Transumbilical Single-port Laparoscopic Surgery Research Articles

Clinical study on laparoscopic minimally invasive surgery and transumbilical single-port laparoscopic surgery in the treatment of benign ovarian tumours and its influence on ovarian functions.

The objective of this study was to explore the influence of traditional laparoscopic surgery and transumbilical single-port laparoscopic surgery on ovarian function in patients with benign ovarian tumours. Forty-four patients with benign ovarian tumours who were treated in our hospital from January 2020 to June 2021 were selected and randomly divided into two groups, with 22 cases in each group according to random number table. The conventional group was treated with conventional laparoscopic surgery, while the modified group was treated with transumbilical single-port laparoscopic surgery. The measurement method was t -test, and the enumeration method was two tests. The clinical operation-related indicators, ovarian function (follicle-stimulating hormone, E 2 and luteinising hormone), complication incidence, Visual Analogue Scale (VAS) and landscaping satisfaction scores of the two groups were compared. There were no significant differences in complications and operation duration between the two groups ( P > 0.05). After treatment, the ovarian function indexes and beautification satisfaction scores of the modified group were significantly superior to those of the conventional group ( P < 0.05). Besides, the intraoperative bleeding volume, post-operative exhaust time, hospital stay and three-dimensional VAS scores on day 1 and day 3 after surgery of the modified group were lower than those of the conventional group ( P < 0.05). Transumbilical single-port laparoscopic surgery for benign ovarian tumours has a significant clinical effect, which can effectively reduce bleeding during the operation, improve ovarian function, relieve surgical pain, promote rapid post-operative recovery and improve patients' satisfaction with landscaping. It is worthy of clinical application.

Laparoendoscopic single-site surgery for deep infiltrating endometriosis based on retroperitoneal pelvic spaces anatomy: a retrospective study

Transumbilical single-port laparoscopy is widely used in gynecological surgery. However, it is rarely used in the treatment of deep infiltrating endometriosis due to its own shortcomings and the complex condition of deep infiltrating endometriosis. The study aims to introduce a transumbilical single-port laparoscopic surgery based on retroperitoneal pelvic spaces anatomy, which can complete the operation of deep infiltrating endometriosis more easily. A retrospective analysis of 63 patients with deep infiltrating endometriosis treated by transumbilical single-port laparoscopy using this method was conducted. The operation duration was 120.00 (85.00 ± 170.00) (35–405) min, the estimated blood loss was 68.41 ± 39.35 ml, the postoperative hospital stay was 5.00 (4.00–6.00) days, and the incidence of postoperative complications was 4.76% (3/63). 1 patient was found to have intestinal injury during operation, 1 patient had ureteral injury after operation, and 1 patient had postoperative pelvic infection, with a recurrence rate of 9.52%. The postoperative scar score was 3.00 (3.00–4.00) and the postoperative satisfaction score was 9.00 (8.00–10.00). In summary, this study demonstrates the feasibility of transumbilical single-port laparoscopic surgery for deep infiltrating endometriosis based on retroperitoneal pelvic spaces anatomy. Hysterectomy, adenomyosis resection, etc. are also feasible with this method, boasting more obvious advantages. This method can make transumbilical single-port laparoscopy more widely used in deep infiltrating endometriosis.

Benign Ovarian Cystectomies in Children and Adolescents: A Comparison of Transumbilical Single-Port and Multi-Port Laparoscopic Surgery

