Single-port Access Technique Research Articles

Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study

Purpose To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). Background Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. Methods Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. Results A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. Conclusions Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.

Single-port access for Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC): technique, feasibility and safety.

Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug delivery system for treatment of peritoneal metastasis (PM). A limitation of this technique is the non-access rate (10-15 %) due to peritoneal adhesions. The aim of the study was to assess feasibility and safety of the single-port access technique for PIPAC. Single-center, pilot study. Case series, retrospective analysis on 17 patients with PM of various origin treated with intraperitoneal cisplatin, doxorubicin and/or oxaliplatin administered as PIPAC. Single-port access was attempted in all patients by minilaparotomy. Twenty-nine PIPAC procedures were performed. Nine patients were subjected to 1 PIPAC, four patients to 2 PIPAC and four patients to 3 PIPAC. Access to peritoneal cavity was possible in all cases. There was no bowel access lesion. Tightness of the abdomen (CO2-flow = 0) was achieved in all cases. No postoperative complications according to CTCAE (Common Terminology Criteria for Adverse Events)>2 were observed, no re-laparotomies required and no postoperative mortality recorded. Single port-access is feasible and safe for PIPAC. Potential advantages over multiple trocars technique are a lower non-access rate, a lower risk of bowel lesions and a better tightness of the abdomen. This has now to be confirmed in a comparative study.

Preliminary application of a single-port access technique for laparoscopic ovariohysterectomy in dogs

Laparoscopic ovariohysterectomy using single-portal access was performed in nine selected owned dogs admitted for elective ovariohysterectomy and the surgical technique and outcomes were detailed. A multiport device (SILS Port, Covidien,...

Towards the perfect anastomosis - quantitative assessment of simulated anastomoses

period examined. 19 patients had an aggressive resection while 29 patients had a conservative resection. There were no differences in gender between the “aggressive” and “conservative” groups with a preponderance of females (58% vs 76%, p = 0.22). The mean age was lower in the “aggressive” group (16.46 years vs 29.12 years, p = 0.007). There were no significant differences in indications for sympathectomy between the groups which included Long QT syndrome (subtypes 1 to 3), CPVT and other. Procedural times were longer in the aggressive group as the mean operating time was longer using the 3-port technique in comparison to the single-port technique (43.95 mins vs 20.38 mins, p <0.0001). Only 1 patient required insertion of chest drain post-operatively for a pneumothorax and there was no difference in hospital stay (1.32 days vs 1.36 days, p = 0.81). There was no significant difference in the shortening of the QT interval between the 2 groups (66.7% vs 56%, p = 0.55). There were no differences between the 2 groups for later requirement for implantable defibrillators, further arrhythmias or death (31.25% vs 26.92%, p = 1.0). Compensatory hyperhidrosis was not significantly different between the groups (6.25% vs 15.38%, p = 0.63). Partial Horner’s syndrome occurred only in the “aggressive” group in 5 patients (31.25% vs 0%, p = 0.005); in only 2 patients did a mild left ptosis persist for longer than 6 months. Discussion: Aggressive approaches that sacrifice the lower third to half of the stellate ganglion run the risk of resulting in a partialHorner’s syndrome,without conferring additional electrocardiographic or clinical benefit. The majority of the stellate ganglion therefore should be spared, and only the very bottom of it should be sacrificed. A single port access technique is an efficient access method for such procedures.

Initial Application of Reduced Port Surgery Using the Single Port Access Technique for Laparoscopic Canine Ovariectomy

To describe the Single port access (SPA) laparoscopic entry technique for canine ovariectomy (OVE), report complications, and outcomes. Pilot study. Intact female dogs (n = 6). With owner consent, 6 intact female dogs had SPA laparoscopic OVE. Data, including signalment, surgical time (from incision to completion of closure), size and location of port placement, need for conversion (both to standard multiport laparoscopy and laparotomy), as well as any intraoperative complications including blood loss or tissue injury were recorded. Mean surgical time was 52.5 minutes (range, 45-60 minutes) and mean incision length, 1.8 cm (range, 1.5-2.0 cm). In an 18-kg mix breed dog (dog 3), a "single port rescue" was required and located on midline 2-cm caudal to the umbilicus. Close positioning of the trocars caused instrument interference, limited viewing, and prevented safe ligation of the ovarian vessels vein with a vessel-sealing device. OVE was successfully completed laparoscopically in all dogs. The SPA laparoscopic entry technique can be used in dogs, although instrument and camera interference can occur if trocar placement is too consolidated within the initial skin incision.

Surgical techniques of laparoscopic inguinal hernia repair in childhood: a critical appraisal.

