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Xie S, Wood TC, Dasgupta P, Aydin A. Robot Assisted Laparoscopic Surgery in Gynaecology: An Evolving Assistive Technology. Surg Innov 2024; 31:324-330. [PMID: 38446503 PMCID: PMC11047015 DOI: 10.1177/15533506241238038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Laparoscopic surgery is extensively utilized to treat a range of gynaecological conditions and pathologies. The advantages of laparoscopic surgery include the minimalization of blood loss and scarring, improved recovery times, and shorter hospital admissions. However, robotic technologies have had an increasing presence within gynaecological laparoscopic surgery in recent decades. This literature review therefore aims to discuss laparoscopy from 3 perspectives. First, the evolution of laparoscopy is reviewed with a focus on its origins, its transition from a diagnostic to an operative tool, and its role in present-day gynaecology. Second, interventions for benign gynaecological conditions (including excision of benign ovarian tumours, total laparoscopic hysterectomy, and laparoscopic myomectomy) are reviewed. The laparoscopic management of malignant gynaecology (including ovarian cancer, endometrial cancer, and cervical cancer) is also discussed. Finally, whilst robot-assisted laparoscopic surgery is experiencing rapid technological advancement, it is pertinent to consider the extent of its benefits when compared to open or conventional laparoscopic approaches in gynaecological surgery.
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Affiliation(s)
- Siwen Xie
- Department of Surgical & Intervention Engineering, King’s College London, London, UK
| | - Thomas Charles Wood
- Department of Obstetrics and Gynaecology, The Hillingdon Hospital, London, UK
| | - Prokar Dasgupta
- MRC Centre for Transplantation, King’s College London, London, UK
| | - Abdullatif Aydin
- MRC Centre for Transplantation, King’s College London, London, UK
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Madelenat P, Chene G. [How Palmer did… Raoul Palmer and the laparoscopic odyssey]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00043-6. [PMID: 38342239 DOI: 10.1016/j.gofs.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Affiliation(s)
- Patrick Madelenat
- Gynécologie-obstétrique, 5, avenue Camille-Deschanel, 75007 Paris, France.
| | - Gautier Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), 59, boulevard Pinel, 69000 Lyon, France; EMR 3738, université de Lyon 1, 69000 Lyon, France
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Sima RM, Crăițan AV, Pleș L, Bobircă F, Amza M, Gorecki GP, Georgescu MT, Hamoud BH. The Beginner Laparoscopists Trends in the Learning Process of Laparoscopy for Adnexal Gynecological Pathologies-The Experience of Our Center. Healthcare (Basel) 2023; 11:1752. [PMID: 37372870 DOI: 10.3390/healthcare11121752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Laparoscopy for benign ovarian pathology is the appropriate surgical approach and it has many well-known advantages. Minimal invasive gynecological surgery increases the quality of life of the patient. The learning process of laparoscopy is difficult and requires many interventions to acquire manual skills. The objectives of the study were to assess the learning process of laparoscopy for adnexal pathology surgery performed by beginner laparoscopists. MATERIALS AND METHODS This study included three gynecological surgeons who were beginners in laparoscopy and who were named A, B, and C. We collected information about patients, diagnosis, surgical technique, and complications. RESULTS We have analyzed the data from 159 patients. The most frequent primary diagnosis was functional ovarian cyst, and the laparoscopic cystectomy was performed in 49.1% of interventions. The need to convert a laparoscopy into laparotomy was necessary in 1.3% of patients. There were no cases of reintervention, blood transfusion, or ureteral lesions. The duration of the surgical intervention varied statistically significantly according to patient's BMI and to the surgeon. After 20 laparoscopic interventions, a significant improvement was found in the time needed to perform ovarian cystectomy (operators A and B) and salpingectomy (operator C). CONCLUSIONS The process of learning laparoscopy is laborious and difficult. We found a significant decrease in operating time after a twenty laparoscopic interventions.
