Single-port laparoscopic surgery

Minimally invasive gastrointestinal surgery: From past to the future

The improvement of the science and art of surgery began over 150 years ago. Surgical core tasks, “cutting and sewing” with hand and direct contact with the organs, have remained the same. However, in the 21st century, there has been a shifting paradigm in the methodology of surgery. The joint union between innovators, engineers, industry, and patient demands resulted in minimally invasive surgery (MIS). This method has influenced the techniques in every aspect of abdominal surgery, such as surgeons are not required to direct contact or see the structures on which they operate. Advances in the endoscope, imaging, and improved instrumentations convert the essential open surgery into the endoscopic method. Furthermore, computers and robotics show a promising future to facilitate complex procedures, enhance accuracy in microscale operations, and develop a simulation to improve the ability to face sophisticated approaches. MIS has been replacing open surgery due to improved survival, fewer complications, and rapid recoveries in recent years. Minimally invasive surgery's further research in diagnostic and therapeutic modalities is under investigation to achieve genuinely “noninvasive” surgery. Thus, MIS has gained interest in recent days and has been improving with promising outcomes.

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Minimally invasive surgery has interfered with multiple aspects of the surgical approach.

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Advancement in the endoscope, imaging, and other instrumentations shifting the current methodological conventional surgery.

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The benefit over risk is the promising primary outcome to achieve an exceptional quality of life.

Single-Port Access Endoscopic Thyroidectomy via Axillary Approach for the Benign Thyroid Tumor: New Aspects from Vietnam

Background

This study aims to describe our new experience with single-port totally endoscopic thyroidectomy via the axillary approach in patients with unilateral thyroid benign tumors. In parallel with that, we also discuss here the challenges and novelty highlights we have confronted and solved and the details of our operative technique.

Methods

Between August 2018 and May 2020, the study involved 54 patients who underwent a single-port single-incision endoscopic thyroidectomy via the axillary approach for benign thyroid tumor at the National Hospital of Endocrinology (Hanoi, Vietnam). Surgical patient indications were in working age, goiter classification of grade 1 or grade 2, the thyroid with mononuclear or multinucleated, lesion diameter of less than 4 cm, unilateral thyroid benign lesion and no previous history of neck surgery or irradiation.

Results

No mortality was observed. Morbidities included transient voice change in 8 patients, swallowing disorders in 2 patients, transient skin paresthesia in 2 patients and wound hematoma in 2 patients. Mean amount of postoperative drainage was 70.2 mL, mean duration of postoperative drainage was 2.7 days, and mean postoperative hospital day was 6.6 days. Mean total operation time was 66.0 minutes and mean blood loss was 13.3 mL. Regarding medium-term follow-up outcomes following surgery, we recorded the hypothyroidism in 3 patients (5.6%) and the hypocalcemia in 1 case (1.8%). Most patients felt normal neck movement and sensation (79.6%), 3 patients were painful (5.6%) and 8 those were numb (14.8%). We saw the soft incision scar in 35 patients (64.8%), convex scar in 14 patients (25.9%), and hard scar in 5 patients (9.3%).

Conclusion

Single-port endoscopic thyroidectomy via axillary approach is a safe and feasible treatment option for removing benign thyroid tumor, delivering favorable surgical outcomes with ideal cosmetic effect and reduction in injury to the anterior neck tissue.

Laparoscopic experience and attitudes toward a low-cost laparoscopic system among surgeons in East, Central, and Southern Africa: a survey study

BACKGROUND

Laparoscopic surgery has become standard of care in high-income countries but is rarely accessible in low- and middle-income countries (LMICs). This study assessed experience with laparoscopy and attitudes toward a low-cost laparoscopic system among surgeons in sub-Saharan Africa.

METHODS

A survey assessing current laparoscopic practice and feedback on a low-cost laparoscopic system was administered to attendees of the College of Surgeons of East, Central, and Southern Africa (COSECSA) Scientific Conference between December 4 and December 6, 2019 in Kampala, Uganda.