Laparoscopic inguinal hernia repair started over two decades ago. It has been gaining ground as a mode of treatment for inguinal hernia in children. Several surgical techniques have emerged since its inception. The aim of this article is to review the role of laparoscopy in inguinal hernia repair in children, the various emerging laparoscopic surgical techniques, and their current trend in pediatric surgical practice. In this study, extensive review and analysis of recent articles on laparoscopic inguinal hernia repair in children revealed that laparoscopy plays a great role in the treatment of inguinal hernia in children. There were several emerging laparoscopic techniques, with trends toward extracorporeal suturing and knotting technique and single-port access technique as well. The recent advance is toward the use of tissue adhesives in laparoscopic inguinal hernia repair in children.

Single-port access laparoscopic surgery using a novel laparoscopic port (Octo-Port)

Objective We present our initial experience with single-port access (SPA) surgery using a novel laparoscopic port (Octo-Port). Materials, Methods, and Results In a prospective study, SPA surgery was carried out on 11 patients with the Octo-Port from July 2009 to December 2009 by a single surgeon (T.-J. K.). The procedures carried out were hysterectomy (seven patients), ovarian cystectomy (two patients) and salpingo-oophorectomy (two patients). In 10 cases the procedure was successfully performed without the use of additional ports. In one case the SPA procedure failed and ancillary ports were required; this patient had anatomical variations that made use of the SPA technique difficult. All procedures were performed without complications. There were no perioperative port-related or surgical problems. The Octo-Port had certain advantages such as reducing the need for long laparoscopic instruments, reducing extracorporeal instrumental crowding, and providing better deflection of smoke compared to other SPA devices that used a wound retractor and a glove. Conclusion Our study demonstrated that the Octo-Port allows laparoscopic surgery to be performed safely and easily with a reduced number of ports.

Single Port Access Surgery in Colorectal Disease: Preliminary Results

IntroductionThe aim of this study is to evaluate the single port access technique in colorectal disease, as regards its suitability to oncological criteria, reliability, safety and reproducibility of the technique. A descriptive and prospective case study is performed describing the preliminary results of our series. Materials and methodsWe present a series of 24 patients with colorectal disease who underwent single port access surgery using a Gel point® device between June and December 2010. The operations performed were: 9 right hemicolectomies, 9 sigmoid resections, 4 high anterior resections, 1 left hemicolectomy due to a tumour of the splenic flexure, and 1 sub-total colectomy. ResultsThe mean surgical time for the right colon was 82.8min (range 40–170), 122.1min (range 75–200) for the left colon and rectum, and 270min for the sub-total colectomy. The median number of ganglia resected was 22 (range: 3–27) for the right colon and 21 (range: 11–28) for the left colon/rectum. The mean length of the surgical specimen was 20.37cm (range: 16.2–27.5) for the right colon, and 24.92cm (range: 14.5–31) for the left colon/rectum. The median overall hospital stay was 6 days (range: 5–13). Morbidity was 8.3% (2 patients); one with an occlusion due to adhesions, and another with a leak in the anastomosis. There were no deaths. ConclusionsThe single port access technique is safe and reproducible, maintaining oncological criteria, for surgeons accustomed to colorectal surgery by conventional laparoscopy.A larger number of cases would be required to standardise the technique.

Cirugía Monopuerto en patología colorrectal: resultados preliminares

Introduction The aim of this study is to evaluate the single port access technique in colorectal disease, as regards its suitability to oncological criteria, reliability, safety and reproducibility of the technique. A descriptive and prospective case study is performed describing the preliminary results of our series . Material and methods We present a series of 24 patients with colorectal disease who underwent single port access surgery using a Gel point ® device between June and December 2010. The operations performed were, 9 right hemicolectomies, 9 sigmoid resections, 4 high anterior resections, 1 left hemicolectomy due to a tumour of the splenic flexure, and 1 sub-total colectomy. Results The mean surgical time for the right colon was 82.8 minutes (range 40-170), 122.1 minutes (range 75-200) for the left colon and rectum, and 270 minutes for the sub-total colectomy. The median number of ganglia resected was 22 (range: 3-27) for the right colon and 21 (range: 11-28) left colon/rectum. The mean length of the surgical specimen was 20.37 cm (range: 16.2 – 27.5) for the right colon, and 24.92 cm (range: 14.5 – 31) for the left colon/rectum. The median overall hospital stay was 6 days (range: 5-13). Morbidity was 8.3% (2 patients); one with an occlusion due to adhesions, and another with a leak in the anastomosis. There were no deaths. Conclusions The single port access technique is safe and reproducible, maintaining oncological criteria, for surgeons accustomed to colorectal surgery by conventional laparoscopy. A larger number of cases would be required to standardise the technique.

