Single-port Laparoscopic Approach Research Articles

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.

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.

Single-port laparoscopic surgery for cecum cancer with intussusception: a case report

BackgroundMost adult cases of intussusception are caused by colorectal cancer, and emergency surgery is performed when symptoms such as abdominal pain and vomiting are present. The patient must customarily undergo both bowel decompression and radical surgery for colorectal cancer at the same time, and laparotomy is generally the procedure of choice.Case presentationAn 86-year-old woman presented to our hospital with diarrhea and bloody stools. Preoperative examination revealed the presence of a cancerous tumor in the advanced part of the transverse colon and bowel intussusception. Radical surgery was successfully performed using the laparoscopic single-port technique through a small incision at the umbilical site to treat intussusception caused by cecum cancer.ConclusionsWith only one wound site at the umbilicus, this single-port laparoscopic approach is much less invasive than endoscopic surgery that requires four to five incision wounds to perform the procedure. Furthermore, the patient was discharged without major complications and this surgical technique could be of great benefit if established as a standard procedure in the future.

Huge Adnexal Masses Managed by Single Port Laparoscopy: A case series

Aim: Adnexal mass is one of the most common surgical indications in gynecology clinics, and laparoscopy is generally accepted as a gold standard in the management of adnexal mass. Materials and Method: Single incision laparoscopic surgery (SILS) is an evolving endoscopic approach in the era of minimal access surgery. Recently, it has been reported that adnexal mass may also be managed by SILS. In this report, we present 3 symptomatic patients with a huge adnexal mass operated by a single port laparoscopic approach. Results: The mean duration of the operations 95 minutes (range 75-135 minutes). None of the patients converted to laparotomy. All patients discharged on postoperative day 1. None of the patients required readmission to the hospital. Postoperatively all patients were satisfied with their incision and cosmetic results. Conclusion: Single port laparoscopic management can be successfully completed via SILS PortTM in patients with large adnexal masses with better cosmetic outcomes.

Successful use of single-port laparoscopic surgery for ovarian cyst removal during pregnancy: a case series of three cases

Abstract Pregnant patients have an increased risk of torsion compared to that seen in nonpregnant patients, and those with larger cysts undergo torsion more frequently, which can cause obstructions during labor. The risks associated with emergent surgery are higher than those with elective surgery. Laparoscopic surgery can be safely performed during pregnancy. Single-port laparoscopic surgery is reported to be a minimally invasive laparoscopic technique. We report three cases of ovarian dermoid cysts, which were successfully removed during pregnancy through elective single-port laparoscopic surgery. In all cases, imaging showed a dermoid cyst and the cyst size was greater than 6 cm. All patients requested the surgery. The ovarian cysts were successfully removed by single-port laparoscopy without additional ports and without intra- or postoperative complications. All pregnancies progressed well and delivered vaginally at full term. The single-port laparoscopic approach is useful for removing ovarian cysts during pregnancy.

Single-port laparoscopic appendectomy for perforated appendicitis using ArtiSential® wristed articulated instrument.

Single-port laparoscopic appendectomy (SPLA) was firstly introduced in 1998 and has been suggested potential advantages including better cosmetic outcome, less post-operative pain and avoidance of possible haemorrhagic complications from injuring epigastric vessels. However, single-port laparoscopic approach using conventional straight instruments may lead to internal and external conflicts and ergonomic discomfort, and new laparoscopic articulating instruments were developed to overcome these limitations of straight instruments. The ArtiSential® (LIVSMED Inc., Republic of Korea) is an 8-mm diameter pistol-handle instrument that has complete articulating function like human wrist and intuitive controllability. We present a technical report of SPLA for perforated appendicitis using ArtiSential® wristed articulated instrument. A 78-year-old female with a body mass index of 23.5 was referred to our emergency room with right lower quadrant abdominal pain. Abdominal computed tomography scan showed a distended tubular structure in the right lower quadrant (1.2 cm in diameter) with periappendiceal fluid collection. The patient's clinical presentation was highly indicative of perforated acute appendicitis. We performed SPLA with ArtiSential® grasper with the left hand, and this instrument helped us to allow greater manoeuvrability and dexterity with double triangulation technique. The total operation time was 40 min, and the patient was discharged without complications on the 1st day after surgery.