RESULTS

Fifty-six surgeons from 14 countries participated. A majority were male (n = 46, 82%) general surgeons (n = 37, 66%) from tertiary/teaching hospitals (n = 36, 64%). For those with training in laparoscopy (n = 33, 59%), 22 (67%) reported less than 1 year of training and over half (n = 17, 52%) reported 1 month or less. Overall, a minority (n = 21, 38%) used laparoscopy in current practice, with 57% (n = 12) of those performing laparoscopy less than once per week. The most common laparoscopic surgeries performed were cholecystectomy (n = 15), diagnostic laparoscopy (n = 14), and appendectomy (n = 12). Few surgeons were performing more complex cases (n = 5). Barriers to laparoscopy included poor access to training equipment (n = 34, 61%), mentors (n = 33, 59%), laparoscopic equipment (n = 31, 55%), equipment maintenance (n = 25, 45%), access to consumable supplies (n = 21, 38%), and cost (n = 31, 55%). Fifty-two participants (93%) were interested in increasing their use of laparoscopy; the majority felt that a low-cost laparoscope (n = 52, 93%) and lift retractor for gasless laparoscopy (n = 46, 82%) would serve an unmet need in their practice.

CONCLUSIONS

While the use of laparoscopy is currently limited in COSECSA countries, there is a significant interest among surgeons to increase implementation. A low-cost, durable laparoscopic system was viewed as a potential solution to the current barriers and could improve implementation in LMICs.

Internal Grasper and Magnetic Anchoring Guidance System in Gynecologic Laparoendoscopic Single-site Surgery: A Case Series

STUDY OBJECTIVE

To evaluate and report preliminary data after the use of an internal grasper and magnetic anchoring guidance system (MAGS) to allow free movement and optimal triangulation in the abdominal cavity during gynecologic laparoendoscopic single-site surgery (LESS).

DESIGN

A prospective, single-center case series.

SETTING

The First Affiliated Hospital of Xi'an Jiaotong University.

PATIENTS

Eighteen female patients underwent MAGS-assisted LESS with an internal grasper.

INTERVENTIONS

A single surgeon performed MAGS-assisted LESS on patients with benign gynecologic diseases while documenting operative time, device insertion time, surgeon assessment of technical adaptation, patient-evaluated pain and cosmetic outcomes, adverse events, and blood loss.

MEASUREMENTS AND MAIN RESULTS

Eighteen patients underwent transumbilical MAGS-assisted LESS using an internal grasper from November 1, 2019, to December 31, 2019. The mean operative time and insertion time were 98.7 minutes and 1 minute, respectively. The use of MAGS was easily mastered by the surgeon and considered consistently useful in overcoming the limitations of LESS. The patients reported average pain scores of 4.8, 2.3, and 0.5 immediately, 24 hours, and 1 week after surgery, respectively. All patients expressed satisfaction with the postoperative cosmetic results. No serious complications were observed. The mean blood loss was 43.6 mL.

CONCLUSION

MAGS-assisted LESS is easy to deploy and use for benign gynecologic disease and seems to result in positive outcomes. Larger randomized controlled trials are warranted.

Trans-umbilical single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty of inguinal hernia by self-made glove port

Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.

Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life?

Background

Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. In recent times, single-incision laparoscopic cholecystectomy(SILC) has developed as a less invasive alternative technique to conventional laparoscopy. In the literature, many studies have compared SILC and conventional laparoscopic cholecystectomy (CLC) procedures but a limited number of studies have compared the two techniques with regard to quality of life (QOL). The choice of surgical procedure was effected by QOL of the patients. The effects of SILC on QOL remain unclear. In this study, we aimed to compare the effects of conventional laparoscopic cholecystectomy (CLC) and single-incision laparoscopic cholecystectomy (SILC) procedures on the clinical outcomes and quality of life of patients by short-term follow-up evaluation.

Material and methods

In this study, 142 patients who underwent cholecystectomy operations with either technique underwent SILC and CLC were evaluated. The quality of life index in the patients was measured with short form 36 (SF 36) test.

Results

The results of mean operative time, length of stay and complication rate for SILC and CLC were similar. The postoperative health-related quality of life (HRQOL) scores were not significantly different between the SILC and CLC patients but only physical functioning score were higher in SILC patients.

