Small Umbilical Incision Research Articles

Omphalomesenteric Ducts and Urachal Remnants: A Retrospective Study and Case Series.

The management strategies for umbilical disorders remain undefined. This study aims to review our experience and propose a management algorithm for symptomatic urachal and omphalomesenteric duct anomalies. We retrospectively reviewed medical charts between January 2013 and September 2017 of 28 patients with clinical concern for umbilical disorders, out of which 10 were diagnosed with omphalomesenteric duct remnants (OMDR) or urachal remnants (UR). We assessed patients' sex, age at operation, initial presentation, imaging findings, surgical approach, histopathological findings, and prognostic outcome. Among 10 patients with OMDR or UR, initial presentations were omphalitis in four, umbilical discharge in three, abdominal pain in two, and umbilical mass in one. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging (MRI), and voiding cystourethrography were performed in 10, seven, three, and four patients, respectively. Transumbilical extraperitoneal excision from a small expanded umbilical incision and laparoscopic approach combined with transumbilical excision was performed in eight and two patients, respectively. Postoperative wound infection occurred in 10% of patients. Ultrasonography was mostly used as an initial diagnostic modality, and in cases in which there were signs of infection, they were drained adequately; CT/MRI was chosen for further evaluation of suspicious cases for other complications. Thus, we recommended surgical excision in cases with persistent umbilical disorders. The umbilical approach displays good cosmetic results with easy, complete excision, and the laparoscopic approach could be an excellent diagnostic and therapeutic method for the management of complicated conditions.

Neonatal presentation of transected sigmoid colon following umbilical cord clamping: Hernia of umbilical cord

The umbilicus is a site of numerous embryopathies involving vessels, urachus, mid gut herniation, anterior abdominal wall defects and congenital cysts. Owing to lack of awareness, umbilical cord hernia (HUC) is often misdiagnosed and underreported, with limited data in the literature. We report an isolated case of congenital HUC and perinatal transection of the sigmoid colon during cord ligature by a midwife in a local health center. A six-day old female neonate presented with discharge of fecal matter through the umbilicus. The clamped cord, became swollen and auto-amputated on day of life three, after which fecal discharge was from the stump was noted. On examination a visible bowel loop containing stool was seen in the umbilical cord. We proceeded with surgical intervention via a small umbilical incision, with findings of transection of the sigmoid colon, no peritoneal contamination, and primary anastomosis was performed. There was event free recovery postoperatively. HUC is poorly understood and often misdiagnosed as omphalocele minor. One should be cognizant of HUC when noting swelling at the base of the cord so as to avoid any inadvertent iatrogenic enterotomy by close umbilical clamping.

Application of morcellation through small umbilical incision in laparoscopic myomectomy

To investigate the effect of morcellation through small umbilical incision in laparoscopic myomectomy. A total of 67 patients who underwent laparoscopic myomectomy in the Second Affiliated Hospital of Soochow University from February 2018 to October 2019 were retrospectively analyzed. Fibroids were loaded into disposable laparoscopic collection bags and then retrieved through small umbilical incision. The operation of all 67 patients were successfully completed. There were no leakage of collection bags or fibroids fragments found in the peritoneal cavity and the puncture holes. There were no spindle cells or malignant cells found in the peritoneal lavage cytology before and after operation. There were 64 cases of uterine leiomyoma, 2 cases of cellular leiomyoma, and 1 case of leiomyoma with cystic degeneration in postoperative pathological diagnosis. The weight of fibroid was 110-420 (227±106) g; the operation time was 58-274 (107±45) min; the time for retrieving specimen was 8-27 (18.4±10.6) min; the time for suturing umbilical incision was 4-11 (7.8±4.6) min; the score of pain numeric rating scale (NRS) at 24 h, 48 h, 72 h after operation was 4-6 (4.5±1.2) points, 2-4 (2.7±1.1) points, and 1-2 (1.6±0.4) points, respectively; the Hollander wound evaluation score was 3-5 (4.6±0.5) points. The umbilical incisions looked and healed well after operation. Morcellation through small umbilical incision in laparoscopic myomectomy is a safe and practical method of specimen removal, which may help to reduce the dissemination of iatrogenic tumors.

Comparison of postoperative pain after needle grasper-assisted single-incision laparoscopic appendectomy versus single-incision laparoscopic appendectomy: a prospective randomized controlled trial (PANASILA trial).

