Two-port Access Research Articles

Двухпортовая хирургия макулярной патологии

Purpose. To evaluate the possibility of two-port surgical treatment of vitreomacular interface pathologies in standard surgical practice. Material and methods. The study included 24 patients (24 eyes) with macular pathology operated by the proposed two-port technique of vitrectomy 25G. The maximum corrected visual acuity before surgery was 0.2 ± 0.12. The minimum follow-up period after surgery is 1 month. Results. In all cases, it was possible to achieve anatomical restoration of the macular zone. The maximum corrected visual acuity after 1 month after surgery increased to an average of 0.6 ± 0.23. In all clinical cases, it was possible to successfully apply the two-port surgery technique. The need to return to traditional 3-port access was not required in any case. Conclusion. The proposed method for the surgical treatment of vitreomacular interface pathology through a two-port access is effective, technically simple and safe. Keywords: vitreomacular traction syndrome, macular hole, two-port vitrectomy 25G.

Single incision laparoscopic surgery using conventional laparoscopic instruments versus two-port laparoscopic surgery for adnexal lesions

Single incision laparoscopic surgery (SILS) has emerged as least invasive interventions for gynecologic disease. However, SILS is slow to gain in popularity due to difficulties in triangulation and instrument crowding. Besides, the costly instruments may influence patients’ will to have this procedure, and limit other medical expense as well. To optimize outcome and reduce cost, the objective of this study is to evaluate the feasibility and safety for patients undergoing adnexal surgeries using conventional laparoscopic instruments with SILS (SILS-C), and to compare with those of patients subject to TP using conventional laparoscopic instruments (TP-C). This is a retrospective case–control study. The data dated from April 2011 to April 2018. Patients who received concomitant multiple surgeries, were diagnosed with suspected advanced stage ovarian malignancy, or required frozen sections for intraoperative pathologic diagnosis were excluded. Demographic data, including the age, body weight, height, previous abdominal surgery were obtained. The surgical outcomes were compared using conventional statistical methods. 259 patients received SILS-C. The operating time was 63.83 ± 25.31 min. Blood loss was 2.38 ± 6.09 c.c. 58 patients (24.38%) needed addition of port to complete surgery. 384 patients received TP-C. Compared with SILS-C, the operating time was shorter (57.32 ± 26.38 min, OR = 0.984, CI = 0.975–0.992). The patients were further divided into unilateral or bilateral adnexectomy, and unilateral or bilateral cystectomy. Other than the operating time in unilateral cystectomy (66.12 ± 19.5 vs. 58.27 ± 23.92 min, p = .002), no statistical differences were observed in the subgroup analysis. Single incision laparoscopic surgery using conventional laparoscopic instruments is feasible and safe as initial approach to adnexal lesions. In complex setting as unilateral cystectomy or pelvic adhesions, two-port access may be considered.

Two-port access for laparoscopic surgery for endometrial cancer using conventional laparoscopic instruments

Minimally invasive surgery is the first-line management for endometrial cancer. The role of 2-port access laparoscopy (TPA) has been underestimated. Compared to conventional laparoscopic surgery (CL), TPA is associated with smaller total incision size and less postoperative pain. Compared to single-incision laparoscopic surgery, no specific instruments and surgical techniques are needed. This study primarily evaluated the surgical and pathologic outcomes of TPA with conventional instruments, and additionally evaluated the surgeon’s learning curve. Consecutive patients who underwent TPA and CL for endometrial cancer between 2015 and 2019 were included. Baseline characteristics were recorded. In total, 148 patients (TPA, 89; CL, 59) were identified. The baseline characteristics were similar, except for a greater proportion of patients in the CL group receiving para-aortic lymph node dissection (5.62% vs. 35.59%, P < 0.01). The mean operation time was significantly less in the TPA group (152.09 vs. 187.15 min; P < 0.01). Both the groups had comparable 5-year progression-free survival (TPA, 86.68%) and 5-year overall survival rates (TPA, 93.24%). Analysis of the learning curve showed that the operation time decreased after 3–4 procedures. TPA using conventional laparoscopic instruments for endometrial cancer is feasible and is easily accessible to patients and surgeons.

Fetoscopic patch coverage of experimental myelomenigocele using a two-port access in fetal sheep.

