Single-incision Laparoscopic Surgery Research Articles

Development of an augmented reality simulator for a robotic system used in single incision laparoscopic surgery

Augmented Reality (AR) became a very useful tool for various domains, with multiple applications in different medical fields, where this technology is integrated in medical training, image-based diagnosis, simulation of medical tasks, or in guiding systems for surgical procedures. The introduction of AR technology in robotic assisted surgery is relatively new and challenging considering the required precision for this type of medical task. The objective of this study is to develop an AR simulator for robotic assisted Single Incision Laparoscopic Surgery (SILS) where the robot performing the procedure is embedded in a virtual environment, providing both an interactive training and a simulation environment. The architecture and particularities of the proposed robot for SILS are analyzed for a better understanding of the structure, to obtain the validation of the kinematic model. The final result is represented in the form of an application which can be operated with Hololens 2 device.

Australian experience of side‐to‐side isoperistaltic stricturoplasty in Crohn's disease

The Michelassi stricturoplasty has demonstrated efficacy for Crohn's disease in European and American series but has not had uptake in Australia. We report the short-term results of side-to-side isoperistaltic stricturoplasty (SSIS) in an Australian Practice. Between March 2015 and October 2021 SSIS procedures were performed on Crohn's patients with long segment Crohn's strictures associated with obstructive symptoms, despite best medical therapy. Surgical demographics and results were recorded via inpatient and outpatient follow-up in a prospective database. Twenty-one SSIS performed in 16 patients, nine female, mean age 40 years. Single incision laparoscopic surgery (SILS) was used in 10 patients. The standard Michelassi SSIS used for 11 strictures and a Poggioli variant used for 10. Mean stricture length 32 cm (range 5-100); mean SSIS length 24 cm (range 6-55). Associated bowel resection in seven cases with a mean length of 47 mm. Ten patients had an average of three additional stricturoplasties. Complications included central line sepsis in one, deep surgical site infection in one and superficial wound infection in four patients. Mean duration of operation; 346 min and length of stay 10 days. SSIS techniques are safe for the management of long segment stricturing Crohn's disease. Although not widely used in Australia, surgeons should consider the Michelassi stricturoplasty, and its variants, for long Crohn's strictures as they are isoperistaltic whilst avoiding bowel resection and blind pouches.

Feasibility study on the use of single-port laparoscopic surgery for diagnosis and tumor sampling in advanced epithelial ovarian cancer — Case series of three cases

IntroductionIn advanced epithelial ovarian cancer (AEOC), it is often difficult to achieve optimal surgery at primary debulking surgery (PDS) due to intra-abdominal dissemination and/or metastasis. When it is determined that optimal surgery is not possible, neoadjuvant chemotherapy (NAC) is performed prior to subsequent debulking surgery. Also, a histological diagnosis of the tumor is very important before initiation of NAC. Laparoscopic surgery is thus useful to objectively diagnose whether an optimal primary debulking surgery is feasible and to obtain tumor biopsy samples. In order to minimize the invasive procedures at initial surgery, we performed laparoscopic surgery using a single-port method. Case presentationThree patients were diagnosed as stage IV ovarian cancer based on imaging and physical examination. Single-port laparoscopic surgery was performed. The intraabdominal findings were evaluated in all patients by predictive index scoring and objectively diagnosed as not ideal candidates for optimal surgery at PDS. Our use of single-port laparoscopic surgery (SPLS) allowed for safe surgical outcomes and sufficient tissue sampling for histological diagnosis. Clinical discussionLaparoscopic surgery is not appropriate for tumor reduction surgery in AEOC; however, its use as an alternative method to laparotomy is recommended for tumor tissue biopsy and/or intraperitoneal observation. Previous studies have reported on the use of conventional multi-port laparoscopic surgery. The single-port method, when compared to conventional laparoscopic surgery, is less invasive with only one abdominal wound at the umbilicus. ConclusionSPLS is feasible and clinically useful for diagnosis and tumor sampling in AEOC.