Conclusions

SILC is a safe and effective alternative to CLC. To detect the effects of SILC on HRQOL, we need long-term prospective comparative studies.

Newly Developed Laparoscopic Needle Holder That Facilitates Knot Tying Makes Vaginal Cuff Suturing Easy in Single-Port Laparoscopic Hysterectomy

BACKGROUND

To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH).

METHODS

We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed.

RESULTS

The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications.

CONCLUSION

The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.

Single-incision laparoscopic surgery increases the risk of unintentional thermal injury from the monopolar "Bovie" instrument in comparison with traditional laparoscopy

BACKGROUND

Single-incision laparoscopic surgery (SILS) places multiple instruments in close, parallel proximity, an orientation that may have implications in the production of stray current from the monopolar "Bovie" instrument. The purpose of this study was to compare the energy transferred during SILS compared to traditional four-port laparoscopic surgery (TRD).

METHOD

In a laparoscopic simulator, instruments were inserted via SILS or TRD setup. The monopolar generator delivered energy to a laparoscopic L-hook instrument for 5-s activations on 30-Watts coag mode. The primary outcome (stray current) was quantified by measuring the heat of liver tissue held adjacent to the non-electrically active 10-mm telescope tip and Maryland grasper in both the SILS and TRD setups. To control for the potential confounder of stray energy coupling via wires outside the surgical field, the camera cord and active electrode wires were oriented parallel or completely separated.

RESULTS

SILS and TRD setups create similar amounts of stray current as measured by increased tissue temperature at the non-electrically active telescope tip (41 ± 12 vs. 39 ± 10 °C; p = 0.71). Stray current was greater in SILS compared to TRD at the tip of the non-electrically active Maryland forceps (38 ± 9 vs. 20 ± 10 °C; p < 0.01). Separation of the active electrode and camera cords did not change the amount of stray energy in the SILS orientation for either telescope (39 ± 10 °C bundled vs. 36 ± 10 °C separated; p = 0.40) or grasper (38 ± 9 °C bundled vs. 34 ± 11 °C separated; p = 0.19) but did in the TRD orientation (41 ± 12 bundled vs. 24 ± 10 separated; p < 0.01). When SILS was compared to TRD with the cords separated, SILS increased stray energy at both the telescope tip and grasper tip (36 ± 10 vs. 24 ± 10 °C; p < 0.01 and 34 ± 11 vs. 17 ± 8 °C; p < 0.01).

CONCLUSION

SILS increases stray energy transfer nearly twice as much as TRD with the use of the monopolar instrument. Strategies to mitigate the amount of stray energy in the TRD setup such as separation of the active electrode and camera cords are not effective in the SILS setup. These practical findings should enhance surgeons using the SILS approach of increased stray energy that could result in injury.

The learning curve of single-port laparoscopic appendectomy performed by emergent operation

Background

Single-port laparoscopic appendectomy (SPLA) has the advantage of minimizing abdominal incision scars with patient satisfaction. However, it has the following disadvantages: it provides a narrower surgical field than conventional laparoscopic appendectomy, which requires a considerably longer operative time to achieve surgical skills. This study was conducted to evaluate the learning curve for SPLA.

Methods

This study included a total of 120 patients with acute abdomen who visited our emergency department and were diagnosed with acute appendicitis between March 2013 and February 2015. They underwent SPLA by a single surgeon. Patients were divided into 4 groups of 30 patients each according to operation dates. Operative time, time to resume oral intake, length of hospital stay, and postoperative complications were analyzed.

Results

The mean operative time was 59.9 ± 19.9 min. It was shortened after completion of 30 operations and remained unchanged until it was further shortened after completion of 90 operations. There was no significant difference in time to resumption of oral intake or length of hospital stay between the 4 groups. Postoperative complications occurred in 18 patients, but the frequency of the complications was not significantly different between the 4 groups.

Conclusions

The results of this study suggest that surgeons can achieve surgical skills for SPLA after completion of 30 operations and more experienced surgical skills by SPLA successfully after completion of 90 operations.