This study aims to assess the feasibility and the effectiveness of a fetoscopic myelomeningocele (MMC) coverage using a sealed inert patch through a two-port access, in the sheep model. Forty-four fetuses underwent surgical creation of a MMC defect at day 75 and were divided into four groups according to the MMC repair technique, performed at day 90. Group 1 remained untreated. Group 2 had an open surgery using suture of the defect. Groups 3 and 4 underwent defect coverage using a Gore®-polytetrafluoroethylene patch secured with surgical adhesive (Bioglue®), with an open approach (group 3) and a fetoscopic one (group 4). Lambs were killed at term, and histological examinations were performed. Fetoscopic patch coverage was achieved in all the lambs of group 4. All the fetuses of group 2 had a complete closure of the defect whereas only 38% in group 3 and 14% in group 4. Fetal loss rate seems to be lower in group 4 than in groups 2 and 3. Fetoscopic coverage of MMC defect can be performed using a sealed patch through a two-port access, but the patch and glue correction may not be the ideal technique to repair fetal MMC.

First clinical experiences using a new in-bag morcellation system during laparoscopic hysterectomy.

Endoscopic techniques have successfully reduced the invasiveness of hysterectomy, when compared to open procedures. Power morcellation, as a part of the minimal invasive concept, carries the risk of disseminating cells from the tissue specimen. The present observational study reports on first experiences using a new system (More-Cell-Safe, A.M.I., Austria) for contained in-bag morcellation during laparoscopic hysterectomy. The dual opening system allows two-port access without bag puncture. The optic is protected against spread cell contamination with a disposable sleeve. Application data were prospectively recorded on the first n = 7 consecutive patients and compared to n = 7 preceding patients undergoing uncontained morcellation. Bag system use was surgically successful in 6 of 7 cases (85.7 %). Morcellated specimen weight ranged from 205 to 638 g (mean 413.33 ± 176.85; median 413). In one patient, the uterine specimen (1050 g) proved too large to be placed into the bag. Average time associated to the bag use was 16.2 ± 7.65 min, ranging from 8.5 to 26.5 min (median 14 min). Removed bags contained bloody fluid with residual tissue fragments weighing overall between 21 and 85 g. Spread spindle cells were detected in two cases after uncontained morcellation, but not after in-bag morcellation. The experiences from our small pilot series prove technical feasibility in the clinical setting.

V28 New 3-dimensional head-mounted display system (RoboSurgeon System) applied to gasless, two-port access total nephroureterectomy

V28 New 3-dimensional head-mounted display system (RoboSurgeon System) applied to gasless, two-port access total nephroureterectomy

Impact on ovarian reserve after laparoscopic ovarian cystectomy with reduced port number: a randomized controlled trial

ObjectivesSingle-port access (SPA) laparoscopic ovarian cystectomy has been reported as a comparable procedure to conventional laparoscopy in terms of operative outcomes. However, whether ovarian function after SPA laparoscopic surgery is similar to conventional laparoscopy is questioned due to the limitations in moving instruments. The aim of this study was to evaluate whether the reduced port number affects the ovarian reserve after laparoscopic ovarian cystectomy. Study designThis was a randomized controlled trial of 87 women with benign ovarian cyst, who attended a university hospital and were scheduled for laparoscopic ovarian cystectomy. Women were randomized to SPA, two-port access (TPA), or four-port access (FPA) laparoscopic groups. The primary outcome was the serum anti-Müllerian hormone (AMH) levels: preoperative, 1 week, 1 month and 3 months after the operation. Secondary outcomes were operative outcomes. ResultsThe mean serum AMH levels of preoperative, 1 week, 1 month and 3 months after laparoscopy were 4.4±2.9, 2.7±2.2, 2.3±1.9, and 2.5±1.5ng/mL (in the SPA group), 3.6±2.5, 2.3±2.2, 2.6±3.2, and 2.7±2.6ng/mL (in the TPA group), and 3.9±3.2, 2.4±2.1, 2.5±2.0, and 2.8±2.2ng/mL (in the FPA group), respectively. There was no statistically significant difference in the serial change of AMH levels among the SPA, TPA and FPA groups. ConclusionsThe laparoscopic ovarian cystectomy with reduced port number does not affect the serial change of ovarian reserve. The SPA or TPA laparoscopy may be the alternative method to conventional laparoscopy in terms of ovarian reserve.

Two-port access versus four-port access laparoscopic ovarian cystectomy.