Single-incision laparoscopic surgery for intestinal intussusception due to neuroendocrine tumor

BackgroundSmall intestinal neuroendocrine tumor (NET) is uncommon, but intestinal intussusception caused by NET is even rare. We report a rare case of single-incision laparoscopic surgery (SILS) for intestinal intussusception due to NET G1.Case presentationA 72-year-old woman presented with vomiting, diarrhea, and abdominal pain. Contrast-enhanced computed tomography (CT) revealed the target sign in the ascending colon. An enhanced nodule was detected at the lead point, leading us to suspect a tumor. Colonoscopy showed a tumor at the lead point of the intestinal intussusception. Histological findings led to a diagnosis of NET G1. Single-incision laparoscopic ileocecal resection with regional lymphadenectomy was then performed. The patient was discharged 10 days postoperatively with no complications.ConclusionWe achieved SILS with regional lymphadenectomy for preoperatively diagnosed intestinal intussusception due to NET G1. Although this condition is rare, surgeons should take this possibility into consideration in cases showing similar findings.

V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION

You have accessJournal of UrologyCME1 Apr 2023V06-06 SINGLE PORT DA VINCI URETEROILEAL CONDUIT REVISION Rogerio Huang, Akhil Saji, Mubashir Billah, Daniel Bassily, Benjamin Rudnick, Michael Stifelman, and Mutahar Ahmed Rogerio HuangRogerio Huang More articles by this author , Akhil SajiAkhil Saji More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Daniel BassilyDaniel Bassily More articles by this author , Benjamin RudnickBenjamin Rudnick More articles by this author , Michael StifelmanMichael Stifelman More articles by this author , and Mutahar AhmedMutahar Ahmed More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003274.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In the United States, 80,000 new cases of bladder cancer are diagnosed every year. 30% are muscle invasive at the time of diagnosis, requiring radical cystectomy and ileal conduit being the most common type of urinary diversion. A rare complication is a ureteroileal anastomotic stricture (UIS), which occurs in 2-3% of cases. The gold standard treatment is an open repair. The advent of laparoscopy and robotics has allowed these revisions to be done with improved morbidity. In 2018, the single port robotic system has further enabled advances in minimally invasive surgery. There remains a paucity of educational videos on how to perform single port surgery. We aim to demonstrate a single port ureteroileal conduit revision. METHODS: An IRB approval was obtained at our institution and prospective data was collected on all patients undergoing a single port robotic UIS revision from January 2019 - April 2022. This case demonstration involves a 74 year old male who had a radical cystectomy with ileal conduit in June 2021. He subsequently developed bilateral UIS and elected for a single port UIS revision. RESULTS: The total operative time was 155 minutes and estimated blood loss was 25 mL. The patient’s pain was well controlled and his length of stay was 24 hours. There were no postoperative complications. The patient’s pfannenstiel incision healed with excellent cosmetic results. A renal ultrasound done at 3 months showed resolution of hydronephrosis. In a preliminary review, a single surgeon at our institution performed 6 single port UIS revisions. The mean OR time was 152.4 minutes and the mean estimated blood loss was 30.8 mL. The mean length of stay was 2.2 days. The 30-day postoperative complication rate was 0%. CONCLUSIONS: The single port Da Vinci robotic UIS revision is a novel and effective technique. The single port robot offers a superior platform to access tight spaces and excellent precision for dissection and ureteral anastomotic suturing. A single Pfannenstiel incision site allows easy access to the conduit as well as improved cosmesis. Single site surgery can significantly reduce pain and length of stay. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e510 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rogerio Huang More articles by this author Akhil Saji More articles by this author Mubashir Billah More articles by this author Daniel Bassily More articles by this author Benjamin Rudnick More articles by this author Michael Stifelman More articles by this author Mutahar Ahmed More articles by this author Expand All Advertisement PDF downloadLoading ...

Trans-axillary single port insufflation technique-assisted endoscopic surgery for breast diseases: Clinic experience, cosmetic outcome and oncologic result.