PurposeThis study was performed to compare the efficacies of newly developed needle grasper-assisted (Endo Relief) single-incision laparoscopic appendectomy (NASILA) and single-incision laparoscopic appendectomy (SILA).MethodsThis study enrolled 110 patients with acute appendicitis without periappendiceal abscess, diagnosed using computed tomography, who were randomized to the SILA (n = 54) and NASILA groups (n = 56) between December 2017 and August 2018 (6 patients withdrawn). The NASILA technique entailed a small umbilical incision for the glove port (equivalent to that for a 12-mm trocar), and a 2.5-mm suprapubic incision for the needle grasper.ResultsThe SILA and NASILA groups included 49 (male, 61.2%) and 55 (male, 54.5%) patients, respectively. Age, body mass index, abdominal surgical history, symptom duration, and use of patient-controlled analgesia did not differ significantly between the 2 groups. The main wound size was significantly smaller in the NASILA group than in the SILA group (1.8 ± 0.4 cm vs. 2.2 ± 0.4 cm, P < 0.001). The operative time and estimated blood loss did not differ significantly between both groups. The immediate postoperative pain score, i.e., the primary endpoint, was significantly lower in the NASILA group than in the SILA group (2.33 ± 0.98 vs. 2.82 ± 1.29, P = 0.031). The complaints for scar status 1 month postoperatively did not differ significantly between the groups.ConclusionNASILA could attenuate postoperative pain by minimizing the size of the surgical wound; further, NASILA may not be inferior to SILA in terms of cosmetic results.

Single-incision laparoscopic surgery portal vein embolisation before extended hepatectomy.

Objective:Portal vein embolisation (PVE) represents the standard procedure for augmentation of the contralateral lobe before extended right hepatectomy. However, possible limitations for the percutaneous transhepatic approach exist, for example, large tumours of the right lobe. Here, we present our experiences with single-incision laparoscopic surgery-PVE (SILS-PVE) as an alternative approach for settings where percutaneous routes are technically not feasible.Methods:A small umbilical incision is performed, and a GelPOINT Mini Advanced Access Platform (Santa Margarida, CA, USA) is placed. Staging laparoscopy is performed routinely followed by identification of an appropriate ileal segment, which is subsequently exteriorized through the small umbilical incision. A peripheral mesenteric vein is encircled and cannulated to access right portal vein branches. After sufficient embolisation of the right lobe, the peripheral vein is ligated, the single port is extracted and the umbilical wound is closed.Results:SILS-PVE was successfully applied in 10 patients (median age 60.5 years) between 12/2015 and 03/2018. The technique was indicated due to extensive tumours in the right lobe (n = 8), extensive hydatid cyst (n = 1) and during SILS right hemicolectomy in Stage IV colon cancer (n = 1). Mean operative time was 184 min (range 116–315). Patients were discharged on post-operative day 4 (range 2–9). Augmentation of the future liver remnant volume was assessed by computed tomography-volumetry 3–4 weeks after SILS-PVE and showed a mean relative increase of 64.95%, future remnant liver function showed a mean increase of 120.77%.Conclusion:The proposed SILS-PVE represents a technically simple and safe alternative to standard percutaneous transhepatic approaches. Perioperative risks can be minimised by minimally-invasive surgery, which is of explicit importance in multimodal approaches before major hepatectomy.

Single Incision Laparoscopic Complete Mesocolic Excision with Central Vascular Ligation for Advanced Transverse Colon Cancer Using Pincer Movement Method

