Transumbilical Laparoscopic Surgery Research Articles

Retracted: Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China.

[This retracts the article DOI: 10.1155/2022/8246761.].

Hysterectomy by Transvaginal Natural Orifice Transluminal Endoscopic Surgery versus Transumbilical Laparoscopic Single-Site Surgery: A Single-Center Experience from East China.

Objective To compare hysterectomy by transvaginal natural orifice transluminal endoscopic surgery (VNOTES) versus transumbilical laparoscopic single-site surgery (LESS) as a minimal invasive technique. Materials and Method. The women undergoing hysterectomy for benign diseases by VNOTES and LESS from January 2020 to June 2021 in a tertiary hospital in Shanghai were retrospectively analyzed. Results 361 women were included in our study, with 228 in the VNOTES groups, 129 in the LESS groups, and 4 conversions from VNOTES to LESS technique. The length of a VNOTES hysterectomy was shorter than that of LESS (80.76 min versus 112.09 min; MD -31.34 min; 95% CI -40.24 to -22.43 min; P < 0.001). VNOTES hysterectomy has a quicker gas passage by the anus (18.80 versus 36.49 hours, MD -17.68 hours, 95% CI -20.23 to -15.14 hours, P < 0.001) and associated with a shorter length of hospital stay (2.31 versus 3.77 days, MD -1.46 days, 95% CI -1.75 to -1.17 days, P < 0.001), while with no increase in blood loss during the operation (median 50 versus 50 ml, P = 0.25). Besides, the VAS pain score in the 24th hour after the operation was lower (median 0 versus 0.5, P < 0.001) in the VNOTES group. Four unique phases of the learning curve were identified using cumulative analysis: the mean operation time of phase I was 82.81 ± 31.45 min (the initial learning curve of 43 cases), phase II was 72.48 ± 23.66 min (the acquisition of command of 91 cases), phase III was 103.77 ± 45.69 min (the further learning of 26 cases), and phase IV was 73.18 ± 26.89 min (postlearning in 68 cases). Conclusions VNOTES is noninferior to LESS as a new minimal invasive procedure for hysterectomy, which also allows patients a faster recovery from surgery and to suffer less pain, and its efficiency and feasibility in large uterine need further exploring.

Application of Transumbilical Laparoscopic Surgery on Low/Ultralow Rectal Cancer for Anal Sphincter Preservation.

Background: Rectal cancer is a common malignant tumor in the gastrointestinal tract. This work compares the effects of transumbilical laparoscopic surgery (TULS) and laparoscopic-assisted surgery on the anus-preserving effect of low/ultralow rectal cancer. Materials and Methods: Eighty patients with rectal cancer admitted to our hospital from February 2011 to July 2016 were randomly selected and divided into the laparoscopic group and TULS group, 40 cases in each group, all underwent radical anorectal cancer radical surgery. Statistical analysis was performed on surgical-related indicators in the two groups. Results: Two patients converted to open surgery were excluded. Five patients were excluded because of radical abdomen perineal resection for rectal cancer. Six patients were converted to TULS from laparoscopic surgery. Sixty-seven patients in the experimental group successfully completed anus-sparing surgery, and none died during the operation. The compliance rate of the distance between the lower edge of the tumor and the incision edge of the specimen in the TULS group was better than that in the laparoscopic group (P < .05). There were no significant differences between the two groups in terms of surgical time, blood loss, number of lymph node dissections, functional time of voluntary defecation and postoperative complications, tumor-free recurrence rate at 3 years, and 3-year survival rate after surgery (P > .05). Conclusions: The TULS method is safe and feasible in low and ultralow rectal cancer surgery. It has more advantages than laparoscopic-assisted surgery for anus preservation.