The Effect of Product Safety Courses on the Adoption and Outcomes of LESS Surgery

BACKGROUND AND OBJECTIVES

As technology in surgery evolves, the medical instrument industry is inevitability involved in promoting the use and appropriate (ie, effective and safe) application of its products. This study was undertaken to evaluate industry-supported product safety courses in laparoendoscopic single-site (LESS) surgery, by using the metrics of surgeons' adoption of the technique, safety of the procedure, and surgeons' perception of the surgery.

METHODS

LESS surgery courses that involved didactic lectures, operative videos, operation observation, collaborative learning, and simulation, were attended by 226 surgeons. With Florida Hospital Tampa Institutional Review Board approval, the surgeons were queried before and immediately after the course, to assess their attitudes toward LESS surgery. Then, well after the course, the surgeons were contacted, repeatedly if necessary, to complete questionnaires.

RESULTS

Before the course, 82% of the surgeons undertook more than 10 laparoscopic operations per month. Immediately after the course, 86% were confident that they were prepared to perform LESS surgery. Months after the course, 77% of the respondents had adopted LESS surgery, primarily cholecystectomy; 59% had added 1 or more trocars in 0-20% of their procedures; and 73% held the opinion that operating room observation was the most helpful learning experience. Complications with LESS surgery were noted 12% of the time. Advantages of the technique were better cosmesis (58%) and patient satisfaction (38%). Disadvantages included risk of complications (37%) and higher technical demand (25%). Seventy-eight percent viewed LESS surgery as an advancement in surgical technique.

CONCLUSION

In multifaceted product safety courses, operating room observation is thought to provide the most helpful instruction for those wanting to undertake LESS surgery. The procedure has been safely adopted by surgeons who frequently perform laparoscopies. The tradeoff is in performing a more difficult technique to obtain better cosmesis for the patient. We must continue to conduct critical evaluations of product safety courses for the introduction of new technology in surgery.

Transumbilical single-incision laparoscopic distal pancreatectomy: preliminary experience and comparison to conventional multi-port laparoscopic surgery

BACKGROUND

Single-incision laparoscopic surgery (SILS), which has been demonstrated to be safely applied on kinds of surgeries, may represent an improvement over conventional multi-port laparoscopic surgery. However, there are still few clinical experiences of SILS in pancreatic surgery until now. In this study, we will summarize our experience of transumbilical single-incision laparoscopic distal pancreatectomy (TUSI-LDP), and compare its related parameters with conventional multi-port laparoscopic distal pancreatectomy (C-LDP).

METHODS

A retrospective analysis was conducted for the patients who underwent C-LDP or TUSI-LDP in our department. The demographic data, operative parameters, and postoperative complications in the two groups were summarized and compared.

RESULTS

Laparoscopic distal pancreatectomy was performed in a total of 21 cases, among which TUSI-LDP was performed in 14 cases. As far as the demographical results concerned, there were no significant differences between the two groups. The conversion to open surgery was conducted in one case in the TUSI-LDP group because of severe adhesion between pancreatic cyst and surrounding tissues, while in the C-LDP group the only one conversion was for the difficult detection of small lesion. The mean operating time and intraoperative blood loss in TUSI-LDP group was a little shorter (166.4 ± 57.4 versus 202.1 ± 122.5 minutes, p > 0.05, and 157.1 ± 162.4 versus 168.6 ± 157.4 ml, p > 0.05). The postoperative pain and post-operation lengths of hospital stay in the TUSI-LDP group were also less, though there was no significant statistical difference between the two groups. For the post-operation complications, in TUSI-LDP group the pancreatic leakage occurred in only one case, and ceased spontaneously with only a drain for 61 days. There were no other complications including postoperative hemorrhage, venous thrombosis, infections and so on in both groups.

CONCLUSION

For the experienced laparoscopic surgeons, in selected patients, TUSI-LDP is a feasible technique, with excellent cosmetic effect, less postoperative pain and post-operation lengths of hospital stay. With the experience accumulated, the operating time and intraoperative blood loss of TUSI-LDP could also gradually reduce.