<h3>Study Objective</h3> To investigate the safety and clinical value of transumbilical single-port laparoscopic surgery (TSPLS) in the treatment of benign ovarian cysts in children and adolescents. <h3>Design</h3> A retrospective analysis was performed on 85 children and adolescents who underwent benign ovarian cystectomies in Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University from January 2019 to January 2022, including 55 cases of mature cystic teratoma, 16 cases of myxoid cystadenoma, 9 cases of serous cystadenoma, 2 cases of parovarium cyst, 2 cases of follicular cyst, and 1 cases of ovarian thecoma-fibroma. Among them, 33 cases with transumbilical single-port laparoscopic oophorocystectomy (TSPLO group), median age was 14 years (7-18 years), mean diameter of ovarian cysts was (13.06 ± 7.80 cm). 52 cases with transumbilical multi-port laparoscopic oophorocystectomy (TMPLO group), median age was 15 years (6-18 years) and mean diameter of ovarian cysts was (7.69 ± 2.80 cm). Operative time, intraoperative blood loss, intraoperative cyst rupture rate, time to anal exhaust and hospital stay, Cosmetic Score (CS) and Visual Analogue Scale (VAS) were compared between the two groups. <h3>Setting</h3> N/A <h3>Patients or Participants</h3> N/A <h3>Interventions</h3> N/A <h3>Measurements and Main Results</h3> No conversion to laparotomy or surgical complications occurred in the two groups, and no statistical significance in operative time, intraoperative blood loss and intraoperative cyst rupture rate (all P > 0.05). The time to anal exhaust (18.82 ± 4.58 h vs. 21.29 ± 5.11 h, P = 0.027) and hospital stay (3.39 ± 0.83 day vs.3.92 ± 1.13-day, P = 0.023) in TSPLO group were shorter than those in TMPLO group. Lower postoperative VAS scores and higher CS scores were seen in the TSPLO group (all P < 0.05). <h3>Conclusion</h3> TSPLS is safe and feasible for benign ovarian cysts in children and adolescents, and has obvious advantages of fast postoperative recovery, good cosmetic effect and high satisfaction rate of patients.

Visceral obesity as a risk factor of incisional hernia after single-port laparoscopic gynecologic surgery

ObjectiveWe aimed to evaluate associations between abdominal fat distribution (AFD) parameters and incisional hernia (IH) in patients who underwent transumbilical single-port laparoscopic surgery (SPLS) for gynecological disease. MethodsMedical records of 2116 patients who underwent SPLS for gynecological disease at Daejeon St. Mary's Hospital between March 2014 and February 2021 were reviewed. Among 21 (1.0%) patients who developed IH requiring surgical treatment after SPLS, 18 had preoperative abdominopelvic computed tomography (CT) images. As a control group, we randomly selected 72 patients who did not develop IH and who had undergone preoperative abdominopelvic CT scan, matched to test patients by type of surgery. Total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), visceral-to-subcutaneous fat ratio (VSR), and waist circumference (WC) were measured at the level of the third lumbar vertebral body on the preoperative abdominopelvic CT images, using National Institutes of Health (NIH) ImageJ version 1.53 k. ResultsReceiver operating curve analysis showed that VFA has the highest predictive value for IH among AFD parameters (AUC = 0.749, 95% CI 0.630–0.869, p < 0.001). Univariate analysis showed that age, BMI, hypertension, dyslipidemia, TFA, VFA, VSR and WC were significant factors for IH. In multivariate analysis, only high VFA was identified as an independent risk factor for IH (HR 6.18, 95% CI 1.13–33.87, p = 0.04), whereas BMI, TFA, SFA, VSR, and WC failed to show statistical significance. ConclusionWe could find high VFA as an independent risk factor of IH in patients who underwent SPLS for gynecologic disease.

Bioinformatic Characterization of Whole Blood Neutrophils in Pelvic Inflammatory Disease: A Potential Prognostic Indicator for Transumbilical Single-Port Laparoscopic Pelvic Abscess Surgery.