Comparison of Transvaginal and Transumbilical Laparoscopic Single-Site Surgery for Ovarian Cysts

Background:Minimally invasive surgery is currently a preferred treatment for symptomatic ovarian cyst(s), with single-site techniques, such as transumbilical laparoendoscopic single-site surgery (TU-LESS) and transvaginal laparoendoscopic single-site surgery (TV-LESS), gaining increasing popularity. Although both methods have delivered positive outcomes, there is currently limited literature directly comparing TU-LESS and TV-LESS.Objectives:This study had two primary objectives: (1) to evaluate the safety and feasibility of TV-LESS and TU-LESS for the treatment of ovarian cysts and (2) to compare the surgical and postoperative outcomes of the two procedures.Method:This was a prospective observational clinical analysis of 81 patients with a diagnosis of benign ovarian cyst with indication for TV-LESS or TU-LESS. Surgeries were performed at a tertiary hospital between February 1, 2018 and January 31, 2020. Patients were divided into TV-LESS (n = 40) and TU-LESS groups (n = 40), with one excluded due to severe pelvic adhesive disease. Demographics, operation outcomes, and follow-up details were compared.Results:All 80 patients underwent uncomplicated procedures. The two groups were demographically matched (except age), with no difference in operation time, intra-operative blood loss, hemoglobin loss, and hospitalization costs (P > 0.05). However, TV-LESS patients had significantly faster time to ambulation (P < 0.001), faster time to return of bowel function (P < 0.001), less postoperative pain level (P < 0.001), and shorter length of hospital stay (P < 0.001). The cosmetic scores at 1, 4, and 24 weeks after surgery were also higher for the TV-LESS group.Conclusion:Our preliminary experience suggested that TU-LESS and TV-LESS are both feasible and safe for ovarian cystectomy and salpingo-oophorectomy. However, TV-LESS may provide three main advantages including: (1) fewer postoperative complications (i.e. incisional hernia); (2) less postoperative pain; and (3) improved cosmetic satisfaction.

A Case of Ileal Inverted Intussusception due to Resection of Meckel’s Diverticulum with ZigZag Trans-umbilical Laparoscopic Surgery

A Case of Ileal Inverted Intussusception due to Resection of Meckel’s Diverticulum with ZigZag Trans-umbilical Laparoscopic Surgery

Periumbilical infiltration of lidocaine with epinephrine for postoperative pain reduction in single-port laparoscopic adnexal surgery

An efficient and simple approach to control postoperative pain in transumbilical single-port laparoscopic surgery appears necessary. We conducted a retrospective analysis in a study group (80 patients who received periumbilical infiltration of lidocaine with epinephrine before their incisional site repair completion) and control group (80 patients who received no analgesic at their incisional site repair completion) matched for their age, body mass index and their frequency of previous abdominal surgery. The pain scores based on the numerical rating scale (NRS) and the analgesic use frequency during the postoperative period were evaluated. The postoperative pain scores based on the NRS were significantly lower in the study group than in the control group immediately after the operation and at postoperative 6 hours. The postoperative analgesic use frequency during the hospital stay and the pain scores at 24 and 48 hours were not significantly different between the two groups. Periumbilical infiltration of lidocaine with epinephrine can reduce surgical pain until 6 hours, postoperatively.Impact statementWhat is already known on this subject? No consensus on whether single port laparoscopic surgery significantly reduces postoperative pain, as compared to conventional laparoscopy exists, and the immediate postoperative pain seems to be severe even with the SPL surgery.What do the results of this study add? The periumbilical infiltration of lidocaine with epinephrine can alleviate surgical pain until 6 hours, postoperatively.What are the implications of these findings for clinical practice and/or further research? Our result may provide an efficient and simple approach to control postoperative pain in a single port laparoscopic surgery.