Single-port endoscopic retroperitoneal adrenalectomy: initial experience

Over the last decade, laparoendoscopic adrenalectomy has become the standard of care for adrenal removal. Elimination of a large incision and difficult exposure has decreased postoperative morbidity and length of stay. Single port access (SPA) surgery was developed as an alternative to traditional multi-port laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery. We applied the SPA technique to adrenalectomy using the posterior retroperitoneal approach. Between January 2010 and July 2010, a 52-year-old female with Conn’s adenoma and two females, aged 31 and 39, both diagnosed with pheochromocytoma, underwent single port endoscopic retroperitoneal adrenalectomies. Procedures were performed using two different commercially available specific access devices and conventional laparoscopic equipment. No conversions to open or conventional retroperitoneal approach were necessary. No perioperative or postoperative complications occurred. Operating time ranged from 120 min to 240 min. All patients were discharged from the hospital 2 days after surgery. The single port access technique has been successfully applied to adrenalectomy as an available alternative to multiport laparoendoscopic adrenalectomy. Exposure, visualization, and dissection are the same as in retroperitoneal endoscopic adrenalectomy. Single port access surgery offers the patient benefits such as faster convalescence, decreased postoperative scarring and better cosmetic effect.

Single-port access prosthetic repair for primary and incisional ventral hernia: toward less parietal trauma

Although still under development, single-port access (SPA) approach may be of interest in patients prone to port-side incisional hernia, ensuring absence of increased fascial incision. This forms the basis for evaluating SPA for prosthetic ventral hernia repair. We report a new SPA technique of ventral hernia repair using working-channel endoscope, standard laparoscopic instruments, and 10-mm port. Prospective experience with SPA prosthetic repair of primary and incisional ventral hernia in 52 patients for 55 ventral hernias is presented. Median (range) patient age was 46 years (26-85 years), and BMI was 28 kg/m2 (20-38 kg/m2). Mean fascial defect was 16.2 cm2 for primary hernia (n=23) and 48.3 cm2 for incisional hernia (n=32). Intraperitoneal composite mesh repair was achieved through single 10-mm flank port using working-channel endoscope. Meshes were fixed using absorbable tackers and transfascial stitches. SPA repair of primary and incisional ventral hernia was completed in all cases without conversion to standard laparoscopy. Median (range) operative time was 54 min (39-95 min). Mesh size ranged from 118 to 500 cm2. No intra- or postoperative complications were recorded, except two seromas. Median (range) hospital stay was 1 day (1-5 days). One patient presented prolonged postoperative pain on mesh fixation that resolved after 3 months. No recurrence or port-site incisional hernias have been recorded at median (range) follow-up of 16 months (3-28 months). SPA prosthetic repair of primary and incisional ventral hernia is easily feasible according to natural exposition by pneumoperitoneum and gravity. In the present series, SPA ventral hernia repair appears to be safe for experienced SPA surgeons. It may decrease parietal trauma and scarring in patients prone to incisional hernia. SPA repair may be associated with a decrease in rate of port-site incisional hernia compared with multiport laparoscopy, but this has to be verified by randomized trial with standard laparoscopic approach on long-term follow-up.

Single Port Access (SPA™) laparoscopic ventral hernia repair: initial report of 30 cases

Laparoscopic ventral hernia repair has been demonstrated to be an acceptable and successful technique. Aside from similar, albeit fewer, complications compared to open hernia repair, the laparoscopic technique has the additional complication of port site hernia to its follow-up criteria. Our initial experience with reduced port surgery in hernias was described as a two-port one-stitch repair technique in 2002. We initially applied our Single Port Access (SPA) technique to ventral hernia repairs and reported it at the American Hernia Society meeting in 2008. Now we present the first 30 cases, some with 6-24-month follow-up. The charts of 30 patients undergoing surgery for primary and recurrent ventral hernias employing the SPA technique were reviewed. The SPA technique was applied through a 1.0-1.6-cm incision remote from and lateral to the hernia location in the abdominal wall. Polypropylene-based coated mesh and non-fascial fixation were used in all cases. All procedures were completed via the SPA technique. Operative time, length of stay, and estimated blood loss were acceptable. The size of mesh placed ranged from 81 to 500 cm(2). Postoperative seromas were observed and all resolved spontaneously. There have been no wound infections or port site hernias during the 6-24-month follow-up period. There have been no recurrent hernias at the primary site. We have successfully demonstrated the applicability of Single Port Access surgery for ventral hernia repair. In our initial series we performed this procedure on smaller hernias but have now begun applying it to larger repairs.