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Affiliation(s)
- Romina-Marina Sima
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Anca-Violeta Crăițan
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Liana Pleș
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Florin Bobircă
- Department of Surgery, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Surgery Department, Dr. Ion Cantacuzino Clinical Hospital, 011437 Bucharest, Romania
| | - Mihaela Amza
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania
- The "Bucur" Maternity, "Saint John" Hospital, 040294 Bucharest, Romania
| | - Gabriel-Petre Gorecki
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
- Department of Anesthesia and Intensive Care, CF2 Clinical Hospital, 011464 Bucharest, Romania
| | - Mihai-Teodor Georgescu
- "Prof. Dr. Al. Trestioreanu" Oncology Discipline, Carol Davila University of Medicine and Pharmacy, 252 Fundeni St., 050474 Bucharest, Romania
| | - Bashar Haj Hamoud
- Department for Gynecology, Obstetrics and Reproductive Medicine, Saarland University Hospital, KirrbergerStraße 100, Building 9, 66421 Homburg, Germany
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Advancements in Thyroidectomy: A Mini Review. ENDOCRINES 2022. [DOI: 10.3390/endocrines3040065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Demand for minimally invasive surgery has driven the development of new gadgets and surgical techniques. Yet, questions about safety and skeptical views on new technology have prevented proliferation of new modes of surgery. This skepticism is perhaps due to unfamiliarity of new fields. Likewise, there are currently various remote-access techniques available for thyroid surgeons that only few regions in the world have adapted. This review will explore the history of minimally invasive techniques in thyroid surgery and introduce new technology to be implemented.
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Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The Development of Laparoscopy-A Historical Overview. Front Surg 2022; 8:799442. [PMID: 34977146 PMCID: PMC8714650 DOI: 10.3389/fsurg.2021.799442] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
The advent of laparoscopy marked a fundamental change in the evolution of medicine. The procedure progressed consistently after the first time it was performed in a human being nearly a hundred years ago. The 1960's and 1980's witnessed groundbreaking changes. During this time, laparoscopy evolved from a purely diagnostic procedure into an independent surgical approach. Outstanding pioneers of the times were Palmer, Frangenheim and Semm. Laparoscopy advanced rapidly and influenced gynecology as well. The procedure was initially attacked most vociferously by the surgical fraternity. However, within a short period of time the pendulum shifted: laparoscopy became the preferred surgical approach for a variety of diseases—whether benign or malignant—in several medical disciplines. Laparoscopy has become a routine approach in the twenty-first century. Technical advancements have led to robot-assisted surgery. Future developments will include artificial intelligence and augmented reality. In the present article we address past milestones, current practices, and future challenges in laparoscopy.
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Affiliation(s)
- Ibrahim Alkatout
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Ulrich Mechler
- Institute of History and Ethics of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Liselotte Mettler
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Julian Pape
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Nicolai Maass
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Matthias Biebl
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Gitas
- Department of Obstetrics and Gynecology, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Damaris Freytag
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
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Rosser JB, Nitsche L, Yee G, Alam H. The evolution of surgical virtual education and telementoring: One surgeon's journey. J Surg Oncol 2021; 124:162-173. [PMID: 34245579 DOI: 10.1002/jso.26563] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/12/2022]
Abstract
The first era of the global proliferation of surgical advancements involved surgical infection rate and technique breakthroughs by Lister, Halsted, and others. This was propagated by letters, academic papers, and international visits. While success was achieved, it was at a suboptimal pace. In the current era of minimally invasive surgical approaches, these methods are inadequate. This paper chronicles the development and application of virtual learning and telementoring as force multipliers to speed procedural adoption and proliferation.
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Affiliation(s)
- James Butch Rosser
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Lindsay Nitsche
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Gabrielle Yee
- School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, New York, USA
| | - Harris Alam
- University of Central Florida, Orlando, Florida, USA
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Dolay K, Hasbahçeci M. The role of surgeons on the development and performance of endoscopy. Turk J Surg 2017; 33:1-4. [PMID: 28589179 DOI: 10.5152/ucd.2017.3728] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/18/2016] [Indexed: 11/22/2022]
Abstract
Endoscopy is being frequently performed for both diagnostic and therapeutic applications in surgical practice. Surgery, as a scientific area, has an important role in the propagation of therapeutic endoscopic procedures. The contribution of surgeons to the evolution of endoscopic applications and its practice is a triggering factor for the improvement of endoscopic instruments and their widespread use. Training and education on basic diagnostic and therapeutic surgical endoscopy should be implemented as part of general surgery residency core program, according to accepted standardized criteria, in order for general surgeons to perform endoscopic applications in the future. In light of this information, it can be concluded that endoscopy training and skills should be standardized within accepted general principles. Standards to be used during post-graduate endoscopic practice should be precisely stated. In addition to accreditation of both surgeons and endoscopic centers, theoretical and practical education programs should be composed and organized.