ObjectiveThis study was conducted to compare the surgical outcomes between two-port access and four-port access laparoscopic ovarian cystectomy.MethodsFour hundred and eighty nine patients who had received two-port access laparoscopic ovarian cystectomy (n=175) and four-port access laparoscopic ovarian cystectomy (n=314) in Chungnam National University Hospital from January 2009 to August 2012 were analyzed retrospectively. The data were compared between the bilaterality of the cysts and cyst diameter of less than 6 cm and 6 cm or more.ResultsThere were no significant differences in patient's age, parity, body weight, body mass index and history of previous surgery between the two-port and four-port access laparoscopy group. Bilaterality of ovarian cysts was more in fourport access laparoscopy group (13.7% vs. 32.5%, P=0.000). There were no significant differences in operation time, hemoglobin change, hospital stay, adhesiolysis, transfusion, and insertion of hemo-vac between the two-port and four-port access laparoscopy group for size matched compare. However additional analgesics were more in four-port access laparoscopy group for unilateral ovarian cystectomy.ConclusionTwo-port access laparoscopic surgery was feasible and safe for unilateral and bilateral ovarian cystectomy compare with four-port access laparoscopic surgery.

Two-Port Access Laparoscopic Surgery in Gynecologic Oncology

The purpose of this study was to evaluate the feasibility and safety of 2-port access (TPA) laparoscopy in gynecologic oncology. This was a retrospective review of 81 consecutive patients who underwent TPA laparoscopic surgery for various gynecologic cancers from March 2009 to September 2011. The TPA system consisted of a single multichannel port at the umbilicus and an ancillary 5-mm port in the suprapubic area. The surgical procedures included comprehensive ovarian cancer staging (33 patients), radical hysterectomy with pelvic lymph node dissection (19 patients), and endometrial cancer staging (29 patients). All surgical procedures were completed laparoscopically with no conversion to laparotomy. Two cases required 1 or 2 additional ports. The mean operating time, estimated blood loss, and number of lymph nodes were 253.8 minutes, 170.7 mL, and 34.9, respectively. Three patients (9.1%) with ovarian cancer and 4 patients (13.8%) with endometrial cancer were upstaged after surgery. The mean postoperative hospital stay was 6.6 days, and the mean postoperative pain scores (0-10 scale) were 3.4 at 6 hours, 3.0 at 24 hours, and 2.5 at 48 hours. Postoperative complications occurred at a low incidence (4.9%) and included one umbilical hernia, one vault dehiscence, and one lumbosacral nerve injury. Two-port access laparoscopic surgery using a single multichannel port system is a feasible and safe procedure in selected patients with gynecologic cancers. Prospective randomized trials will permit the evaluation of the potential benefits of this minimally invasive surgical technique.

Two-Port Access Versus Conventional Staging Laparoscopy for Endometrial Cancer

The purpose of this study was to compare surgical outcomes of 2-port access (TPA) and conventional laparoscopy in staging operations for endometrial cancer. The ultimate goal of TPA system was to perform proper cancer operation with less invasive access and to complement technical limitations of minimally invasive surgery. The TPA system consisted of a single multi-channel port system at the umbilicus and an ancillary 5-mm trocar in the suprapubic area. Twenty-one consecutive patients who underwent TPA staging laparoscopy for endometrial cancers were enrolled in the study. Data coming from this group of patients were prospectively collected and compared with those coming from 42 consecutive patients who underwent conventional staging laparoscopy for the same period. The selected patients were matched (1:2 ratio) to control patients based on age (± 5 years), body mass index, and tumor stage. Patient status was estimated in operative morbidity and surgical outcomes. All operations were completed laparoscopically, with no conversion to laparotomy. The TPA group had a significantly longer operating time (238 ± 51 minutes vs 188 ± 65 minutes; P = 0.001), more retrieved para-aortic lymph nodes (13 vs 5; P < 0.001), shorter postoperative hospital stay (5 vs 8 days; P = 0.001), and less postoperative pain (P = 0.045). There were no postoperative complications requiring further management. Two-port access staging laparoscopy using a single multi-channel port system could be a feasible procedure in selected patients with endometrial cancer with only minimal skin incisions. Prospective randomized trials will permit the evaluation of potential benefits of this minimally invasive surgical technique.