With an increasing demand for postoperative cosmetic effects in breast diseases, the single port by trans-axillary incision and air-inflation system, which provided better space and spared the assistant the effort of retraction, is widely used in clinic surgical treatment for multiple breast diseases. According to inclusion and exclusion criteria, patients who underwent trans-axillary single-incision surgery at Tianjin Medical University Cancer Hospital between December 2020 and July 2022 were included in the study. We collected and analyzed data on age, fertility history, ultrasound grade, clinical stage, pathological results, oncological prognosis, patient-centered cosmetic outcome, etc. A total of 115 cases were included, of which 33 patients with benign disease underwent mass resection, 68 patients with malignant tumors underwent mastectomy. 10 patients had a special type of breast lesion. A mastectomy was performed in 4 patients with male mammary gland development. Of the 115 cases, the maximum mass diameter was 3.00 ± 1.644 (0.6-8.5) cm. Blood loss during surgery was 85.77 ± 50.342 (10-200) ml. The surgery took 131.84 ± 59.332 (30-280) minutes to complete. The patient spent a total of 5.05 ± 2.305 (2-18) days in the hospital. And the length of surgical incision in all patients was 3.83 ± 0.884 (3-8) cm. All patients were very satisfied with the appearance of their breasts after dressing. 94.78% of patients were satisfied with the position of the incision. Through this study, we believe that in benign breast diseases and malignant breast tumors, trans-axillary single port insufflation technique-assisted endoscopic surgery has oncological safety and an aesthetic effect for most people with breast diseases.

Single-incision robotic colorectal surgery with the daVinci SP® surgical system: initial results of 50 cases.

The daVinci SP® (dVSP) surgical system (Intuitive Surgical, Sunnyvale, CA, USA), a robotic platform designed for single-incision surgery, overcame the need for multiple ports in traditional robotic surgery and issues including triangulation and retraction in single-incision laparoscopic surgery. However, previous studies only included case reports or series with small sample sizes. The aim of this study was to assess the safety and performance of the dVSP surgical system and its instruments and accessories for colorectal procedures. The medical records of patients who had surgery with the dVSP from March 2019 to September 2021 at Ewha Womans University Seoul Hospital were investigated. The pathologic and follow-up data of patients who had malignant tumors were analyzed separately to evaluate oncological safety. Fifty patients (26 male and 24 female) with a median age of 59years (interquartile range 52.5-63.0years) were enrolled. The procedures included low anterior resection with total mesorectal excision (n = 16), sigmoid colectomy with complete mesocolic excision and central vessel ligation (CME + CVL) (n = 14), right colectomy with CME + CVL (n = 9), left colectomy with CME + CVL (n = 4), right colectomy (n = 6), and sigmoid colectomy (n = 1). Operative time significantly decreased after 25 cases (early phase vs. late phase; operative time 295.0min vs. 250.0min, p = 0.015; docking time 16.0min vs. 12.0min, p = 0.001; console time 212.0min vs. 190.0min, p = 0.019). Planned procedures were successfully completed in all patients. Postoperative outcomes were acceptable with only six cases of mild adverse events through a 3-month follow-up. No local recurrence and only one case of systemic recurrence occurred within 1year postoperatively. This study demonstrated the surgical and oncological safety and feasibility of dVSP, which may be a novel surgical platform for colorectal surgery.

Single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy in ulcerative colitis; surgical technique and results of a 7-year experience

Total abdominal colectomy with end ileostomy is the first stage of the three-stage surgical treatment of medically refractory ulcerative colitis. Laparoscopic surgery is a safe approach offering several benefits. Single-incision laparoscopic surgery is an alternative minimally invasive approach providing excellent cosmetic results. Literature on single-incision laparoscopic clockwise continuous total abdominal colectomy in the treatment of ulcerative colitis is limited. Aim of the study is to describe our surgical technique and report the outcomes. Medically refractory ulcerative colitis patients who underwent single-incision laparoscopic clockwise continuous total abdominal colectomy with end ileostomy by a single surgeon between January 2013 and December 2020 at our tertiary care center are included. Patient charts were reviewed retrospectively. 52 patients were included in the final analysis. 51.9% patients were male with the median age of 31.5years and body mass index of 22.2kg/m2. Median duration of operation was 100min with estimated blood loss of 50ml. There were no intraoperative complications, conversions to conventional laparoscopy or open surgery. Postoperative complications were reported in 13 (25%) patients with most common being ileus (17.3%). 3 patients had surgical site infections. 2 patients had postoperative bleeding requiring blood transfusion. 2 patients had reoperation within postoperative 30days. Median length of hospital stay was 2days. No mortalities were reported. Single-incision laparoscopic clockwise continuous approach is safe and effective in ulcerative colitis patients undergoing total abdominal colectomy with end ileostomy. Further prospective randomized studies are warranted.