Reversal of Hartmann's Procedure: Evaluating Outcomes of Single-Port Laparoscopic Approach Versus Conventional Approach.

Bowel restoration following Hartmann's procedure (HP) remains a topic of discussion and innovation. This article seeks to highlight and analyze the outcomes of conventional reversal approaches such as open surgery (OS) and conventional laparoscopic (CL) to single-port laparoscopic reversal (SPLR) approach to evaluate whether SPLR is a feasible alternative to the OS or CL approach. A PubMed search using keywords yielded 5,750 articles. After applying the inclusion/exclusion criteria, 40 articles of relevance were reviewed, and endpoints considered. These included 13 systematic reviews and 27 observational reviews, three of which identified themselves as retrospective or comparative studies. The analysis showed overwhelming support for CL over OS as a choice for HP reversal. Studies comparing SPLR to CL showed SPLR to be a safe and feasible alternative, given its significantly shorter operating times, hospitalization times, and complication rates.

Comparison of Single-Port and Multi-Port Laparoscopic Methods of Nephrectomy in Young Infants

A single-port laparoscopic approach for nephrectomy is not widely used in newborns and infants. Primarily, this is due to the fact that the majority of pediatric surgeons are satisfied with the cosmetic results of the multi-port endoscopic techniques. Another explanation of this phenomenon is the lack of technology and practical skills to implement a SIPES in small babies. The aim of this study was to compare a result of treatment of non-functioning kidneys in neonates and infants using Single-Incision Laparoscopic Nephrectomy (SIL-N) and multi-ports laparoscopy.

Apendicectomía laparoscópica por sistema «glove port»: nuestros primeros 100 casos

IntroductionSingle port laparoscopic appendectomy is an advance in minimally invasive techniques. The objective of this study is to show our series of 100 cases of acute appendicitis, operated through a single port technique using the ‘glove port’ system, exposing our technique, results and follow up of our patients. Material and methodsWe present the series of 100 cases intervened from February 2013 to January 2017 detailing the elements that make up the ‘glove port’ system. ResultsOf the 100 operated appendicitis, there were 3 postoperative collections and 1 surgical wound infection, which shows the good results obtained with this technique, emphasizing the excellent aesthetic result. We also point out that it is an economic system that does not make conventional laparoscopy more expensive. ConclusionsSingle port laparoscopic appendectomy is safe, effective, economical and useful for the surgeon to acquire skills in a single port laparoscopic approach.

A comparative study on trans-umbilical single-port laparoscopic approach versus conventional repair for incarcerated inguinal hernia in children.

PURPOSE:The purpose of this study is to determine whether singleport laparoscopic repair (SLR) for incarcerated inguinal hernia in children is superior toconventional repair (CR) approaches.METHOD:Between March 2013 and September 2013, 126 infants and children treatedwere retrospectively reviewed. All the patients were divided into three groups. Group A (48 patients) underwent trans-umbilical SLR, group B (36 patients) was subjected to trans-umbilical conventional two-port laparoscopic repair (TLR) while the conventional open surgery repair (COR) was performed in group C (42 patients). Data regarding the operating time, bleeding volume, post-operative hydrocele formation, testicular atrophy, cosmetic results, recurrence rate, and duration of hospital stay of the patients were collected.RESULT:All the cases were completed successfully without conversion. The mean operative time for group A was 15 ± 3.9 min and 24 ± 7.2 min for unilateral hernia and bilateral hernia respectively, whereas for group B, it was 13 ± 6.7 min and 23 ± 9.2 min. The mean duration of surgery in group C was 35 ± 5.2 min for unilateral hernia. The recurrence rate was 0% in all the three groups. There were statistically significant differences in theoperating time, bleeding volume, post-operative hydrocele formation, cosmetic results and duration hospital stay between the three groups (P < 0.001). No statistically significant differences between SLR and TLR were observed except the more cosmetic result in SLR.CONCLUSION:SLR is safe and effective, minimally invasive, and is a new technology worth promoting.