Transumbilical laparoscopic cholecystectomy

Background: Single port surgery and transumbilical surgery are progressing rapidly. The advantages of the cosmetic appearance of this surgery encourages the surgeon to do it which has good acceptance from the patients. Moreover transumbilical laparoscopic cholecystectomy has the miratus of the single port surgery and traditional laparoscopic surgery. Single port surgery seemed to be expensive more than traditional laparoscopic surgery. Transumbilical Laparoscopic surgery is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). Aim: Hereby, we report of the initial clinical experiences in Saudi Arabia with this new technique. Ten cases of gallbladder stone are selected for this new technique. Materials and Methods: Tow curved intra-umbilical incision was made with 5mm port for camera (30 degree angle) and 8mm working port. Two separate incision 2mm each at right upper quadrant. Dissection was performed using an electric cautery hook and an endograsper. Result: Nine out of ten procedures were completed successfully and one case converted to conventional laparoscopic cholecystectomy because acutely inflamed. Average operative time 48 min with minimal blood loss. Postoperative follow-up did not reveal any umbilical wound complication. Conclusion: Therefore, transumbilical laparoscopic cholecystectomy is feasible and a promising alternative method as less scar in abdominal surgery for the treatment of some patients with gallbladder stone. No extra cost or special instruments are used. Moreover, we reduce the risk of the post single port hernia surgery.

Sa1595 Germanium Photodiode: New Technique for the Development of Endoscopic Implantable Gastric Pacemaker

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors Wen LI*, Zikai Wang, Baoqing Jia, Xiaohui Du, Xiaopeng Wang, Tingting Huang, Xuan Su, Lili Wu, Xiuxue Feng Gastroenterology and Hepatology, the Chinese PLA General Hospital, Beijing, China; Department of Oncological Surgery, the Chinese PLA General Hospital, Beijing, China; Department of General Surgery, the Chinese PLA General Hospital, Beijing, China Background: Complete endoscopic or laparoscopic resection of gastric stromal tumors (GST) in the cardia & fundus is only partially feasible. A combined endoscopic-laparoscopic approach has been recently recognized as the favorable modality for these lesions. Aims: To assess the feasibility and efficacy of combined endoscopic and transumbilical single-port laparoscopic surgery (CETSLS) for the GST. Methods Between April, 2010 and July, 2013, 14 patients with GST were assigned to undergo CETSLS (n Z 7) and standard laparoscopic surgery (SLS) (n Z 7) at the Chinese PLA general hospital. The subjects undergiong CETSLS were managed with laparoscopy-assisted endoscopic techniques (i.e. endoscopic snare resection, endoscopic mucosal resection and endoscopic submucosal dissection) or endoscopy-assisted laparoscopic techniques (i.e. laparoscopic gastric wedge resection). Several parameters were analyzed: operation time, conversion rate, operative complications, pain scores, cost and duration of hospital stay, cosmetic satisfaction and follow-up evaluation. Results: There was no difference in the age, gender and indications for CETSLS and SLS groups. All lesions were located in the gastric cardia/ fundus, They were confirmed to be GST on immunohistochemical staining and showed similar mean diameter. CETSLS was successfully carried out in 85.7% (6/7) of our patients with one case requiring conversion to open surgery due to intraoperative bleeding. However, there was no conversion in the SLS group. The mean operative time was similar in both groups (108.0 59.2 vs. 164.3 49.3 minutes: P Z 0.09). The intra-operative blood loss was lower in CETSLS than SLS group (25.0 15.2 ml vs. 74.3 32.6 ml: P Z 0.006). Complete resection rate was 100%. It was achieved without serious complications in both groups. Despite a shorter postoperative hospitalization time in the CETSLS group (5.7 1.4 vs. 8.9 2.8 days, PZ 0.03), the cost of hospitalization was almost similar (40942.8 11158.6 vs. 57246.7 16049.4 RMB, P Z 0.06). There was no re-admission or tumor recurrence during a median follow-up of 26 months (range, 4 43 months). Conclusions: CETSLS is a feasible and effective technique, which offers superior cosmesis during resection of the GST.