The merging of dual umbilical port-incisions for contained morcellation in laparoscopic myomectomy

Uncontained power morcellation during laparoscopic myomectomy may spread tissue fragments or malignant cells into the abdominal cavity. Recently, various approaches to contained morcellation, have been adopted to retrieve the specimen. However, each of these methods has its own drawbacks. Intraabdominal bag-contained power morcellation adopts a complex isolation system, which prolongs the operation and increases medical costs. Contained manual morcellation via colpotomy or mini-laparotomy increases the trauma and the risk of infection. Contained manual morcellation via umbilical incision during single-port laparoscopic myomectomy may be the most minimally invasive and cosmetic approach. But the popularization of single-port laparoscopy is challenging because of technical difficulties and high costs. We have therefore, developed a surgical technique using 2 umbilical port-incisions (5 mm and 10 mm), which are merged into 1 large umbilical incision (25-30mm) for contained manual morcellation during specimen retrieval, and one 5mm incision in the lower left abdomen for an ancillary instrument. As demonstrated in the video, this technique significantly facilitates surgical manipulation using conventional laparoscopic instruments while still keeping the incisions minimal. It is also economical because the use of an expensive single-port platform and special surgical instruments is avoided. In conclusion, the merging of dual umbilical port-incisions for contained morcellation adds a minimally invasive, cosmetic, and economical option to laparoscopic specimen retrieval that would enrich a gynecologist's skill set, which is particularly relevant in a low-resource settings.

Single-port laparoscopic versus single-port robotic right hemicolectomy: Postoperative short-term outcomes.

This study aimed to compare the short-term postoperative outcomes of single-port robotic (SPR) using da Vinci SP® system and single port laparoscopic (SPL) right hemicolectomy and determine whether the novel SPR system is safe and feasible. From January 2019 to December 2020, a total of 141 patients (41 patients for SPR and 100 patients for SPL) who electively underwent right hemicolectomy for colon cancer performed by a single surgeon were included in the study. The time to the first bowel movement was 3 (range, 1-4) days after surgery in the SPR group and 3 (2-9, range) days in the SPL group (p=0.017). However, there were no differences in pathologic outcomes or postoperative complications. SPR is a safe and feasible surgical technique and has an advantage in the time to first postoperative bowel movement over SPL with no other complications.

Comparison of transumbilical single-incision laparoscopic TAPP versus conventional laparoscopic TAPP in the elderly: A retrospective analysis

BackgroundTo analyze and compare the clinical efficacy of transumbilical single-incision laparoscopic surgery TAPP(SILS-TAPP) and conventional laparoscopic TAPP(CL-TAPP) in the treatment of senile inguinal hernia. MethodsFrom January 2019 to June 2021, a total of 221 elderly patients (≥60 years old) with inguinal hernia received SILS-TAPP and CL-TAPP in General Surgery Department of Affiliated Hospital of Nantong University. The perioperative indicators, postoperative complications and follow-up of the two groups were compared to explore the feasibility and superiority of SILS-TAPP in the treatment of inguinal hernia in the elderly. ResultsThere was no difference in demographic characteristics between the two groups. The mean operation time (28.6 ± 4.2 min vs 28.2 ± 5.3 min) in the SILS-TAPP group was not significantly different from that in the CL-TAPP group (Ρ = 0.623), and there was no significant increase in hospital costs(Ρ = 0.748). The intraoperative blood loss (7.4 ± 3.4 ml), VAS score on the postoperative day (2.2 ± 0.7), mean time of resuming activity (8.2 ± 1.9 h) and mean postoperative hospital stay (0.8 ± 0.2 d) in the SILS-TAPP group were better than those in the CL-TAPP group (Ρ < 0. 05).There was no statistical difference in the overall incidence of intraoperative (Ρ = 0.128) and postoperative complications (Ρ = 0.125) between the two groups. ConclusionSingle-incision laparoscopic surgery TAPP (SILS-TAPP) is feasible and effective in elderly patients, providing a new alternative surgical method for patients who can tolerate general anesthesia.