Introduction: Single incision laparoscopic techniques1–3 for advanced transverse colon cancer are technically difficult to perform with a complete mesocolic excision (CME) with central vascular ligation (CVL). The main reason for this technical difficulty lies in the limited access to the abdominal cavity and anatomical complexity around the middle colic vessels (MCVs). This video describes a pincer movement method using an internal organ retractor to effectively complete the dissection around the MCVs for a tranverse colon cancer. Methods: The pincer movement method refers to an original strategy used to simplify the anatomical complexity around the MCVs by approaching the transverse mesocolon caudally and cranially. This method approaches the MCVs from both sides of the transverse mesocolon to safely complete the actual circumferential dissection around the base of the MCVs at the superior mesenteric artery (SMA) and superior mesenteric vein (SMV). A 2.5 cm Z type skin incision is made, and an access platform is placed in the small umbilical incision area. The ascending colon is mobilized and the hepatic flexure is dissected using a conventional medial-to-lateral retroperitoneal approach. The omentum is divided, and the divided omentum is retracted toward the cranial space to maintain a working space by using internal organ retractors. The fascia along the inferior border of the pancreas is then transected. As a result, intraoperative pancreatic injury is avoided by securing a free space around the MCVs. Lymph nodes along SMA/SMV can be safely dissected caudally and cranially. The single incision CME with CVL can be completed along with an extracorporeal anastomosis. Results: Single incision CME for advanced transverse colon cancer was performed for nine patients.4–6 There were four men and five women. The mean age of the patients was 66.5 ± 6.9 years (range 58–79) and the mean body mass index was 22.7 ± 3.8 kg/m2 (range 19–25). All procedures were effectively completed and there were no postoperative complications such as anastomotic leakages, bleeding, ileus, wound infections, or hernias. The length of hospital stay was 9 days. In the final pathologic staging, there were two patients with stage I, two patients with stage II, and five patients with stage III. The mean tumor diameter was 4 cm, the mean tumor-free resection margin was 11 cm, and the mean harvested lymph nodes were 25. Conclusion: Single incision laparoscopic CME with CVL for advanced transverse colon cancer is safe and feasible using the pincer movement method. Acknowledgment: We express our sincere thanks to Prof. Masaki Fukunaga for valuable comments on this article. No competing financial interests exist. Consent for the publication of this case report and any additional related information was taken from the patient involved in the study. Runtime of video: 8 mins 50 secs

Strangulated right paraduodenal hernia successfully treated with single-incision transumbilical surgery

Abstract Right paraduodenal hernia (RPH) has been recently reported to be treated with laparoscopic surgery. We report a case of strangulated ileus that occurred as a result of RPH treated via a small umbilical incision. An 11-year-old boy presented to our hospital with complaints of sudden upper abdominal pain associated with bilious vomiting and bloody stool. We preoperatively diagnosed the case to be strangulated ileus caused by an internal hernia and thus performed emergency surgery. After the entire small intestine was carefully exteriorized via a small umbilical incision, a strangulated ileus as a result of the internal hernia was observed. A large hernia sac with its orifice on the right side of the jejunal origin was found behind the right mesocolon, on the basis of which the diagnosis of RPH was made. After releasing the strangulation, the ischemic intestine was reperfused. The hernia orifice was closed. All the abovementioned procedures were transumbilically performed. The patient's postoperative course was uneventful. An umbilical approach is useful for treating RPH because of its favorable cosmetic outcome. In addition, manual delivery of the herniated or incarcerated intestine provides a sense of safety compared with operation using forceps during laparoscopic surgery.

Robotic valvuloplastic esophagogastrostomy using double flap technique following proximal gastrectomy: technical aspects and short-term outcomes.

Valvuloplastic esophagogastrostomy by double flap technique (VEG-DFT) is a promising procedure to prevent reflux after proximal gastrectomy (PG), and is achieved by the burial of the abdominal esophagus into the gastric submucosa; however, laparoscopic VEG-DFT is technically demanding due to complicated suturing and ligation maneuvers. The present study was designed to determine the feasibility and safety of robotic VEG-DFT. After robotic PG, seromuscular flaps were extracorporeally created at the anterior wall of the remnant stomach through a small umbilical incision. Then, using a robot, the posterior wall of the esophagus was fixed to the cranial end of the mucosal window, and layer-to-layer sutures were placed between the anterior aspects of esophagus and the remnant stomach. Finally, the anastomosis was covered by seromuscular flaps. Short-term outcomes of 12 consecutive patients who underwent VEG-DFT between January 2014 and December 2015 were assessed. Operations were successfully completed using robotic assistance in all patients. Median operative, surgeon console, and anastomosis times were 406 (324-613 min), 267 (214-483), and 104 (76-186) min, respectively, and median estimated blood loss was 31 (5-130) ml. The first six cases were required to reach a learning plateau. Both mortality and morbidity rates within 30 days after surgery were 0%. Postoperative hospital stay was 10 (9-30) days. No postoperative reflux esophagitis was observed, whereas anastomotic stenosis, which required endoscopic balloon dilation, developed in three patients (25%) in postoperative month 2. There was a significant association between the total number of stitches used for VEG-DFT and anastomotic stenosis (p < 0.001). Robotic assistance may be useful for VEG-DFT with a short learning curve. Attention is required to prevent postoperative anastomotic stenosis possibly caused by an excessive number of stitches for esophagogastrostomy.

Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis - Early Results.