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Affiliation(s)
- Kemal Dolay
- Department of General Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
| | - Mustafa Hasbahçeci
- Department of General Surgery, Bezmialem Vakif University School of Medicine, Istanbul, Turkey
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Stark M, Pomati S, D'Ambrosio A, Giraudi F, Gidaro S. A new telesurgical platform--preliminary clinical results. MINIM INVASIV THER 2015; 24:31-6. [PMID: 25627435 DOI: 10.3109/13645706.2014.1003945] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A new European telesurgical system, the Telelap Alf-x, is introduced. Its main features are individual arms, which enable free access to the patient throughout surgery, a large range of reusable surgical instruments, an open console with eye-tracking system, where the camera follows the eye and head movements of the surgeon, and the existing force feedback enables for the first time to feel the consistency of the tissues and avoid tearing of the stitches while suturing. The system combines the benefits of open surgery and endoscopy. The first clinical application, which involved 146 operations at the gynecological department of the Gemelli University Hospital in Rome, proved the safety and the surgical team's quick adaptation to the system.
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Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA) , Berlin , Germany
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Leeder S. Assuring quality in an age of rapid technological advance. Med J Aust 2015; 202:395, 399. [PMID: 25929488 DOI: 10.5694/mja15.c0504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 11/17/2022]
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Moran ME. Imaging the Beast: Sounding, Lithoscopes, and Röntgen Rays. Urolithiasis 2014. [DOI: 10.1007/978-1-4614-8196-6_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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An objective comparison of novice trainees learning LESS versus traditional laparoscopy with the use of a pelvic trainer. Urologia 2013; 80:302-6. [DOI: 10.5301/urologia.5000026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2013] [Indexed: 01/22/2023]
Abstract
Objectives To compare the differences between LESS and SL among a population of subjects inexperienced of both techniques. Materials and Methods Participants were randomly assigned to the LESS or SL arm of the course; between the population examined, none had previous laparoscopic experience. The trial consisted in performing three increasingly difficult exercises either with LESS or standard laparoscopy. Results Time of execution and Objective Structured Assessment of Technical Skills score (OSATS) were recorded. Statistical analysis failed to detect any significant difference between the two arms of the trial. A trend in favor of standard laparoscopy was observed anyway. Discussion Our study evaluates the technical performance on a surgical simulator in the laboratory setting, with the use of standardized tasks and validated metrics. We believe that a controlled and safe environment aids objective evaluation of LESS compared to SL. Literature on this particular topic is somehow conflicting and heterogeneous. Our trial demonstrated that novices performed LESS tasks without any additional difficulties compared to standard laparoscopy. The aim of such investigation is to support knowledge of this new technology in order to facilitate its use in selected patients and surgical procedures.
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Abstract
PURPOSE OF REVIEW The evaluation of liver histology is an important component of the diagnosis and staging of liver diseases. The most common technique employed to sample liver tissue for decades has been percutaneous liver biopsy. Although this is a relatively well tolerated technique in the early stages of liver disease, it carries a high risk of complications, particularly hemorrhage, in patients with advanced cirrhosis. Mini-laparoscopy allows macroscopic assessment and biopsy under direct vision and therefore is a well tolerated and effective technique. RECENT FINDINGS The major advantages of this technique are direct visualization of the liver surface, thereby allowing inspection for morphologic changes of cirrhosis as well as targeted biopsies, the ability to immediately treat potential complications (bleeding and bile leakage), furthermore the peritoneal cavity can be visualized to stage gastrointestinal (GI) malignancies. Additionally, 'blind' percutaneous liver biopsy fails to establish a diagnosis in about 25% of cases, largely because of sampling error. SUMMARY This technique presents the opportunity to visualize the surface of the liver and the peritoneal cavity, making it a valuable tool for liver biopsy. This review summarizes the technique of mini-laparoscopy and addresses its potential uses and limitations as a diagnostic modality.
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Stark M, Benhidjeb T, Gidaro S, Morales ER. The future of telesurgery: a universal system with haptic sensation. J Turk Ger Gynecol Assoc 2012; 13:74-6. [PMID: 24627681 DOI: 10.5152/jtgga.2012.05] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Michael Stark
- The New European Surgical Academy (NESA), Berlin, Germany
| | - Tahar Benhidjeb
- The New European Surgical Academy (NESA), Berlin, Germany ; Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Gidaro
- Department of Surgical Science University "G. D'Annunzio" Chieti-Pescara, Italy
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The road to reduced port surgery: from single big incisions to single small incisions, and beyond. World J Surg 2011; 35:1526-31. [PMID: 21523502 DOI: 10.1007/s00268-011-1099-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Single-port surgery has seen almost as rapid an application as multiport laparoscopy during the early 1990s. Hopefully, we will learn from our predecessors to apply the dictums of safety and science as we move forward with this new technique to ensure adequate adoption and successful outcomes with limited errors and concerns along the way.