Prospective randomized comparison of three-dimensional (3D) versus conventional laparoscopy in total colectomy for ulcerative colitis.

3D laparoscopy has been proposed with the aim of improving the depth perception and overall operative performance. To aim of this study is to compare 3D laparoscopy with conventional 2D laparoscopy in terms of operative time and visual parameters. This is a prospective, randomized, single-center trial designed to determine 10% reduction in the mean operative time. Ulcerative colitis patients >18 years of age who underwent laparoscopic total abdominal colectomy with end ileostomy between 2015 and 2020 were included. Patients were randomized into 3D and 2D laparoscopy groups. Duration of operation and surgeons' evaluation of the visualization system were the primary outcomes. Fifty-three subjects (26 in 2D, 27 in 3D group) were included in the analysis, with 56% being male. Mean age and body mass index were 40 (16.3) years and 23.5 (4.7) kg/m2 , respectively. Twenty-five subjects underwent single port laparoscopic surgery, of whom 13 were in 3D and 12 in 2D group. Mean operative time was 75.3 (30.8) versus 82.7 (38.6) minutes (P=0.4) for 3D and 2D groups, respectively. Operative times spent for individual steps were comparable. Post-operative minor complications (8 in 3D versus 8 in 2D, P=1) and median number of times for scope maintenance were also similar between the groups. 69% of the visual evaluation survey results favoured 3D over 2D (P=0.014). Three-dimensional laparoscopy for total colectomy in ulcerative colitis patients is safe and feasible option providing better visualization with no difference in operative time.

Mesothelial cyst of uterus in a nullipara patient: A case report.

Uterine mesothelial cysts represent a diagnostic challenge because of their low incidence, with very few cases reported in the English literature. We report the case of a 27-year-old nullipara woman complaining of self-discovery of a mass in the abdomen for 1 week. Supersonic examination revealed a pelvic cystic lesion measuring 8.9 × 8.2 cm. The patient underwent exploratory single-port laparoscopic surgery and had a large uterine cystic mass located within the posterior wall of the uterus. After excision of the uterine cyst, the final histopathological diagnosis was uterine mesothelial cyst. We treated her with a single-port laparoscopic uterine cystectomy. Close follow-up of the case for 2 years showed that the patient was free of any symptoms, and no recurrence was noted. Uterine mesothelial cysts are extremely rare. They are often misdiagnosed by clinicians as extrauterine masses or cystic degeneration of leiomyomas. This report aims to share a rare case of uterine mesothelial cyst and improve gynecologists' academic vision of the disease.

Abstract OT3-21-01: A pilot study of robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction using da Vinci SP ® single-port system