Cœlioscopie par mono-trocart et chirurgie annexielle : quelles applications en chirurgie oncologique ?

ObjectiveTo show the interest of single trocar in order to perform uni- or bilateral salpingo-oophorectomies. Patients and methodsA descriptive study monocentric. ResultsA total of 79 unilateral or bilateral salpingo-oophorectomies were performed by single-port laparoscopy between January 2010 and September 2012 at the Institut Paoli-Calmettes (Marseille). There are three surgical indications: diagnostic, therapeutic and prophylactic. The median age was 50years (22–78years). The median BMI was 22.4kg/m2 (17.5 to 37.7kg/m2). The median blood loss was 0cc (0cc–50cc). The median hospital stay of patient was one day (0–6 days). The conversion rate in this study was 8.8%. Discussion and conclusionThe single-port laparoscopic approach to perform uni- or bilateral salpingo-oophorectomies is a natural evolution of the conventional laparoscopy. If the cosmetic role seems obvious, its therapeutic value compared to traditional technique must be demonstrated by prospective studies with larger numbers.

Single-Port Laparoscopic Right Hemicolectomy: Intermediate Results

Single-port laparoscopic colectomy was first described in 2008 as a new technique for colorectal surgery. No available reports have stated the intermediate- or long-term outcome. We report our intermediate results for the first 20 single-port laparoscopic right hemicolectomies performed by a single laparoscopically trained surgeon at our institution. Between February 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy who were candidates for laparoscopic surgery underwent a single-port laparoscopic approach. The only exclusion was a previous midline laparotomy. The patients were followed for outcomes after a median of 27 months (range: 15 to 35). The mean age was 65 years (range: 59 to 88). The mean body mass index was 28 (range: 20 to 35). Seventy five percent of patients had significant comorbidities, with an American Society of Anesthesiologists class of III or IV. The median estimated blood loss was 25 mL (range: 25 to 250). The mean number of lymph nodes was 13 (range: 0 to 29). There was one conversion to hand-assisted laparoscopic colectomy and one to open colectomy secondary to bleeding. The mean hospital stay was 5 days (range: 3 to 7). Thirty-day postoperative complications included 1 wound infection, 1 patient with alcohol withdrawal, and 1 incidence of colitis caused by Clostridium difficile infection. At a median follow-up of 27 months, there were no local recurrences or distant metastases. One death occurred at 17 months from myocardial infarction. Two patients developed incisional hernias, with one requiring a laparoscopic hernia repair. One patient required a completion proctocolectomy for a pathological diagnosis of hyperplastic polyposis syndrome. Single-port laparoscopic right hemicolectomy has been safely performed in patients who are candidates for conventional laparoscopic hemicolectomy. This small series indicates that intermediate-term results are similar to conventional laparoscopic surgery in efficacy, safety, and oncological outcomes. Larger datasets are necessary to determine cost-effectiveness, differences in postoperative outcomes, and patient satisfaction.

Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve

Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. Various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.

Single-port laparoscopic right hemicolectomy: the learning curve.