The application of McBurney's single-incision laparoscopic colectomy alleviates the response of patients to postoperative wound pain

BACKGROUND

Single-incision laparoscopic colectomy (SILC) is one of several promising operation choices. Our previous study demonstrated that SILC with a self-made glove-port system both improves the feasibility of SILC and decreases the cost expense of surgery. Because the incision site for SILC could be made at either the umbilicus or McBurney's point, we are interested in whether the incision site affects the outcomes of patients, which is a less explored topic. The purpose of this study is not only to show the results of SILC with a self-made glove-port system for supporting its feasibility, but also to compare the short-term surgical outcomes between SILC with the incision made at the umbilicus and at McBurney's point.

SUBJECTS AND METHODS

We collected and reviewed the medical records of patients who received SILC with a self-made glove-port system for tumors in the left side of the colon from August 2009 to March 2011. All operations were performed by a single surgeon. Comparisons of the demographic characteristics, perioperative data, and clinical outcomes between umbilical and McBurney's SILCs were performed. Postoperative pain was assessed by a visual analog scale and opiate demand.

RESULTS

In total, 61 patients were enrolled in this retrospective study. Five of 48 (10.4%) tumors in the umbilical SILC group and 5 of 13 (38.5%) tumors in the McBurney's SILC group were located below the peritoneal reflection. The tumor location was significantly different between these two groups (P=.015). Patients in the umbilical SILC group had significantly higher frequency of opiate demand than those in the McBurney's SILC group (0.4±0.7 versus 1.4±1.8, respectively; P=.002).

CONCLUSIONS

This study further provides evidence for supporting the safety and feasibility of SILC in treating colorectal diseases. More important is that McBurney's SILC not only alleviates the patient response to wound pain, but also provides the same site for a diverting enterostomy to avoid creating an additional wound.

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

BACKGROUND

Laparoendoscopic single site (LESS) surgery may have perceived benefits of reduced visible scarring compared to conventional laparoscopic (LAP) totally extraperitoneal (TEP) hernia repairs. We reviewed the literature to compare LESS TEP inguinal hernia repairs with LAP TEP repairs.

METHODS

We searched electronic databases for research published between January 2008 and January 2012.

RESULTS

A total of 13 studies reported on 325 patients. The duration of surgery was 40-98 minutes for unilateral hernia and 41-121 minutes for bilateral repairs. Three studies involving 287 patients compared LESS TEP (n = 128) with LAP TEP (n = 159). There were no significant differences in operative duration for unilateral hernias (p = 0.63) or bilateral repairs (p = 0.29), and there were no significant differences in hospital stay (p > 0.99), intraoperative complications (p = 0.82) or early recurrence rates (p = 0.82). There was a trend toward earlier return to activity in the LESS TEP group (p = 0.07).

CONCLUSION

Laparoendoscopic single site surgery TEP hernia repair is a relatively new technique and appears to be safe and effective. Advantages, such as less visible scarring, mean patients may opt for LESS TEP over LAP TEP. Further studies with clear definitions of outcome measures and robust follow-up to assess patient satisfaction, return to normal daily activities and recurrence are needed to strengthen the evidence.

Adnexal Masses Treated Using a Combination of the SILS Port and Noncurved Straight Laparoscopic Instruments: Turkish Experience and Review of the Literature

Objective. To report our experience treating adnexal masses using a combination of the SILS port and straight nonroticulating laparoscopic instruments. Study Design. This prospective feasibility study included 14 women with symptomatic and persistent adnexal masses. Removal of adnexal masses via single-incision laparoscopic surgery using a combination of the SILS port and straight nonroticulating laparoscopic instruments was performed. Results. All of the patients had symptomatic complex adnexal masses. Mean age of the patients was 38.4 years (range: 21–61 years) and mean duration of surgery was 71 min (range: 45–130 min). All surgeries were performed using nonroticulating straight laparoscopic instruments. Mean tumor diameter was 6 cm (range: 5–12 cm). All patient pathology reports were benign. None of the patients converted to laparotomy. All the patients were discharged on postoperative d1. Postoperatively, all the patients were satisfied with their incision and cosmetic results. Conclusion. All 14 patients were successfully treated using standard, straight nonroticulating laparoscopic instruments via the SILS port. This procedure can reduce the cost of treatment, which may eventually lead to more widespread use of the SILS port approach. Furthermore, concomitant surgical procedures are possible using this approach. However, properly designed comparative studies with single port and classic laparoscopic surgery are urgently needed.