The purpose of this research is to determine the prognosis of patients treated with transumbilical single-port laparoscopic surgery for acute pelvic inflammatory illness. Postoperative data on 129 patients treated with laparoscopic surgery for acute pelvic inflammatory illness were obtained retrospectively. It was observed that the shorter the time required for postoperative leukocyte recovery to normal, the shorter the time required for postoperative pain and diet recovery, as well as hospital stay, in such individuals. CIBERSORT was used to examine patient data from GEO. The most significant difference between the normal and pelvic inflammatory groups was in neutrophil content. Association study found a substantial positive correlation between the quantity of neutrophils infiltrating the immune system and the abundance of monocyte M0 infiltrating the immune system. Neutrophil immune infiltration was strongly inversely linked with plasma cells, activated CD8+ Tm cells, and active CD4+ Tm cells. Four mRNAs linked with pelvic inflammatory illness were revealed to be strongly associated with neutrophil immune infiltration, notably CALML4, COQ10B, DCPS, and PPP2R1A. The ROC revealed that CALML4 (area under the curve (AUC): 0.769, 95% confidence interval (CI): 0.638–0.881), COQ10B (AUC: 0.742, 95% CI: 0.587–0.881), PPP2R1A (AUC: 0.733 95% CI: 0.593–0.857), and DCPS (AUC: 0.745, 95% CI: 0.571–0.900) were potential markers for predicting pelvic inflammatory disease. CALML4, COQ10B, PPP2R1A, and DCPS may be critical determinants determining the amount of preoperative neutrophil infiltration and the time required for leukocyte recovery after single-port laparoscopy in acute pelvic inflammatory illness.

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 Single-Port Laparoscopic Surgery for Colorectal Cancers: Experience of 258 Consecutive Cases with Rational Manipulation of Instrument for Safety and Benefit

Transumbilical Single-Port Laparoscopic Surgery for Colorectal Cancers: Experience of 258 Consecutive Cases with Rational Manipulation of Instrument for Safety and Benefit

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

Transumbilical single port laparoscopic surgery for the treatment of concomitant disease

Background: We report our experience of transumbilical single port laparoscopic surgery (TUSPLS) for multiple concomitant intraabdominal pathologies, and assess the feasibility of this technique with several technical tips. Methods: Various combined procedures using TUSPLS were performed since April, 2008. All records of concomitant laparoscopic procedures using TUSPLS were searched at three hospitals. Results: Forty-one patients underwent 82 combined procedures using TUSPLS in a single session. The perioperative outcomes of simultaneously performed cholecystectomy and ovarian cystectomy using TUSPLS (n = 14) are compared with those of using CLS (n = 11). The operating time was significantly longer with the TUSPLS method than with the CLS method. However, postoperative convalescent outcomes such as postoperative hospital stay, VAS pain score, and required analgesics showed no differences between the two methods. Also, there were no significant operative complications associated with the two methods. Fewer trocars were used with the TUSPLS method. Conclusions: Combined laparoscopic procedures for various concomitant pathologies in the abdomen can be performed using transumbilical single port laparoscopic surgery without increasing morbidity or hospital stay in patients with acceptable risk.

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.

Single Port Laparoscopic Surgery and Transanal Specimen Retrieval for Sigmoid Colon Cancer

Transumbilical single-port laparoscopic surgery (SPLS) is a newly emerged and rapidly evolving, minimally invasive treatment method. Transumbilical SPLS produces minimal parietal injury and can achieve cosmetic advantages by reducing additional trocar placement. The in-line or chopstick arrangement of laparoscopic instruments can make the operative procedures somewhat strange and inconvenient at first, but experienced laparoscopic surgeons can achieve the same coverage as conventional laparoscopic surgery with time. Here, we report the first case of transumbilical SPLS anterior resection (SPLS-AR) with transanal retrieval of aspecimen and intracorporeal single stapling anastomosis. The operating time was 270 min. There were no intraoperative or postoperative complications. Transumbilical SPLS resulted in a 1.5-㎝ wound with early recovery. Transumbilical SPLS-AR with transanal retrieval and intracorporeal anastomosis for sigmoid colon cancer is feasible by experienced laparoscopic colorectal surgeons based on careful evaluation and selection of patients. This operation fulfills both oncological principles and cosmetic demand.