Sa1594 Novel Endoscopic Preoperative Localization Method Using Magnet in Laparoscopic Gastrointestinal Surgery

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors Wen LI*, Zikai Wang, Baoqing Jia, Xiaohui Du, Xiaopeng Wang, Tingting Huang, Xuan Su, Lili Wu, Xiuxue Feng Gastroenterology and Hepatology, the Chinese PLA General Hospital, Beijing, China; Department of Oncological Surgery, the Chinese PLA General Hospital, Beijing, China; Department of General Surgery, the Chinese PLA General Hospital, Beijing, China Background: Complete endoscopic or laparoscopic resection of gastric stromal tumors (GST) in the cardia & fundus is only partially feasible. A combined endoscopic-laparoscopic approach has been recently recognized as the favorable modality for these lesions. Aims: To assess the feasibility and efficacy of combined endoscopic and transumbilical single-port laparoscopic surgery (CETSLS) for the GST. Methods Between April, 2010 and July, 2013, 14 patients with GST were assigned to undergo CETSLS (n Z 7) and standard laparoscopic surgery (SLS) (n Z 7) at the Chinese PLA general hospital. The subjects undergiong CETSLS were managed with laparoscopy-assisted endoscopic techniques (i.e. endoscopic snare resection, endoscopic mucosal resection and endoscopic submucosal dissection) or endoscopy-assisted laparoscopic techniques (i.e. laparoscopic gastric wedge resection). Several parameters were analyzed: operation time, conversion rate, operative complications, pain scores, cost and duration of hospital stay, cosmetic satisfaction and follow-up evaluation. Results: There was no difference in the age, gender and indications for CETSLS and SLS groups. All lesions were located in the gastric cardia/ fundus, They were confirmed to be GST on immunohistochemical staining and showed similar mean diameter. CETSLS was successfully carried out in 85.7% (6/7) of our patients with one case requiring conversion to open surgery due to intraoperative bleeding. However, there was no conversion in the SLS group. The mean operative time was similar in both groups (108.0 59.2 vs. 164.3 49.3 minutes: P Z 0.09). The intra-operative blood loss was lower in CETSLS than SLS group (25.0 15.2 ml vs. 74.3 32.6 ml: P Z 0.006). Complete resection rate was 100%. It was achieved without serious complications in both groups. Despite a shorter postoperative hospitalization time in the CETSLS group (5.7 1.4 vs. 8.9 2.8 days, PZ 0.03), the cost of hospitalization was almost similar (40942.8 11158.6 vs. 57246.7 16049.4 RMB, P Z 0.06). There was no re-admission or tumor recurrence during a median follow-up of 26 months (range, 4 43 months). Conclusions: CETSLS is a feasible and effective technique, which offers superior cosmesis during resection of the GST.

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors

Sa1593 Comparing the Feasibility and Efficacy of Combined Endoscopic and Transumbilical Single-Port Laparoscopic Surgery With Standard Laparoscopic Resection of Gastric Stromal Tumors

Single-incision Laparoscopic Surgery for Colon and Rectal Cancer

Single-incision laparoscopic surgery seems destined to take its place in the evolution of minimally invasive surgery. Although isolated cases have been reported in the literature, no series has yet been published on the use of this approach to treat colorectal cancer. We describe the surgical technique and perioperative outcomes of this approach in 15 patients diagnosed for colorectal cancer. We have used several devices to gain transumbilical access to the abdominal cavity, usually working with 3 cannulae to insert the instruments. We used a 5 mm endograsper, and articulated rotating (roticulating) endoscissors and endodissector to assist dissection. Vascular control and section of the rectum were performed using roticulating endostaplers. We combined the use of curved and straight instruments as required for each step during surgery. The dissection technique performed was the same as the one we normally use in conventional laparoscopy. Specimens were extracted through the umbilical incision. The most commonly performed procedure was sigmoidectomy (n=7), followed by high anterior resection of the rectum (n=5). The mean surgical time was 185±44.9 minutes. The mean hospital stay was 6.2±4.7 days. Three cases (20%) were converted to conventional laparoscopy. Surgery was curative in all of the patients. Single-access transumbilical laparoscopic surgery is feasible and safe for treating colorectal carcinoma when performed by surgeons with ample experience in laparoscopic colorectal resection. Further studies are needed to determine the advantages and drawbacks of this procedure.