Large conization and laparoendoscopic single-port pelvic lymphadenectomy in early-stage cervical cancer for fertility preservation

Fertility preservation in early-stage cervical cancer is a hot topic in gynecologic oncology. Although radical vaginal trachelectomy (RVT) is suggested as a fertility preserving approach, there are some serious concerns like cervical stenosis, second trimester loss, preterm delivery in survivors, and lack of residual tumor in the majority of the surgical specimens. Therefore, less radical surgical operations have been proposed in early-stage cervical carcinomas. On the other hand, single-incision laparoscopic surgery (SILS) is an evolving endoscopic approach for minimal access surgery. In this report, we present a case with early-stage cervical cancer who wishes to preserve fertility. We successfully performed single-port pelvic lymphadenectomy and large conization to preserve fertility potential of the patient. We think that combination of less radical approach like conization and single-port pelvic lymphadenectomy might be less minimally invasive and is still an effective surgical approach in well-selected cases with cervical carcinomas. Incorporation of single-port laparoscopy into the minimally invasive fertility sparing management of the cervical cancer will improve patients outcome with less complications and better cosmesis. Further studies are needed to reach a clear conclusion.

Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study

PURPOSE

Minimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain.

METHODS

Ninety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded.

RESULTS

A total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05).

CONCLUSION

In conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Randomized prospective study to compare laparoscopic appendectomy versus umbilical single-incision appendectomy

INTRODUCTION

The use of single-incision laparoscopic surgery may represent an improvement over conventional laparoscopic surgery. In recent years, more and more articles have been published demonstrating the feasibility of this approach. Hence, for this reason, we present this randomized prospective study to compare the 2 techniques.

METHODS

Between September 2009 and December 2010, a total of 184 patients with a diagnosis of acute appendicitis and indicated for surgery were included in the study, of whom, 91 received an appendectomy via a single umbilical incision and 93 via conventional laparoscopy. The study protocol was approved by the ethical committee of the Virgen de la Arrixaca University Hospital (Murcia). The study was registered on ClinicalTrials.gov with inscription number NCT0151529. All the operations were performed by the same team of surgeons.

RESULTS

As far as the demographical results of the study population are concerned, there were no significant differences between the 2 groups for age, weight, sex, body mass index, and removed appendix type. Operating time was longer with the single-port approach: 38.13 ± 13.49 versus 32.12 ± 12.44 minutes (P = 0.02). Significant differences were observed for postoperative pain, which was measured on the visual analog scale, with less pain reported in the single-incision group: 2.76 ± 1.64 versus 3.78 ± 1.76 (P < 0.001). There were no significant differences between the 2 groups for early and late complications and lengths of hospital stay measured in postoperative hours.

CONCLUSIONS

The transumbilical single-port approach is seen as a feasible technique for performing appendectomy. It does not increase the rate of complications and represents a possible alternative to conventional laparoscopic appendectomy.

Single-port laparoscopic hysterectomy versus conventional laparoscopic hysterectomy: a prospective randomized trial

OBJECTIVE

To compare transumbilical single-port laparoscopic hysterectomy (TSPLH) with traditional four-port total laparoscopic hysterectomy (TLH).

METHODS

Patients with benign uterine disease were assigned to receive either TSPLH (n = 52) or TLH (n = 56). Duration of surgery, intraoperative blood loss, conversion rate, time to first flatus, duration of immobilization, post operative analgesia requirement, port site infection, port hernia, duration of hospital stay, postoperative fever rate and percentage patient satisfaction were recorded.

RESULTS

TSPLH and TLH were both performed successfully. TSPLH was associated with significantly longer duration of surgery, shorter duration of immobilization, lower rate of port site infection and higher patient satisfaction than TLH. There were no other significant differences between the two groups. All subjects recovered fully and no postoperative complications occurred during a 6-month (minimum) follow-up period.

CONCLUSIONS

TSPLH was found to be a feasible and safe approach for laparoscopic hysterectomy.