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

The feasibility of scarless single-port transumbilical total laparoscopic hysterectomy: initial clinical experience

The purpose of the present study is to demonstrate the feasibility of single-port transumbilical laparoscopic surgery (SPLS) for hysterectomy and elaborate on our experience in order to introduce the single-port approach for gynecologic surgery. Between August 2008 and February 2009, 30 patients who initially planned to undergo single-port laparoscopic surgery at Yonsei University Health System in Seoul, Korea were enrolled in this study. The authors used a single-port three-channel system with a wound retractor, surgical gloves, and one 10/11-mm and two 5-mm trocars. All surgical procedures were performed with 30 degrees , 5-mm laparoscope, conventional laparoscopic instruments, and the LigaSure system (Valleylab, Boulder, CO, USA). Patient characteristics and surgical outcomes were prospectively evaluated. A visual analog score (VAS) scale was used to measure postoperative pain. Twenty-nine of 30 patients underwent single-port laparoscopic surgery without conversion to laparotomy or conventional laparoscopic hysterectomy. Median operative time was 100 min (57-155 min), median blood loss was 100 ml (10-400 ml), median postoperative hospital stay was 3 days (2-6 days), and median weight of resected uteri was 167 g (45-482 g). VAS scoring of pain at 6, 24, and 48 h after surgery was 4, 3, and 2, respectively. There were no operative complications. SPLS is a feasible approach for hysterectomy in terms of operative time, complication rates, and cosmetic results. However, the possible benefits for patients such as better cosmetic outcomes, reduced pain, and lower complication rates should be evaluated in randomized prospective studies.

The Feasibility of Scarless Single Port Transumbilical Total Laparoscopic Hysterectomy: Initial Clinical Experiences

Objective The purpose of the present study is to demonstrate the feasibility of single-port transumbilical laparoscopic surgery (SPLS) for hysterectomy and elaborate on our experience in order to introduce the single-port approach for gynecologic surgery.

Single-Port Transumbilical Laparoscopic Cholecystectomy: A Preliminary Study in 37 Patients with Gallbladder Disease

Since the introduction of laparoscopic surgery, surgeons have not only been concerned about clinical outcomes, but also surgical scars. Although natural orifice transluminal endoscopic surgery (NOTES) is promising, it is not applicable to clinical practice thus far due to safety concerns. As a transitional procedure between standard laparoscopic surgery and NOTES, single-port transumbilical laparoscopic surgery might be an ideal alternative. The main advantage of single-port transumbilical laparoscopic surgery is that it is performed with existing instruments. Thus, we applied single-port surgery for cholecystectomies and the clinical outcomes were analyzed. Between July and October 2008, 37 adults with gallbladder pathologies were enrolled in this study. Only one transumbilical incision was made for accessing the abdominal cavity and a multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform the cholecystectomy. There were 13 males and 24 females. The mean age of the patients was 47.5 +/- 12.2 years. Twenty-nine patients had gallbladder stones, 7 patients had gallbladder polyps, and 1 patient had biliary dyskinesia. The mean operative time was 83.6 +/- 40.2 minutes. Gallbladder perforations occurred in 11 patients. In 5 patients, the procedure was converted to a standard laparoscopic technique due to technical difficulties. Complications occurred in 2 patients; specifically, a mesenteric injury was caused by the inadvertent grasping of the small-bowel mesentery during the removal of the wound retractor and an inadvertent injury of the right hepatic duct. The mean hospital stay was 2.7 +/- 1.5 days. Our series has demonstrated the feasibility and safety of single-port transumbilical laparoscopic cholecystectomy. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. Additional studies randomizing standard laparoscopic cholecystectomy and single-port transumbilical cholecystectomy are necessary for defining the exact role of this procedure.

New Tools for a New Job-Single Port Laparoscopic Surgery Equipment

Single port transumbilical laparoscopic surgery (LESS, SILS, ENOTES) is a technique which has recently emerged with a view to improving the cosmesis following minimal access surgery, aiming to achieve ‘scarless’ surgery. This rapidly progressing technique is facilitated by developments in port and instrument technology, allowing surgeons to perform a wider range of surgical procedures with increasing ease. This paper aims to summarise the equipment available at present for single port surgery.