Mechanical evaluation of three access devices for transumbilical laparoscopic surgery

Objective To make the horizontal and vertical mechanical evaluation for different access devices(Port) in transumbilical laparoscopic surgery,and to compare the maneuverabilities of these devices during the process.Methods A laparoscopic training box was combined with Multi-ports,TriPort and SILS Port to construct the evaluation platforms.A universal testing machine was used for evaluating the mechanics of the three devices on horizontal and vertical direction by traction experiments.Results In the horizontal traction experiment,the forces were significantly different on the instruments with different access devices(Multi-portsSILS PortTriPort,P0.05).In the vertical friction test,there were also significant differences among the three groups,with the friction forces being Multi-portsSILS PortTriPort when the instrument entered the ports(P0.05) and being Multi-portsTriPortSILS Port when the instrument was pulled out(P0.05).Conclusion Compared with SILS Port and TriPort,Multi-port needs the least forces for horizontal and vertical movements,and therefore has superior maneuverability.

Multi-incisional transumbilical laparoscopic surgery for nonpalpable undescended testes: A report of 126 cases

PurposeThe aim of this study was to evaluate the feasibility of multi-incisional transumbilical laparoscopic surgery for the management of nonpalpable undescended testes. Material and methodsA series of 126 patients with 162 nonpalpable undescended testes underwent transumbilical laparoscopic surgery. Their mean age was 1.8years (range, 1.1–6.5years). Of the 126 cases, 73 were left-sided, 17 were right-sided, and 36 had bilateral cryptorchidism. Primary orchidopexy and the Fowler–Stephens procedure were used to mobilize the testes. ResultsAll the operations were successfully performed without intraoperative complications. No additional ports or any conversions to an open procedure were required. Of the 162 nonpalpable undescended testes, 21 were absent or atrophied. One-hundred thirteen testes underwent primary orchidopexy, and 28 cases underwent a Fowler–Stephens orchidopexy. Patients were followed-up for 6–15months. Only one case of testicular retraction was observed, and all others maintained a good size and the correct position. The scars were hidden within the umbilicus. ConclusionTransumbilical laparoscopic surgery is safe and feasible for nonpalpable undescended testes, and leaves no obvious abdominal or inguinal scar.

Can cross-handed approach improve maneuver in transumbilical laparoscopic surgery?