Abstract Introduction- Robotic mastectomy is a novel breast surgery approach accessed from a concealable anterior axillary incision showing better cosmetic outcomes with a scarless front view. The oncological safety awaits further follow-up from clinical trials or registered studies to mature. Compared to older da Vinci systems with multiple arms, the new SP system is single-armed, equipped with flexible instruments and a camera that may avoid instrument collision and dead spots in the surgical field. This trial (NCT05448963) is not only the leading SP mastectomy trial in Asia but also the first one that incorporates autologous flap reconstruction. Methods- -Objectives: To determine the performance, technical algorithm, safety data, and patient-reported outcomes in single-port-accessed nipple-sparing mastectomy using da Vinci SP® system. -Study design: This study is a pilot clinical study conducted in a single-arm, non-randomized design with a goal to recruit 30 participants. The da Vinci SP ® surgical robot is applied in the nipple-sparing mastectomy and axillary lymph node dissection (if indicated) of each enrolled patient in Chang Gung Memorial Hospital Linkou Medical Center. The post-mastectomy reconstructive method may use autologous flaps or implants depending on the type of build, technical feasibility, and flap site availability of the patient. The eligibility criteria include: I. Meet at least one of the following indications of NSM for breast cancer: 1. Preoperative clinical tumor sizes less than 5 cm, with an adequate tumor-skin distance of at least 3mm and above, and without nipple-areolar involvement in at least 1cm around the nipple by image 2. Breast cancer up to stage IIIa (T3, N1-2) as the initial clinical stage showing adequate response to neoadjuvant therapy and meeting criteria 1. 3. Germline pathogenic/likely pathogenic BRCA1 or 2 mutation carriers (actionable mutations including pathogenic and likely pathogenic mutations) with a breast cancer diagnosis or requiring unilateral or bilateral prophylactic mastectomy as a risk reduction procedure II. Age equal to or above 20 years III. ECOG (Eastern Cooperative Oncology Group) performance score 0-1 IV. ASA anesthesia risk class 1~2, and with adequate organ functions Endpoint measures: -Primary endpoint: Ability to complete nipple-sparing mastectomy with da Vinci SP system in the per-protocol population. -Secondary endpoints: Safety measured by adverse events through 30-day post-operative follow up -Exploratory endpoints: Surgical time, blood loss, hospital stay, breast specimen weight, cancer resection margin, nipple-preservation rate morbidity and mortality rate within 30 days of operation, and reoperation within 30 days post-surgery -Statistical analysis: Point estimation with a 95% confidence interval will be used to analyze the mean or proportion of key performance parameters. No interim analysis will be performed due to the limited number intended to recruit. -Trial status: Active recruitment Conclusion: The single-port robotic system features single port access with multi-jointed instruments which is particularly designed for narrow surgical spaces such as mastectomy. The feasibility of applying da Vinci SP systems to robotic nipple-sparing mastectomy and robiotic axillary lymph node dissection will be demonstrated in this study. Citation Format: Wen-Ling Kuo, Chia-Huei Chu, Jung-ju Huang. A pilot study of robot-assisted nipple-sparing mastectomy followed by immediate breast reconstruction using da Vinci SP ® single-port system [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-21-01.

Abstract P2-14-12: Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases

Abstract Purpose: The purpose of this study is to to introduce an early experience of endoscopic nipple-sparing mastectomy (NSM) combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Methods and Materials: Between November 2018 and June 2022, 48 female patients with breast cancer, total 50 cases of breast cancer (bilateral breast cancer in 2 patients) were treated with endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision. Forty-six patients, total forty-eight cases, underwent breast reconstruction with silicone implant, two patient underwent TRAM reconstruction. Surgical procedures of endoscopic NSM: Patients were placed in a supine position with both upper limbs on arm boards abducted 90 degree. An incision of 5 cm was made along the anterior axillary line from the inferior mammary fold. The sentinel lymph node was excised through the incision. .A workspace for the insertion of a Glove Port (Nelis, Republic of Korea) was created within a radius of 3 cm from the incision, and the subcutaneous tissue flaps were raised. The Glove Port was inserted first into the retromammary space, carbon dioxide (CO2) gas was insufflated, and the pressure was maintained at approximately 7 mmHg. The retromammary space dissection was performed with caution to avoid dissecting the interpectoral space, using an energy device and an endoscopic grasper guided by a flexible endoscope (ENDOEYE FLEX 10 mm, OLYMPUS, Japan). The breast was elevated to the edge of the latissimus dorsi muscle laterally, to the thoracoabdominal aponeurosis inferiorly, to the level of the clavicle superiorly, and to the edge of the sternum medially. After dissecting the retromammary fat plane, the Glove Port was relocated into the subcutaneous space. Skin flap was dissected using an energy device, and the duct beneath the nipple was cut off using endoscopic scissors. The subcutaneous flap was dissected completely along the boundaries of the breast, and the entire breast was removed Results: The patients were 30-55 years old (mean, 43 years). The tumor located at the left breast in 26 cases and at the right breast in 23 cases. The diameter of tumor ranged from 1.5 to 5.2 cm (mean, 3.4 cm). Median operation time was 153 minutes. After operation, nipple necrosis or skin flap necrosis was not observed. No subcutaneous emphysema occurred. There is one tumor involvement to nipple in postoperative pathological examination. So, excision of nipple-areolar-complex was performed 2 weeks after first operation. All patients were followed up 1-43 months (median, 19 months). According to the Harris assessment criteria for appearance of reconstructed breast, there were 43 cases of excellent and 7 cases of good. No tumor recurrence or metastasis occurred during follow-up. Conclusion: It is a safe and feasible method of endoscopic NSM combined with immediate breast reconstruction through simple single-port access that placed in axillary incision, and can obtain good cosmetic results. It is a new option to breast reconstruction. Citation Format: HYEYOON LEE, Kyusang Cho, YOUNGWOO CHANG, GILSOO SON. Endoscopic Nipple-Sparing Mastectomy: A single Institutional Experience of 50 Consecutive Cases [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-14-12.