Symptomatic umbilical and/or epigastric hernias are often seen concomitantly with rectus abdominis diastasis (RAD), and suture repair of such defects has a high recurrence rate. In the literature, there are reports of both endoscopic and open techniques for repair of symptomatic umbilical and/or epigastric hernias in association with RAD. This paper now reports on the early results of a hybrid technique used for reconstruction of the linea alba and mesh augmentation [endoscopic-assisted linea alba reconstruction plus mesh augmentation (ELAR plus)]. Between 15 June 2015 and 31 January 2016, 40 patients with symptomatic umbilical and/or epigastric hernia and concomitant RAD underwent reconstruction of the linea alba using a hybrid technique involving a small umbilical incision and the use of video-endoscopic equipment. The patients comprised 29 men and 11 women with a mean age of 53.6 years and mean BMI of 32.6. The mean operating time was 120 min. The mesh had a mean longitudinal extension of 18.6 cm and transverse extension of 9.1 cm. Thirty-day follow-up results are available for all patients. Thirty-seven out of 40 patients (92.5%) experienced no postoperative complication. Two cases of discrete impaired umbilical wound healing and one seroma were successfully managed with conservative treatment. On 30-day follow-up, 3 out of 40 patients (7.5%) complained of intermittent pain on exertion, and 2 out of 40 patients (5%) still took painkillers when required. ELAR plus is a novel minimally invasive procedure for repair of symptomatic umbilical and/or epigastric hernias with concomitant RAD. Reconstruction of the linea alba via a minimally invasive access route is able to restore the normal anatomy of the abdominal wall.

Single-Incision Laparoscopic Surgery for Undiagnosed Small Bowel Obstruction in a Patient without a History of Abdominal Surgery.

We herein report a 66-year-old female patient who developed an undiagnosed small bowel obstruction without a history of prior abdominal surgery and was successfully treated by single-incision laparoscopic surgery. A small bowel obstruction with unknown cause typically requires some sort of surgical treatment in parallel with a definitive diagnosis. Although open abdominal surgery has been generally performed for the treatment of small bowel obstructions, laparoscopic surgery for small bowel obstructions has been increasing in popularity due to its less invasiveness, including fewer postoperative complications and a shorter hospital stay. As a much less invasive therapeutic strategy, we have performed single-incision laparoscopic surgery for the treatment of an undiagnosed small bowel obstruction. We were able to make a definitive diagnosis after sufficient intra-abdominal inspection and to perform enterotomy through a small umbilical incision. Single-incision laparoscopic surgery appears to be comparable to conventional laparoscopic surgery and provides improved cosmesis, although it is an optional strategy only applicable to selected patients.

Natural orifice specimen extraction using prolapsing technique in single‐incision laparoscopic colorectal resections for colorectal cancers

It is often technically difficult to cut the lower rectum with an endoscopic linear stapler in single-incision laparoscopic colorectal resections (SILC) because some surgical devices are inserted through the same access platform. If the rectum is cut incorrectly, it may cause anastomotic leakage. We recently applied natural orifice specimen extraction (NOSE) using the prolapsing technique to overcome this technical difficulty in SILC procedures in selected patients. The access platform is placed in the small umbilical incision area. SILC is performed using a surgical technique similar to the conventional laparoscopic medial-to-lateral approach. The proximal part of the tumor site is transected with laparoscopic staplers. Then, the tumor lesion and bowel are pulled out of the body through the anus by means of inversion. Next, the distal side of the bowel is cut with a stapler and the rectal stump is reinforced with sutures under direct vision. The distal side of the bowel is then pushed back into the body. NOSE with prolapsing technique is then complete. After that, the anvil is attached to the proximal part of the bowel at the umbilical incision site, and intracorporeal anastomosis is performed. NOSE with prolapsing technique was applied in 14 SILC procedures for colorectal cancer patients. All procedures were successful, and there were no anastomotic leakages in the series. This technique enabled us to perform pure SILC safely without affecting cosmesis, even in cases where we needed to cut the lower rectum.

Laparoscopic management of primary intestinal trichobezoar

We report a rare case of primary small intestinal trichobezoar in a 5-year-old girl presenting as subacute intestinal obstruction. Clinical, radiological, endoscopic, and laparoscopic investigations suggested the diagnosis. Most reported cases use diagnostic or laparoscopic assisted removal mainly in the adults. We describe the complete laparoscopic removal of a primary intestinal trichobezoar without significant spillage. A retrieval bag allowed the trichobezoar to be removed via a small umbilical incision before closing the enterotomy.