Transumbilical laparoscopic or laparoendoscopic singlesite surgery (LESS) is an emerging concept that has developed rapidly during the past 5 years. Almost all traditional laparoscopic surgeries can be performed transumbilically, including surgeries for morbid obesity, liver, splenic, or gastrointestinal diseases. It is estimated that 50–80 % of traditional laparoscopic surgery could be performed transumbilically in the next 5 years according to the LESSCAR consensus [1]. However, the procedure is more difficult than traditional laparoscopic surgeries due to associated technical challenges, including laparoscope and instruments crowding around the umbilicus, loss of triangulation between the two instruments in the operative field, and the required ambidexterity of the surgeons to adopt relatively difficult maneuvers. The enlarged end of the trocars is the main reason for external interference. Another factor is the instruments handles, which are usually very close to the ports. The crowding around the umbilicus can be effectively overcome by using our improved ports, because their maximum diameters are much smaller than those of commercially available trocars. The distance from the handles to the ports becomes longer when using the lengthened instruments, which results in longer distance between the instruments handles and can partly avoid external interference [2]. To overcome the problem of loss of ‘‘triangulation’’ caused by in-line viewing in transumbilical laparoscopic surgery, the articulated instruments have been developed. The problem is that when the tips of the instruments are bent in toward the target tissue, the surgeon’s hands tend to collide and the handles externally move toward one another. To avoid crossing the hands with this technique, the possible solution could be using the cross-handed approach, whereby the operator’s left hand operates the instrument on the right, and vice versa. Theoretically, cross-handed manipulation can overcome the problem of loss of triangulation under the circumstance of the in-line viewing system. Some people believe that it is an ideal solution to the most difficult problem in transumbilical laparoscopic surgery. Others consider that it can be uncomfortable and create additional difficulty in safe dissection of the target tissues. In addition, with the crossing of two instruments internally, they may compete for the same space in a vertical plane, which may limit their motion in the abdomen [3]. Do articulated instruments and cross-handed approach really benefit transumbilical laparoscopic surgery? To answer this question, it needs to be further evaluated objectively. Botden et al. [4] compared maneuver of curved instruments and cross-handed approach on standardized box trainer tasks and showed the results that the dissection task was performed faster and with less errors by using curved instruments than the crossed SPA setting. Their study also showed that the double-curved instruments were more potential for safe use than the cross-handed maneuver in conventional instruments in single-port laparoscopic surgery. However, other research concluded that crossed maneuver system gave a task performance equivalent to that of obtained with uncrossed system [5]. We recently set up a mechanical evaluation platform for single-port laparoscopic surgery on which a port (SILS Port, Covidien, Mansfield, MA) with two sensors around it was introduced. The instruments motion in the port can J. Zhu (&) A. A. Xu Department of General Surgery, East Hospital, Tongji University School of Medicine, 150 Jimo Road, Pudong, 200120 Shanghai, China e-mail: zhujiangfan@hotmail.com

Single-Incision Transumbilical (SITU) Surgery After SITU Laparoscopic Roux-en-Y Gastric Bypass

Recently, single-incision transumbilical (SITU) laparoscopic bariatric surgery has been adopted as an alternative option for treating morbid obesity. Patients prefer SITU because it leaves minimal scarring. However, second surgery after SITU is a new challenge for surgeons. Here, we report on the safety and results for patients at a university hospital who underwent second surgery with the SITU procedure after SITU-laparoscopic Roux-en-Y gastric bypass (LRYGB). From November 2008 to May 2011, in total, 78 morbidly obese patients underwent SITU-LRYGB. After follow-up, 7 cases required reoperation with the SITU procedure because of dilated gastrojejunostomy in 1 patient, intractable hiccups in 1 patient, gallstones in 2 patients, and internal hernia from Petersen's defect in the remaining 3 patients. SITU was repeated via the previous umbilical incision to avoid creating a new scar. Three trocars were inserted separately, and pneumoperitoneum was created. The surgical procedures were performed with straight instruments. All surgical results and complications were recorded. The procedure was successfully completed in all 7 patients without addition of trocars or conversion to conventional LRYGB or open procedure. Mean surgical time was 63±23 minutes. There were no intraoperative complications or postoperative wound complications noted in 3 months of follow-up. Second surgery can be successfully done via a single umbilical incision after SITU-LRYGB, with reasonable operative time and good recovery, without additional abdominal scarring.

Transumbilical laparoscopic surgery using GelPort through an umbilical zigzag skin incision

We report herein a new method of transumbilical laparoscopic surgery using a GelPort through an umbilical zigzag skin incision. The method involves collaborating with plastic surgeons to ensure the procedure was minimally invasive. After marking a zigzag skin incision in the umbilical region, the skin was incised along this line. Then, a GelPort double-ring wound retractor was inserted through the incision, which enlarged the diameter of the fascial opening to 6 cm. The Gelport was latched on the wound retractor ring, following the inflation of the pneumoperitoneum by CO (2). One or more additional ports were inserted as necessary. All operations were performed in the standard fashion. The specimen was easily extracted from the abdomen through the umbilical incision, and anastomosis was performed. Using the above method, we performed the following procedures: one total gastrectomy, one distal gastrectomy, three gastric local resections, five right hemicolectomies, two high anterior resections, three cholecystectomies, and seven transabdominal preperitoneal hernioplasties. All cases were accomplished without any complications using this method. The wounds of the umbilical region were almost "scarless" in all cases. We developed an umbilical zigzag skin incision technique to perform abdominal laparoscopic operations using a GelPort, with a minimal number of skin incisions. We consider that our method reduces the technical difficulties associated with laparoscopic surgery and maintains cosmesis.