Single-port laparoscopic colectomy is described as a new technique in colorectal surgery. The initial case reports show the safety and feasibility, but the learning curve for this technique is unknown. Between July 2009 and September 2010, 20 consecutive patients with an indication for right hemicolectomy underwent a single-port laparoscopic approach without bias in selection. The only exclusion criterion was a prior midline laparotomy. The patients were followed up for 30 days. Chart review was completed for up to 35 months to assess long-term morbidity and mortality rates. The median age was 65 years (range, 59-88 years). Ninety percent of patients were men. The median body mass index was 28 kg/m(2) (range, 20-35 kg/m(2)). Seventy-five percent of patients had significant comorbidities with an American Society of Anesthesiologists class of 3 or 4. The estimated blood loss was 25 mL (range, 25-250 mL). The median number of pathologic lymph nodes for patients diagnosed with adenocarcinoma was 16 (range, 8-23). There was one conversion to hand-assisted laparoscopic (case 6) and one to open colectomy (case 9) because of the inability to achieve safe vessel ligation. The median hospital stay was 4.5 days (range, 3-7 days). The length of stay for the first 10 patients was 5.1 days, and it was 3.9 days for the last 10 patients (P = .045). There were no significant postoperative complications within 30 days. The mean operative time for the first 10 cases was 198 minutes (range, 148-272 minutes), and it was 123 minutes (range, 98-150 minutes) for the subsequent 10 cases (P = .0001). All intraoperative complications (minor bleeding) occurred within the first 10 patients, with no significant bleeding recorded for the last 10 cases. Single-port laparoscopic right hemicolectomy can be safely performed in patients who are candidates for conventional or hand-assisted right hemicolectomy with very low intraoperative and postoperative complication rates. The 30-day morbidity rate remained low with this technique. The higher technical difficulty compared with conventional laparoscopy is reflected in the longer initial operative times. The learning curve for a surgeon with advanced laparoscopic skills and adequate procedure numbers seems to be short, requiring approximately 10 cases to decrease operative times to baseline. The role and feasibility of broad adaptation for single-incision laparoscopy in colorectal surgery need to be further evaluated in larger case series and trials.

Single-Port Laparoscopic Adrenalectomy for Ganglioneuroma: A Case Report

Introduction: Single-port laparoscopy has gained popularity in both the adult and the pediatric populations. Experience thus far is limited in single-port laparoscopy for adrenalectomy. We present a 4-minute video of a single-port laparoscopic adrenalectomy performed for benign disease in a girl. Methods: The patient was a 16-year-old girl (49 kg) who was found to have an incidental 3.2-cm calcified mass in the right adrenal gland. The patient was normotensive and clinically asymptomatic. Urine metanephrines, Vanillylmandelic acid (VMA), Homovanillic acid (HVA), norepinephrine, epinephrine, and dopamine levels were normal. At the time of surgery, the patient was placed in a lateral decubitus position with the right flank elevated. A 2-cm transverse, muscle-splitting incision was made in the flank at the mid-axillary line, and the TriPortTM (Advanced Surgical Concepts, Wicklow, Ireland) was placed into the peritoneum. A 5-mm, 30-degree endoscope and two 5-mm straight-working instruments were used for dissection. A 5-mm self-retaining retractor was used to retract the liver. The medial aspect of the gland was dissected from the inferior vena cava to expose the main adrenal pedicle. The main adrenal pedicle was ligated with 5-mm titanium clips and divided. Dissection continued superiorly, where the superior adrenal vein was clipped and divided. The inferior aspect of the adrenal gland was freed from the superior aspect of the kidney, and the inferior adrenal pedicle was clipped and divided. The adrenal gland was removed intact. Results: The operative time was 124 minutes with minimal blood loss. The patient began a liquid diet the night of surgery. She was discharged to home on the third postoperative day. The pathology revealed mature ganglioneuroma. At her 6-month follow-up visit, the results of renal ultrasonography and urinary catecholamines remained normal. Conclusion: Since the initial description in the adult literature in 1992,1 laparoscopic adrenalectomy has become the accepted approach for children with benign disease.2 The identification of incidental adrenal lesions is increasing in the pediatric population, and resection is recommended because malignancy may be found in up to 30%.3 The flank approach allowed for direct access to the retroperitoneum. As experience increases, the single-port laparoscopic approach through the umbilicus can provide a virtually scarless operation. This group of patients may be excellent candidates for a single-port laparoscopic approach to adrenalectomy. No competing financial interests exist. Runtime of video: 4 mins Presented at the International Pediatric Endosurgery Group's 20th Annual Congress of Endosurgery in Children, May 3–7, 2011, Prague, Czech Republic.