Single-site umbilical laparoscopic pyloromyotomy

Laparoscopic pyloromyotomy was first reported 20 years ago. This technique uses a small umbilical incision and 2 small upper abdominal incisions. During the last 5 years, this approach has become the preferred technique for many pediatric surgeons in the infant who needs a pyloromyotomy. Recently, with the advent of single-site umbilical laparoscopic surgery, this approach is being used for several common pediatric conditions, including pyloric stenosis. This article will describe the single-site approach used at the Children's Hospital of Alabama and the early outcomes from its use in a relatively small group of infants. An improvement in the cosmetic appearance of the abdominal wall with the single-site approach appears to be the primary reason for its use.

Single-incision laparoscopic appendectomy using conventional instruments: an initial experience using a novel technique

Laparoscopic appendectomy has gained wide acceptance. This study aimed to evaluate the feasibility, safety, and cosmetic results of a novel technique: single incision laparoscopic (SIL) appendectomy. The study enrolled consecutive patients undergoing appendectomy for acute appendicitis. Appendectomy was performed using three trocars and conventional laparoscopic instruments through a single small umbilical incision (length, ~3 cm). The patients received standard pre- and postoperative care and presented for a follow-up visit after a mean of 27 days. The study cohort consisted of 26 patients (10 women and 16 men) with an average age of 44 years (range, 13-83 years). Of 26 appendectomies, 22 (85%) were achieved through a single surgical site. The mean SIL appendectomy operative time was 58 min (range, 33-107 min). No operative complications occurred. The average postoperative hospital stay was 1.2 days for nonperforated appendicitis and 2.7 days for perforated appendicitis. At the follow-up visit, no patient showed any evidence of incisional hernia. The operative incisions were minimally visible, and all the individuals reported a highly favorable cosmetic outcome. The results of the study demonstrated that laparoscopic appendectomy can be achieved through a single umbilical incision using conventional instruments and that this approach is successful, safe, and aesthetic.

Single-Incision Laparoscopic-Assisted Right Colon Resection for Cancer

We present an approach to laparoscopic right colon resection utilizing a single port placed through the umbilicus. The technique described is performed through a single small umbilical incision with a virtually scar-free result. A 77-year-old woman with a tubulovillous adenoma in her cecum underwent a laparoscopic right colectomy using a single port placed through the umbilicus. Straight and reticulating laparoscopic instruments were utilized. The total operative time was 112 minutes. No intraoperative or postoperative complications occurred. The patient was discharged home on day 5 postoperatively with normal bowel function and tolerance of a solid diet. Laparoscopic right colectomy can be safely performed through a single incision through the umbilicus with an excellent cosmetic result.

Single-incision laparoscopically assisted colectomy using standard laparoscopic instrumentation

A prospective case series of transumbilical single-incision laparoscopic colectomies using conventional laparoscopic trocars and instruments is described. Seven selected patients with colonic neoplasm underwent transumbilical SIL colectomy between November 2008 and March 2009. Three trocars via a single small umbilical incision were used. The bowel was mobilized and the vessels ligated intracorporeally with an extracorporeal anastomosis. This series of seven patients (6 men and 1 woman) had no conversion to standard multiport laparoscopy or open surgery. Six of the patients had pathology in the right colon, and one had a carcinoma at the splenic flexure. The patients had an average age of 71 years (range, 63-83 years) and an average body mass index (BMI) of 24.3 kg/m(2) (range, 21-28 kg/m(2)). The average operating time was 89 min (range, 75-115 min). No significant blood loss or complications occurred. The average length of hospital stay was 5.4 days (range, 4-11 days). The average incision length was 3.1 cm (range, 2.5-4.5 cm). Histopathology showed adequate tumor excision margins and an average lymph node yield of 15 nodes (range, 7-26 nodes). Single-incision laparoscopic surgery for colectomy is feasible. It can be performed without specialized instrumentation and at no extra cost. Further evaluation is required.