Single-incision versus conventional laparoscopic cholecystectomy: a meta-analysis

BACKGROUND

Conventional laparoscopic cholecystectomy (CLC) is now accepted as the gold standard surgical treatment for gallbladder stone disease. Single-incision laparoscopic technology has recently been introduced into laparoscopic clinical practice in order to reduce the invasiveness of this procedure. A meta-analysis of randomized clinical trials (RCTs) was performed to compare single-incision laparoscopic cholecystectomy (SICL) and CLC.

METHODS

Medline, Embase, ISI Web of Knowledge CPCI-S and the Cochrane Library were searched and the methodological quality of the included trials was evaluated. Outcomes evaluated were adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain, total wound length, operative time and wound satisfaction score. Results were pooled in meta-analyses as odds ratio and weighted mean differences (WMD).

RESULTS

Five RCTs on 264 patients qualified for the meta-analysis, 139 being allocated to SILC and 125 to CLC. There was no significant difference between SICL and CLC for adverse events, conversion rate, post-operative hospital stay, blood loss, post-operative pain and total wound length; however, operative time was significantly longer in SICL than in CLC (WMD 7.72 (95% confidence interval (CI): 1.38-14.07) min; P = 0.02, χ(2) P = 0.02, I(2) = 69%). Furthermore, wound satisfaction score was significantly higher in SICL than in CLC (WMD 1.40 (95% CI: 1.19-1.61) min; P < 0.00001, χ(2) P = 0.19, I(2) = 42%).

CONCLUSION

SILC may be superior to CLC in terms of cosmetic outcome, but not in operative time. Currently, SILC is a safe procedure for proper patients in experienced surgeons.

[Single incision laparoscopic surgery: analysis of the national register]

INTRODUCTION

Laparoscopic surgery through a single incision is an innovative concept which is a challenge for surgeons to implement and develop. The interest aroused by these techniques in Spain led to the Endoscopy Section of the Spanish Association of Surgeons (AEC) to start a National Register for Single-Incision Surgery (RNCIU). The aim of this study was to collect the primary clinical data, techniques, and the possible complications of these techniques in Spain.

MATERIAL AND METHODS

Data were gathered using a form available on the AEC website. The forms included in this study correspond to those received between June 2010 and June 2011.

RESULTS

A total of 35 centers had taken part during the study period, with 1,198 forms being collected. The surgeries performed included 62.2% cholecystectomies, 22% appendectomies, and 7.8% colectomies. Procedures on solid organs (3.4%), bariatric surgery (2.7%), and various hernia repairs (1.9%), were also registered. The overall incidence of complications was 0.8%. The mortality rate in the series was 0.1%.

CONCLUSIONS

Single incision laparoscopic surgery is a novel concept that is not beyond our scientific community. The results of the Register demonstrate the feasibility of numerous effective and safe procedures. Finally, the RNCIU is an important data source to be able to study sub-groups of diseases in detail, with the aim of advancing the knowledge of these techniques and generating scientific evidence.

Comparison of clinical outcome of single-incision laparoscopic surgery using a simplified access system with conventional laparoscopic surgery for malignant colorectal disease

AIM

Instrument crowding is encountered in single-incision laparoscopic surgery (SILS). Our aim was to compare the results of SILS with those of conventional laparoscopic surgery (CLS) for malignant colorectal disease.

METHODS

The records of 27 patients who received SILS for the treatment of malignant disease using a home-made multiple-port system were compared with those of 68 patients who received CLS performed in a standard manner using four to five trocar sites.

RESULTS

There were no significant differences in age, gender, disease stage, tumour location or tumour size between the SILS and CLS groups. The most common surgery was high anterior resection in both groups (SILS, 63.0%vs CLS, 58.8%). There were no significant differences between the groups in types of surgery performed, length of bowel resected, resection margin, blood loss, duration of surgery or postoperative complications. Postoperative pain scores were significantly higher in the SILS group than in the CLS group (3.07 ± 1.14 vs 2.41 ± 0.63, respectively, P < 0.001).

CONCLUSIONS

SILS is as effective as CLS, and is not associated with increased duration of surgery, blood loss or complications.

Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy

BACKGROUND

This study aimed to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy (LC).

METHODS

From November 2009 to August 2010, 51 patients with symptomatic gallstone or gallbladder polyps were randomized to SILC (n = 24) or 4-port LC (n = 27).

