive surgical approach

Abstract Background Hartman’s procedure is a safe operation for emergency colonic resections. Hartman’s reversal, however, is a technically challenging operation with high morbidity. Hence, almost half of the patients choose to live with lifelong stoma. Hartman’s reversal can be done open or laparoscopic, with single incision laparoscopic surgery (SILS) as an emerging minimally invasive technique. We will discuss the different surgical techniques along with their results and challenges. Methods This is a single centre retrospective study done at District General Hospital. All the Hartman’s reversals done between July 2021 to July 2023 were included in the study. Demographics, primary disease, interval between primary operation and reversal, post-operative complications and hospital stay was calculated. Results A total number of 19 Hartman’s reversal operations were done between July 2021 to July 2023. Average age of the patients was 61.8 years. The pathology was cancer in 7 patients and 12 cases were benign. The average interval between Hartman’s procedure and reversal was 23.2 months. Only 3 (15.7%) patients had a co-morbid. Out of 19 Hartman’s reversals done, 11 (57.89%) were done open, 5 (26.3%) SILS, 1 (5.2%) laparoscopic, and 2 (10.5%) laparoscopic converted to open. The complication rate in open cases was 61.5% vs 33.33% in laparoscopic/SILS. Average length of stay (LOS) was 10.38 days in open vs 9.19 days in laparoscopic group. Conclusion The limitations of this study are single centre and low sample size. The length of stay is slightly better in minimally invasive group, and much better post-operative outcomes. We suggest a multicentre study can help establish more reliable results.

Initial Experience of Single-Port Robotic Lobectomy for Large-Sized Non-Small Cell Lung Cancer: A Single-Center Retrospective Study.

Single-port robotic-assisted thoracic surgery (SP-RATS) lobectomy using the da Vinci Xi system has been performed by several pioneers. However, due to the severe collisions and the steep learning curve, this approach is not yet widely used. This study aimed to evaluate the feasibility of SP-RATS lobectomy for large-sized non-small cell lung cancer (NSCLC). As we believe that for large-sized tumors it is reasonable to make a slightly larger incision, we performed SP-RATS lobectomy for large-sized NSCLC (greater than 5 cm) through a single incision (6-8 cm). Eleven patients underwent SP-RATS lobectomy using the da Vinci Xi system at our institution from April 2022 to May 2024. The median tumor size on computed tomography and on pathology was 6.6 cm [interquartile range (IQR), 6.1-7.5 cm] and 6 cm [IQR, 5.1-7.1], respectively. The median total operative time was 198 min [IQR, 159-260 min], and the median postoperative length of stay was 4 days [IQR, 4-10 days], with no major postoperative complications (≥grade III on the Clavien-Dindo classification). Our approach may combine the benefits of single-port surgery with those of robotic surgery and is safe, feasible, and may promote better outcomes in patients with large-sized NSCLC.

New Exploration of Single-Incision Plus Two Ports Laparoscopic Pancreaticoduodenectomy Based on the Principle of Enhanced Recovery after Surgery.

Background: Despite single-incision laparoscopic surgery (SILS) being a standard procedure, its main shortcomings include narrow operating space and instrument collisions. Although the proposal of single-incision plus one-port laparoscopic surgery (SILS + 1) reduces the operational difficulty, laparoscopic pancreaticoduodenectomy (LPD) involves complex digestive tract resection and anastomosis. To reduce the number of incisions while ensuring the quality of LPD, we propose a single-incision plus two ports LPD (SILPD + 2) procedure wherein a surgeon uses two trocars with a traditional layout while the assistant and scope assistant conduct subumbilical incision. Methods: Retrospective analysis was performed of the perioperative data of 64 patients who underwent total LPD at our department from January to June 2023, including their age, gender, surgical operation time, estimated bleeding loss, and postoperative complications. Based on the number of inserted trocars, the patients were assigned to the conventional LPD (CLPD) group (n = 55) with five incisions and the new SILPD + 2 group (n = 9). Results: A total of 64 patients were included in this study, including 55 in the CLPD group and 9 in the SILPD + 2 group. The SILPD + 2 group patients had lower age and body mass index when compared to the CLPD group patients, albeit there was no statistical significance. In both groups of patients, laparoscopic surgery was completed. Regarding the operation time, estimated blood loss, and intraoperative blood transfusion, the SILPD + 2 group showed no significant disadvantage. Conclusion: When compared to CLPD, SILPD + 2 reduced the surgical difficulty by reducing incisions, and there was no significant difference in the short-term prognosis outcomes.