Early experience with single incision laparoscopic surgery: eliminating the scar from abdominal operations

Purpose Single incision laproscopic surgery (SILS) involves performing abdominal operations with laparoscopic instruments placed through a single, small umbilical incision. The primary goal is to avoid visible scarring. This is the first report of SILS cholecystectomy in children and the first report in the literature of SILS splenectomy. Methods A retrospective chart review was performed in 20 consecutive inpatient SILS procedures (13 males, 7 females; ages 2-17 years) from May to December 2008. Outcome measures included need for conversion, operative time, time to oral analgesia, length of hospitalization, cosmetic outcome, and complications. Results There were 4 total splenectomies, 3 cholecystectomies, 2 combined splenectomy/cholecystectomies, and 11 appendectomies performed. All procedures were completed successfully without need for conversion to standard laparoscopy or open surgery. Mean operative time was 90 minutes for splenectomy, 68 minutes for cholecystectomy, 165 minutes for combined splenectomy/cholecystectomy, and 33 minutes for appendectomy. Mean hospital stay was 1 day for appendectomy, 1 day for cholecystectomy, and 2.5 days for splenectomy. One splenectomy patient received 1 U packed red blood cell transfusion. All appendectomy patients were converted to oral analgesia within 24 hours and splenectomy patients within 48 hours. All families were very pleased with the cosmetic outcome. Conclusion Single incision laparoscopic surgery is feasible for a variety of pediatric general surgical conditions, allowing for scarless abdominal operations. This early experience suggests that outcomes are comparable to standard laparoscopic surgery but with improved cosmesis, however, a larger series is necessary to confirm these findings and to determine if there are any benefits in pain or recovery. Surgeons performing SILS should have a firm foundation of advanced minimal access surgical skills and a cautious, gradated approach to attempting the various procedures. Technological refinements will further enable SILS.

Transumbilical Single-Port Laparoscopic Appendectomy (TUSPLA): Scarless Intracorporeal Appendectomy

Laparoscopic appendectomy is generally performed with the three-port system. In this study, we performed a unique single-port laparoscopic appendectomy, which we refer to as the transumbilical single-port laparoscopic appendectomy (TUSPLA). From April 19, 2008, 33 cases of TUSPLA were performed. A surgical glove was used as the "single-port" with an extra-small wound retractor, which was set up through a small umbilical incision. The surgical glove attached with one trocar and two pipes were then fixed to the outer ring of the wound retractor, which served as a single port with three working channels. Using this single-port system, TUSPLA was performed. The overall procedure was similar to that used for the three-port laparoscopic appendectomy. TUSPLA was attempted in 33 patients (11 males and 22 females), with an average age of 31.2 years (range, 14-73). Average patient body mass index was 22.8 kg/m2 (range, 16.8-35.8). TUSPLA was successfully completed in 31 patients. In 2 cases, the operation was converted to the conventional three-port laparoscopic appendectomy due to a gangrenous change at the base of the appendix in 1 case and the need for drainage in another. Mean operation time was 40.8 minutes (range, 15-90), and mean postoperative hospital stay was 2.5 days (range, 1-11). Postoperative complications occurred in 3 cases; 2 cases were of localized pericecal abscess and 1 case was of omphalitis, and all were treated conservatively. TUSPLA is a safe, effective technique that allows nearly scarless abdominal surgery.

Transumbilical single-port laparoscopic cholecystectomy

Many laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. We performed transumbilical single-port laparoscopic cholecystectomy (TUSPLC) in 15 patients with cholelithiasis by using a special "single-port" with virtually no scar. We used an extra-small wound retractor and a surgical glove as the "single-port." The wound retractor was set up through the small umbilical incision and the surgical glove attached with one trocar and two pipes was then fixed to the outer ring of the wound retractor. The commonly used trocar and two slim pipes attached to the surgical glove served as three working channels. Using this single-port and conventional laparoscopic instruments, such as a straight 5-mm dissector, grasper, scissors, and a 30-degree 5-mm rigid laparoscope, we performed TUSPLC in 15 patients with cholelithiasis. The overall procedure was similar to three-port laparoscopic cholecystectomy. Fifteen well-selected patients with cholelithiasis underwent TUSPLC (4 males and 11 females; mean age, 39 (range, 29-63) years). Body mass index ranged from 20 to 34 (mean, 25.2). No case required extra-umbilical skin incisions or conversion to standard laparoscopy. The mean operative time was 79 (range, 35-165) min. Blood loss was minimal in all cases. The mean postoperative hospital stay was 1.6 (range, 1.0-2.5) days. No postoperative complications were observed. The results of our initial experience of TUSPLC in 15 well-selected patients with cholelithiasis are encouraging. All procedures were completed successfully within a reasonable time. No extra-umbilical incisions were used and virtually no scar remained. TUSPLC could be a promising alternative method for the treatment of some patients with symptomatic gallstone disease as scarless abdominal surgery.

Cryoablation for breast cancer: No need to turn a cold shoulder

Cryoablation for breast cancer: No need to turn a cold shoulder