Transanal Single-Port Surgery for the Resection of Large Polyps

Introduction: Transanal endoscopic microsurgery (TEM) is widely used for the excision of both benign and malignant rectal tumours. It is relatively expensive and can be a challenging technique. A recent development in laparoscopic surgery is the single-port technique (single-incision laparoscopic surgery, SILS). The SILS port is a flexible multichannel port for transumbilical laparoscopic surgery. Even though not developed for transanal use the port could be ideal because of its shape and texture. Methods: 12 patients underwent transanal resection using an SILS port and normal laparoscopic instruments. Results: 10 out of 12 patients were treated successfully with the SILS port. Two polyps were resected using an open transanal technique because the distance between the SILS port and the polyp was too small. The average operative time was 55 min (range 40–80 min). All patients could be discharged on the first postoperative day. There were no major complications. Conclusion: Our current data show that transanal surgery using a single port is a relatively easy procedure with operative times comparable to TEM. More surgeons will therefore be able to perform transanal endoscopic surgery.

Single port transumbilical laparoscopic surgery for adnexal lesions: a single center experience in Korea

ObjectivesThe purpose of this study was to demonstrate the feasibility of single port transumbilical laparoscopic surgery (SPLS) for the treatment of adnexal lesions. MethodsWe have performed SPLS to treat adnexal lesions using a single three-channel port system with a wound retractor and surgical glove since October 2008. All patients who underwent SPLS for adnexal lesions between October 2008 and September 2009 were included in the study. We retrospectively reviewed their medical records and analyzed demographic data and surgical outcomes including age, medico-surgical illness, surgical indications, operative times and pathologic results. ResultsEighty-six patients underwent SPLS for adnexal lesions. The median age of the patients was 31 years (range 14–78 years), the median body mass index was 21.0kg/m2 (range 16.7–32.2kg/m2), and the median operation time was 64.5min (range 21–176min). The median blood loss was 10ml (range 10–300ml). The median length of postoperative hospital stay was 2 days (range 1–7 days). Endometriosis was the most frequently diagnosed etiology (34.9%). Other laparoscopic approaches were employed in two cases (2.3%). There were four cases (4.7%) with complications: three with pelvic infections and one with postoperative hemorrhage. ConclusionsSPLS is a feasible approach for the treatment of adnexal lesions.

Transumbilical endoscopic surgery: History, present situation and perspectives

Transumbilical endoscopic surgery or laparo-endoscopic single site (LESS) surgery has become an exciting area of surgical development as innovation continues to move in the 21(st) century to minimally invasive surgery. The history, present situation and perspectives are reviewed and the nomenclature of this technique is discussed in this article. The range of this technique has been applied in almost all abdominal diseases, surgeries for morbid obesity, hernia and so on, in recent years. It is estimated that 50%-80% of traditional laparoscopic surgery could be performed transumbilically in the next five years according to the LESSCAR consensus. Although the concept of transumbilical laparoscopic surgery is gaining traction rapidly and the instruments have been improved greatly, we should not advocate for slightly improved cosmetic value over safety. Multicenter, randomized and clinical trials are necessary to further elucidate the safety and efficiency of this new technique. Research that examines the efficacy of the new instruments on the market may be helpful to simplify the confusing landscape of new and novel products designed for this purpose.

A Randomized Prospective Study of Single Port Transumbilical Laparoscopic Surgery and 4 Port Approach for Hysterectomy in Terms of Pain

A Randomized Prospective Study of Single Port Transumbilical Laparoscopic Surgery and 4 Port Approach for Hysterectomy in Terms of Pain