Green Guidewire Combined with Epidural Needle-Saline Separating Minimize Invasiveness and Optimize Outcomes in Single-Port Laparoscopic Treatment for Pediatric Inguinal Hernia.

Objective: To investigate the application value, feasibility, and safety of modified single-port laparoscopic surgery in the treatment of pediatric inguinal hernia. Methods: One hundred and twenty cases of children with indirect inguinal hernia admitted from 2017 to 2022 were enrolled in the Control and Observation groups, with 80 and 40 cases, respectively. They underwent traditional open high ligation of the hernia sac and modified single-port laparoscopic high ligation of the hernia sac, respectively. The operation duration, surgical incision size, intraoperative bleeding, postoperative hospital stay, first ambulation time, and hospitalization expenses were compared between the two groups, as well as the incidence of surgical complications in the two groups. Results: The surgical incision size, intraoperative bleeding, postoperative hospital stay, and first ambulation time of the Observation group were less than those of the Control group. There was no significant difference in operation duration or hospitalization expenses between the two groups. Only two cases in the Observation group showed suture knot reactions after surgery, with no incision infection, inguinal hematoma, iatrogenic cryptorchidism, etc. The overall incidence of complications in the Observation group was lower than that of the Control group. Conclusion: Modified single-port laparoscopic surgery for inguinal hernia in children has the advantages of minimal invasiveness, and enhanced recovery, along with fewer complications and recurrence, hence it is worthy of recommendation in clinical practice.

A retrospective analysis of single-port laparoscopy in myoma management

ObjectiveThis study assesses the effectiveness and safety of single-port laparoscopic myomectomy (SPLM) versus conventional laparoscopic myomectomy (CLM). MethodsWe conducted a retrospective case-control study at a university tertiary hospital, involving 262 patients treated from July 2020 to December 2022. Participants were divided into two groups: 132 underwent SPLM and 130 underwent CLM. ResultsThe two groups were comparable in terms of age, body mass index, parity, delivery history, preoperative anemia, number of myomas, and size of the largest myoma. The SPLM group showed a significant reduction in operation time (average 93 min) and estimated blood loss (average 50 ml) compared to the CLM group (average 118.5 min and 100 ml, respectively). Subgroup analysis based on the size, location, and number of myomas further highlighted the advantages of SPLM, particularly for patients with large (diameter ≥8 cm) or multiple myomas (number ≥4). Patient satisfaction was also notably higher in the SPLM group. ConclusionsSingle-port laparoscopic myomectomy offers a highly effective, safer, and patient-preferred option for the surgical management of fibroids, especially in cases of large or multiple myomas. These findings suggest that SPLM could become the preferred surgical approach for complex fibroid cases, promising less trauma and quicker recovery for patients.

Segmental Bowel Resection for Rectal Endometriosis Using the da Vinci SP

ObjectiveThe da Vinci SP Surgical System (SP) received regulatory approval for use in gynecological surgeries in Japan in 2023. Given the advantages of the precision of a robot, less pain, and the cosmesis of single-port surgery, the da Vinci SP is expected to be further used for minimally invasive surgeries. To the best of our knowledge, this is the first report of the use of SP for the treatment of rectal endometriosis with segmental bowel resection. SettingAn urban general hospital. Stepwise demonstration of the technique with narrated video footage. ParticipantsThe patient was a 46-year-old woman presented with chronic pelvic pain, pain on defecation, and constipation. Magnetic resonance imaging showed uterine large fibroid, left ovarian endometrioma, and 38 mm of rectal endometriosis, with complete cul-de-sac obliteration. InterventionsWe made a 30-mm vertical incision at the umbilicus, then placed the access port, and inserted three articulating instruments and a camera. An assistant port was placed in the right lower quadrant for using the linear stapler. The surgical steps were completely identical to conventional multiport laparoscopic robotic surgery. This suggests that conventional laparoscopic or robotic skills are highly transferrable to SP. SP offer several advantages, including high-resolution three-dimensional visualization, articulating instruments, and improved dexterity and range of motion. In addition, the umbilical access port was particularly useful for proximal bowel resection, specimen retrieval, and anvil positioning during bowel resection. The total operative time was 216 minutes. The estimated blood loss was 100 ml without any complications. The uterine weight was 800 g. The postoperative course was uneventful, with no perioperative complications, including no postoperative bladder dysfunction or low anterior resection syndrome [1,2]. ConclusionThe use of SP with the access port for segmental bowel resection for rectal endometriosis is technically safe and feasible, with good cosmesis and less pain.