Single-Port Laparoscopic Total Colectomy for Medically Uncontrolled Colitis

New-generation multi-instrument ports for laparoscopic surgery now allow abdominal surgery via a single-access small incision. Here, we detail how laparoscopic total colectomy can be safely performed within the constraints of such single site operating. Three patients (2 males and 1 female; mean age, 28.3 y; mean body mass index, 24.1 kg/m) requiring urgent total colectomy with end ileostomy for colitis resistant to medical therapy fully consented to have their operation performed by a single-port laparoscopic approach. The single port was placed at the site marked preoperatively for the end ileostomy. The operation commenced with rectosigmoid transection and proceeded with a close pericolic dissection proximally along the colon to the cecum. The resected colon was withdrawn via the port site and the end ileostomy fashioned within this wound. The operation was safely completed in its entirety without additional abdominal access in each case. Mean operative time was 206 minutes. All patients are well with normal stoma appearance and function at a minimum follow-up of 4 months. Judicious patient selection and considered operative technique allow major resectional colonic surgery to be safely performed solely by a single-port technique. Proof of clinical benefit along with refined instrumentation is required if such surgery is to progress from anecdotal reports to mainstream practice.

Transumbilical Totally Laparoscopic Single-Port Nissen Fundoplication: A New Method of Liver Retraction: The Istanbul Technique

IntroductionMustafa Kemal Atatürk, founder of the Turkish Republic, had guarded many German scientists of a Jewish descent before the Second World War. Dr. Rudolf Nissen was one of the outstanding surgeons who had served in the Turkish university hospitals. He had created an antireflux procedure which is named after his own name while he was working in our clinic, the Cerrahpaşa Hospital. From a laparoscopic approach, the Nissen fundoplication was the gold standard intervention for the surgical treatment of gastroesophageal reflux disease (GERD). Currently, video laparoscopic surgery is evolving quickly with the guidance of new technology. Single-port (SP) laparoscopic transumbilical surgery is one of the newest branches of advanced laparoscopy. DiscussionSimple or complex manipulations may be performed with SP laparoscopic transumbilical surgery. The advantages, which are gained from conventional laparoscopy, can be invigorated by an SP laparoscopic approach. The retraction technique of the liver and the optical system were the most important factors, which made the Nissen fundoplication possible via single port. Here, we report that totally laparoscopic transumbilical SP Nissen fundoplication procedure was performed in three patients for sliding hiatal hernia with GERD. ConclusionTotally laparoscopic transumbilical SP Nissen fundoplication is a safe and feasible technique for the surgical treatment of GERD.

Editorial Comment

This is an original manuscript describing a nephrectomy using a single-port laparoscopic approach in a pediatric patient. It is evident that as laparoscopy evolves, our desire for less invasive surgery is leading surgeons to develop novel surgical approaches, such as natural orifice or laparoendoscopic single site (LESS) surgery. But the question remains, “How far are we going to make the laparoscopic approach more minimal and less invasive?” Pediatric Transumbilical Laparoendoscopic Single-site Nephroureterectomy: Initial ReportUrologyVol. 74Issue 5PreviewTo present a case of laparoendoscopic single-site surgery (LESS) nephroureterectomy (NUx), a type of embroyonic natural orifice translumenal endoscopic surgery, which is one of the recent innovations in the era of laparoscopy, in a child. Full-Text PDF ReplyUrologyVol. 74Issue 5PreviewRecently, laparoscopic surgery has gained popularity and become one of the standard techniques in most of the surgical departments, although it has technical difficulties and a steep learning curve. The experience gained in standard laparoscopic surgery, technical improvements, and technological innovations constituted a base for successful operations with LESS. There is an ongoing improvement in the technology to perform LESS in a safe and easy manner. Full-Text PDF Editorial CommentUrologyVol. 74Issue 5PreviewSingle-port surgery is a form of minimally invasive surgery, which uses basic concepts from laparoscopy but with a whole new dimension in manipulation. In the conventional laparoscopic surgery, 3-5 incisions are made where instruments are inserted. Because it uses only 1 port, single-port surgery has only 1 entry site and scarring is limited to that site externally. For most surgeons, the single-port approach is more challenging than conventional laparoscopy because the surgeon has less freedom of movement with all the instruments entering the same entry point. Full-Text PDF