Initial Surgeon Training for Single Port Access Surgery: Our First Year Experience

We have developed a single port access (SPA) surgical technique that allows for procedures to be done through a single umbilical port incision <20 mm in length. For a new approach to be universally beneficial, it needs to be easily learned and applied. Single port access abdominal procedures are performed through one umbilical incision where skin and soft tissue flaps are raised from the underlying fascia to allow insertion of up to 4 instruments. Fifty surgeons with varying degrees of laparoscopic training participated in SPA training programs at Drexel University to learn and apply the SPA technique through participation in an animate (porcine) laboratory. All surgeons successfully performed the SPA access technique without difficulty and completed the cholecystectomy in <55 minutes (average, 42). Eight surgeons successfully performed placement of a cholangiogram catheter. All recognized the value of a formal training symposium to learn SPA techniques before performing SPA procedures in their practice. The SPA technique has been successfully shown to be an approach that is easily learned and accomplished. We believe this is a necessary and important bridge towards proficiency in performing SPA procedures in clinical patients.

Single Port Access (SPA) Splenectomy

Over the last decade, laparoscopic splenectomy has become the standard of care for spleen removal. Elimination of a large incision and difficult exposure has decreased postoperative morbidity and length of stay. Single port access (SPA) surgery was developed as an alternative to traditional multiport laparoscopy, potentially exploiting the already proven benefits of minimally invasive surgery. We apply the SPA technique to splenectomy via a single umbilical incision. SPA splenectomy was performed in a 36-year-old male for staging. The single-port access technique was used to gain abdominal entry. Exposure, dissection, and removal were performed via a single incision within the umbilicus. The final incision was extended for removal of a complete specimen for pathologic evaluation. Splenic mobilization and control of the short gastrics was successfully performed via a single umbilical incision. The final incision was extended inferiorly for en bloc organ removal. Follow-up at 18 months revealed a well-healed incision with no signs of hernia formation. The single-port access technique has been successfully applied to splenectomy as an available alternative to multiport laparoscopic splenectomy. Use of standard instrumentation and trocars maintains costs and familiarity of the procedure. Exposure, visualization, and dissection are the same as in standard laparoscopy. SPA surgery may be more ergonomically pleasing to the surgeon and offer patient benefits, such as faster recovery and decreased adhesion formation in the long term.

Experience with Modified Single-Port Laparoscopic Procedures in Children

The aim of this study was to determine the safety and efficacy of limited-access laparoscopic procedures in children by using a modified single-port access (SPA) technique. A number of different basic laparoscopic procedures were attempted by using a modified 8-mm operating laparoscope with a 4-mm, 6-degree lens and an incorporated 5-mm operating channel. The operating scope was placed though an umbilical incision. The majority of cases also involved the use of a 3-mm instrument placed through a separate stab-wound incision or 3-mm port. Patient age ranged from 9 months to 16 years and weight from 7 to 60 kg. Procedures included laparoscopic cholecystectomy in 10, appendectomy in 8, enterolysis in 2, ovarian cystectomy in 1, and inguinal hernia repair in 15 patients. All procedures, except one, were successfully completed by using the SPA technique. A hernia repair in a 15-year-old male was converted to a three-port laparoscopic repair, because the operating scope could not adequately access the area. Operative times were longer than comparable procedures if using a standard laparoscopic approach, but a statistical analysis was not performed. There were no operative or postoperative complications. A modified SPA technique appears to be a safe, viable alternative to a standard laparoscopic approach for some procedures in children. The primary advantage is cosmetic. Visualization and tissue manipulation are more difficult and time consuming. The addition of a single 3-mm instrument at a separate site allows for easier dissection and triangulation, with almost no visible scarring. This may be more beneficial than creating a single 20-mm incision in the umbilicus with multiple ports, with nearly the same cosmetic result.

Single Port Access (SPA™) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement

Access procedures for alimentation have been performed both endoscopically and surgically. In those patients in whom endoscopic tubes cannot be placed, the minimally invasive approach is a viable alternative. To minimize incisions and their sequelae, we have developed a single port access (SPA) technique in which minimal access surgery can be done through one portal of entry, often the umbilicus. We have used the SPA technique to place gastric feeding tubes in patients who are not candidates for PEG tubes due to supraglottic stenosis. We reviewed our experience in the first five procedures we performed. In all five patients a gastrostomy tube was placed laparoscopically via an umbilical incision and a left-upper-quadrant tube insertion point. Mean operative time was 44 min. All patients began tube feeds on postoperative day 1. We present the first series of five SPA gastric tube placements, offering a viable alternative to PEG or open placement.