Two-port access staging laparoscopy for endometrial cancer: A case–control study

Two-port access staging laparoscopy for endometrial cancer: A case–control study

Overcoming Technical Difficulties with Single-Port Access Laparoscopic Surgery in Gynecology: Using Conventional Laparoscopic Instruments

The aim of this report was to investigate ways to overcome technical difficulties of the single-port access (SPA) laparoscopic surgery using conventional laparoscopic instruments in gynecology. We performed 140 cases of SPA total laparoscopic hysterectomy for benign gynecologic diseases and 40 cases of two-port access laparoscopic surgery for gynecologic cancers. The conventional laparoscopic instruments, including a 45-cm-long, 5-mm-diameter, 30-degree-angled laparoscope, a 90-degree light cable adaptor, a curved instrument, and nonbulky trocars, and intracorporeal suturing and tying technique were used. All operations were laparoscopically completed with no conversion to conventional laparoscopy or laparotomy. We obtained tolerable surgical outcomes with these instruments. As the technical difficulties have been overcome, the SPA laparoscopic surgery will be a more and more widespread procedure in the gynecologic field with only minimal skin incision.

Single-incision laparoscopic percutaneous extraperitoneal closure for inguinal hernia in children: an initial report

This report describes the first use of single-incision, two-port access for single-incision laparoscopic percutaneous extraperitoneal closure (SILPEC) to manage inguinal hernia in children. Between December 2009 and April 2010, 92 SILPECs of inguinal hernia and hydrocele were performed for 62 patients at Osaka City University Graduate School of Medicine. The SILPEC technique was performed using two ports (a 4.2-mm port placed using the open technique and an additional 4.2-mm port) inserted through the same periumbilical skin incision with different entrances through the abdominal wall. A 19-gauge LPEC needle (a special instrument with a wire loop at the tip to hold the material for circuit suturing around the internal inguinal ring) was used to close the orifice of the hernial sac extraperitoneally with circuit suturing around the internal inguinal ring. Data regarding patient demographics, type of hernia, operating time, complications, postoperative hospital stay, and recurrence were prospectively collected. The mean operative time was 26.9min. The estimated blood loss was almost nil, and no intraoperative complications occurred. The use of SILPEC for inguinal hernia and hydrocele in children appears to be safe, effective, and reliable.

Two-Port Access Staging Laparoscopy for Endometrial Cancer: A Pilot Study

Two-Port Access Staging Laparoscopy for Endometrial Cancer: A Pilot Study

Two-Port Access Staging Laparoscopy for Gynecologic Cancers: A Pilot Study

The aims of this work were to introduce a two-port access (TPA) staging laparoscopy in gynecologic cancers and evaluate the feasibility and surgical outcomes of this operation. We performed 12 cases of TPA staging laparoscopy. The TPA system consisted of a single multichannel port at the umbilicus and an ancillary 5-mm port in the suprapubic area. Patient status was estimated in terms of operative morbidity and surgical outcomes. All operations were completed laparoscopically, with no conversions to conventional laparoscopy or laparotomy. Procedures included endometrial cancer staging (n = 6), ovarian cancer staging (n = 3), 2 cases of type III radical hysterectomy, and 1 type II radical hysterectomy. Median patient age and body mass index were 48 years and 20.4 kg/m(2), respectively. Median operation duration was 241 minutes (range, 188-360). Median estimated blood loss was 175 mL. Median number of lymph nodes obtained was 30 (range, 14-49). Median postoperative hospital stay was 8 days. There were no perioperative complications. TPA staging laparoscopy, using the single multichannel port system, could be a feasible procedure in selected gynecologic cancer patients, with only minimal skin incisions. Prospective, randomized trials will permit the evaluation of potential benefits of this minimally invasive surgical technique.

Design of Stacked SRAM Celt using Dual Port

A stacked SRAM cell for high density memories has been designed using two level polysilicon technology. The inverted thin film transistor forms the load, using common gate electrode (first polysilicon) to the driver transistor. Cell area is reduced by elimination of the N well, parallel layout and smaller cell ratio. Second polysilicon layer forms the drain/source and channel region of the TFT. It also offers superior electrical characteristics. The dual ports have been provided in the SRAM cell using a modified six transistor cell design to provide uncontested and overlapped two-port read access to one cell and read/write access to another. CMOS design rules have been used and as an example MOSIS technology with 0.5 μm design features have been chosen for computation.