Laparoscopic surgery of large adnexal masses (>12 cm): Single port or conventional?

We aimed to compare single-port laparoscopic surgery (SPLS) and conventional multiport laparoscopic surgery (CMLS) for large adnexal mass (AM). Patients undergoing laparoscopy (LS) due to huge AMs (≥12 cm) between 2016 and 2021 were evaluated retrospectively. The SPLS procedure was applied in 25 cases, and CMLS was performed in 32 cases. The premier result was the grade of the postoperative improvement according to the Quality of Recovery (QoR)-40 questionnaire score (24 h after the surgical procedure; postoperative day 1). Observer Scar Assessment Scale (OSAS) and Patient Observer Scar Assessment Scale (PSAS) were also evaluated. A total of 57 cases undergoing SPLS (n=25) or CMLS (n=32) due to a large AM (≥12 cm) were analyzed. No meaningful distinctions in age, menopausal status, body mass index, or mass size were observed between the two cohorts. The operation time was shorter in the SPLS than CPLS cohort (42.2 ± 3.3 vs. 47.6 ± 6.2; p < 0.001). Unilateral salpingo-oophorectomy was performed in 84.0% of cases in the SPLS cohort and 90.6% of patients in the CMLS cohort (p=0.360). The QoR-40 points were significantly higher in the SPLS than the CMLS group (154.9 ± 12.0 vs. 146.2 ± 17.1; p=0.035). The OSAS and PSAS scores were lower in the SPLS than the CMLS group. LS can be used for large cysts that are not considered to be at risk of malignancy. The postoperative recovery time was shorter in patients undergoing SPLS compared to CMLS.

Single incision laparoscopic right hemicolectomy: incisional hernia rate and postoperative pain management

Background: Single incision laparoscopic surgery (SILS) is a relatively new minimal invasive surgical technique for abdominal surgery compared to the multiport laparoscopic surgery. It has shown to have cosmetic advantages and has the potential to reduce postoperative pain and length of hospital stay. However, a drawback of SILS appears to be a higher incisional hernia rate. It is still unclear whether this rate is related to a larger incisional length or location of the incision. The aim of this study was to determine whether right hemicolectomy performed with SILS affected the postoperative incisional hernia rate.

Design and modelling of an anisotropic continuum robot end-effector for single-port access surgery suturing