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Dhumane PW, Diana M, Leroy J, Marescaux J. Minimally invasive single-site surgery for the digestive system: A technological review. J Minim Access Surg 2011; 7:40-51. [PMID: 21197242 PMCID: PMC3002006 DOI: 10.4103/0972-9941.72381] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 08/02/2010] [Indexed: 12/13/2022] Open
Abstract
Minimally Invasive Single Site (MISS) surgery is a better terminology to explain the novel concept of scarless surgery, which is increasingly making its way into clinical practice. But, there are some difficulties. We review the existing technologies for MISS surgery with regards to single-port devices, endoscope and camera, instruments, retractors and also the future perspectives for the evolution of MISS surgery. While we need to move ahead cautiously and wait for the development of appropriate technology, we believe that the “Ultimate form of Minimally Invasive Surgery” will be a hybrid form of MISS surgery and Natural Orifice Transluminal Endoscopic Surgery, complimented by technological innovations from the fields of robotics and computer-assisted surgery.
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Affiliation(s)
- Parag W Dhumane
- IRCAD/EITS, Hôpitaux Universitaires, 1 Place de l'Hôpital, 67091 Strasbourg Cedex, France
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Podolsky ER, Curcillo PG. Single port access (SPA) surgery--a 24-month experience. J Gastrointest Surg 2010; 14:759-67. [PMID: 20155330 DOI: 10.1007/s11605-009-1081-6] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 10/26/2009] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In April 2007, we performed our first single port access (SPA) surgical procedure. Beginning with simple procedures, we progressed to more complex procedures employing modifications of the initial technique. METHODS Maintaining our abdominal entry technique through a single incision, typically umbilical, we have now successfully performed cholecystectomies, colon resections, small bowel procedures, liver biopsy, splenectomy, adrenalectomy, and surgery of the gastroesophageal junction. RESULTS Two procedures have required additional port sites, none has employed transabdominal sutures, and <5% of all procedures have required articulation. Immediate follow-up demonstrates safe completion of multiple procedures with acceptable outcomes of blood loss and hospital stay. Although initial operative times are extended, a decrease is seen following a learning curve. At 2-year follow-up, two hernias developed at the extended incision for colon extraction. DISCUSSION AND CONCLUSION With initial procedures performed in April 2007, we now report 24-month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that SPA surgery is an alternative to multiport procedures with proposed initial benefits of decreased number of incisions and improved cosmesis for the patient. Long-term prospective randomized large case series will be necessary to assess pain, recovery, and hernia formation proving advantages, if any, over multiport laparoscopy.
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Affiliation(s)
- Erica R Podolsky
- Department of Surgery, College of Medicine, Drexel University, 219 North Broad Street, 10th Floor, Philadelphia, PA 19107, USA
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Abstract
INTRODUCTION Laparoscopy is a constantly evolving field of surgery. New technology, applications, and benefits prompt continual improvement. We have developed a Single Port Access (SPA) surgical technique that allows for the entire cholecystectomy to be performed through a single incision within the umbilicus while maintaining safe standard dissection and retraction techniques of currently performed multiport laparoscopic cholecystectomy. METHODS Fifteen consecutive patients underwent SPA cholecystectomy. Indications were cholelithiasis, cholecystitis, CBD stones, and biliary akinesia. The entire procedure was performed through a single umbilical incision measuring <1.8 cm within the umbilicus. Three trocars and a rigid grasper were inserted through separate fascial sites within the same skin incision. The cholecystectomy procedures are then performed in the standard fashion described in multi-port cholecystectomy. RESULTS Fifteen patients successfully underwent Single Port Access cholecystectomy. One patient required a second 5-mm port site secondary to difficulty with retraction of a large liver. Operative times averaged 107 minutes. Blood loss, patient recovery, and outcomes have been comparable to those of standard multi-port procedures. No umbilical hernias have been seen at 2 years of follow-up. CONCLUSION We present the SPA cholecystectomy as an alternative to multi-port cholecystectomy. In the first 2 years, SPA surgery has evolved into a technique easily taught and performed without the restrictions of new equipment or added cost.
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Affiliation(s)
- Erica R Podolsky
- Drexel University, College of Medicine, Department of Surgery, Philadelphia, PA 19107, USA.
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Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG. Single Port Access (SPA™) Cholecystectomy: A Completely Transumbilical Approach. J Laparoendosc Adv Surg Tech A 2009; 19:219-22. [DOI: 10.1089/lap.2008.0275] [Citation(s) in RCA: 126] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Erica R. Podolsky
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Steven J. Rottman
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Honesto Poblete
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Stephanie A. King
- Department of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Paul G. Curcillo
- Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
- Department of OB/GYN, Drexel University College of Medicine, Philadelphia, Pennsylvania
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