RESULTS

Mean surgical time (43.5 vs 46.5 min), median blood loss (1 vs 1 mL) and mean hospital stay (1.5 vs 1.8 d) were similar for both the SILC and 4-port LC group. There were no open conversions and no major complications. The mean total wound length of the SILC group was significantly shorter (1.76 vs 2.25 cm). The median visual analogue pain score at 6 hours after surgery was similar (4.5 vs 4.0) but the SILC group had a significantly worse pain score on day 7 (1 vs 0). There was no difference in time to resume usual activity (mean, 5.6 vs 5.0 d). The median cosmetic score of SILC was significantly higher than at 3 months after surgery (7 vs 6).

CONCLUSIONS

SILC was feasible and safe for properly selected patients in experienced hands.

Single-port access transaxillary totally endoscopic thyroidectomy: a new approach for minimally invasive thyroid operation

PURPOSE

Various techniques for minimally invasive thyroid surgery have been described over the last decade. As interest in single-port access laparoscopic surgery (SPA™) continues to grow, the authors present their technique and short-term outcomes for single-port access transaxillary totally endoscopic thyroidectomy in the management of benign thyroid tumors in a series of 4 patients.

PATIENTS AND METHODS

Four consecutive patients from a prospectively maintained endoscopic thyroidectomy database were analyzed under an institutional review board-approved protocol. Clinical characteristics and short-term outcomes were reviewed.

RESULTS

All the patients were young women with no prior neck surgery. A single-port totally endoscopic thyroidectomy was performed for thyroid adenoma in 2 cases and for nodular goiter in 2 cases. Retraction, exposure, and extraction were possible in all cases. The average operating room time was 92.5 minutes. Postoperative pain scores on postoperative day 1 were all 1/10. No patient experienced complications. The median hospital stay was 1.75 days. The mean specimen size was 2.7 cm × 2.375 cm × 2.625 cm. The patients were uniformly pleased with the cosmetic results of the operation.

CONCLUSIONS

Single-port access transaxillary totally endoscopic partial thyroidectomy appears to be safe and feasible. This technique may provide both an attractive way to reduce injury to the anterior neck tissue and a method for ideal cosmetic effect.

Single-incision multiport laparoscopy does not cause more pain than conventional laparoscopy: a prospective evaluation in children undergoing appendectomy

BACKGROUND

The benefit of single-incision multiport laparoscopy (SIMPL) remains a matter of vivid discussion. For good reason it has been speculated that SIMPL causes more postoperative pain, because a minilaparotomy is required to place the multiport system. We prospectively evaluated postoperative pain scores and requirement of analgesic medication following conventional laparoscopic (CL) versus SIMPL appendectomy in children.

METHODS

The access for laparoscopic appendectomy was decided upon the surgeon's preference. Between April and October 2010, individual abdominal pain scores at 8, 16, 24, 48, and 72 hours postoperatively as well as the incidence of umbilical or shoulder pain and the total amount of peri- and postoperative analgesics, operative time, length of hospital stay, and demographics were assessed. Analgesics (paracetamol and/or metamizole, 15 mg/kg body weight) were administered regularly or on inquiry of the patient. Data are presented as means±standard deviation tested at a significance level of P<.05.

RESULTS

All operations were laparoscopically completed without conversion or addition of extra ports. Thirty-nine patients (8 SIMPL appendectomy) at a mean age of 12.3±2.4 years and a mean body mass index of 19.16±3.2 kg/m(2) were included. Equal operation times were observed (SIMPL: 68.5±19.9 minutes versus CL: 66.2±19.5 minutes). There were no significant differences for the individual pain scores or the incidence of umbilical and shoulder pain between study groups. The total amount of required analgesic medication was significantly lower after SIMPL appendectomy (SIMPL: 65.73±43.8 mg/kg versus CL: 106.39±46.4 mg/kg, P=.04).

CONCLUSION

In summary, the present study substantiates the evidence that SIMPL appendectomy in children and adolescents is not only feasible but also beneficial for the patient without translation into increased postoperative pain. Presently, we are conducting a randomized, blinded study to validate these findings.