Single port access surgery has brought many advantages and new challenges to the field of minimally invasive surgery. In principle, many of these challenges can be addressed through robotics. Continuum robots in particular have seen a surge in interest in recent years for their miniaturisation potential. However, many applications with these robots have been developed for contactless or low-force tasks. This paper tackles several barriers to high-force tasks with continuum robots such as suturing for Open Spina Bifida repair. A novel continuum robot end-effector is proposed. The end-effector is composed of a distal bending segment and hybrid gripper. First, the novel hybrid gripper specifically designed for continuum robots is introduced. The hybrid gripper can function both as a general surgical gripper and as a needle driver while overall keeping the required input force limited. Second, an optimisation of the continuum structure of the distal bending segment is conducted. The objective of this optimisation is to sustain high tip forces – required by the said high-force contact tasks – while keeping deformations acceptable. Third, a quasi-static model that predicts the coupled effect of bending and gripping is derived. This model predicts the deformation of the continuum structure that is induced by the gripping action itself. It could hence be used to compensate for such deformation and establish a stable grip with the otherwise flexible instruments. Finally, experiments are conducted to validate the new designs and the model. The hybrid gripper has a diameter of [Formula: see text] mm, a length of [Formula: see text] mm and can hold securely a needle with a [Formula: see text] N input force, outputting a [Formula: see text] N gripping force. The optimised bending segment is validated for Open Spina Bifida suture: it can bend freely up to 90° and it can support a [Formula: see text] N tip load up to a 35° bending angle. The bending and gripper model error varies between 1% and 14.55%, yielding useful results to predict the shape of the bending segment and potentially compensate for the disturbance created by actuating the gripper.

SINGLE PORT LAPAROSCOPIC CONGENITAL INGUINAL HERNIA REPAIR

Aim and Objectives:The present study was undertaken to evaluate the effectiveness of single port laparoscopy incongenital inguinal hernia repair with respect to operative time, intra and postoperative complications, hospital stay and rate of recurrence. Materials And Methods: Total 30 patients of age between 2-15 years admitted with diagnosis of congenital inguinal hernia, unilateral or bilateral hernia, with reducible non obstructive, primary were included in the study. All cases were performed under general anaesthesia by using a modication of technique described by Ozgediz et al. Results: Among 30 patients, 25 (83.3%) were male and 5 (16.7%) were female. Maximum numbers of patients were in the age group of ≤5 years (56.7%) with mean age of patients was 6.39 ± 3.43 years. Most of the patients (17; 56.7%) had right inguinal hernia. Mean operative time required was 16.23±4.39 minutes. Only in one patient (3%) extra port placement needed to reduce the contents of hernia. Intra operatively, one patient (3.3%) had retro peritoneal hemorrhage and post operatively one patient (3.3%) had complained of nausea for some hrs. The mean hospital stay was 1.48±0.58 Day. There was no recurrence occur in any case. Conclusion: In the paediatric population, single port laparoscopic inguinal hernia repair can be performed safely. This enables extension of the advantages of reduced access surgery to patients with limited resources to be handled. It also incorporates the benet of being fast, shortened operating time and better cosmesis. The benet of limited instrumentation and the intracorporeal knotting avoidance makes this a feasible technique

A Feasible Technique for Transoral Endoscopic Thyroidectomy Through Vestibular Access Using a Single-port Technique: A Video Vignette in Cadaver Dissection

The aim of this study was to evaluate the safety and feasibility of a single-port system for transoral endoscopic thyroidectomy with vestibular access (TOETVA). Two embalmed human cadavers were used to test the single-port technique. After positioning, a median vestibular incision was made. Adipose tissue was dissected through the mentum with a Kelly clamp to reach the subplatysmal level. The Keyport Single Port System (Richard Wolf) was then inserted. After port placement, flexible endoscopic dissectors and a 5-mm endoscope were advanced. After removing the dissectors, we inserted the ArtiSential laparoscopic instruments. We also used a 3-port TOETVA on another human cadaver to compare the results with those of the single-port surgery. In the first cadaver, skin tension was observed during trocar insertion and dissection. Trocar insertion resulted in skin perforation in the submental area. In the second cadaver, the single-port trocar was successfully inserted despite the significant skin tension. However, the trocar did not allow the necessary surgical maneuvers to proceed with subsequent surgical steps and create a working space. Postprocedural anatomic dissection revealed that the distal branches of the mental nerve were related to the trocar passage. Our cadaver study demonstrated that single-port TOETVA is unsafe and not feasible with the current technology of the Keyport single-port system. This approach needs to be improved to perform this technique without injury to distal branches of the mental nerve, skin perforation, and other complications.