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Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
December-2008
Alex Sáenz Coromina
Marc Martí Gallostra
Joan Martí Ragué
E-mail : [email protected]
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Prof Dr Med Erich Mühe of Böblingen, Germany, performed the first
laparoscopic cholecystectomy on September 12, 1985.
Dr Phillipe Mouret, has got the credit to perform the first
laparoscopic cholecystectomy in Lyons, France using video technique,
in Mars 1987. Cholecystectomy is the laparoscopic procedure which
revolutionized the general surgery
20 years later
????
In May 2007, Dr Paul Curcillo became the first in the world to remove
a gallbladder through a single incision in the patient’s belly button .
The single port access (SPATM) surgery left only a hidden scar.
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
First
In May 2007, Dr. Paul Curcillo became the first in the world to remove
a gallbladder through a single incision in the patient’s belly button.
The single port access (SPATM) surgery left only a hidden scar.
Paul G Curcillo, MD
Drexel University,
Philadelphia, Pennsylvania
and with Drexel University multidisciplinary surgical team,
performed laparoscopic SPA:
Laparoscopic cholecystectomy
Gynecologic procedures
Urologic procedures
Left Adrenalectomies (n=2)
Spleen surgery
Colorectal procedures
Hernia repair
...
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the
umbilicus.
Piskun G, Rajpal S. J Laparoendosc Adv Surg Tech A. 1999 Aug;9(4):361-4.
The Brookdale University Hospital and Medical Center, Brooklyn, New York, USA. [email protected]
Laparoscopic cholecystectomy has become the gold standard in the care of patients with cholelithiasis. A standard
laparoscopic cholecystectomy employs three trocar incisions outside the umbilicus, which are a source of potential
wound complications and an undesirable cosmetic outcome. We describe here a modification of the laparoscopic
cholecystectomy which utilizes two transumbilical trocars and two transabdominal gallbladder stay sutures and
does not require abdominal wall incisions outside the umbilicus. When technically feasible, this technique results in
superior cosmesis and may reduce postoperative wound complications.
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Arch Esp Urol. 2008 Jul-Aug;61(6):667-72.
[Multi-instruments cannula: a new concept of laparoscopy]
de Badajoz ES, Garrido AJ, Mata AS, Vacas FG.
Area de Conocimiento de Urología, Facultad de Medicina y Area de Ingeniería
Mecánica, Escuela Técnica Superior de Ingenieros Industriales, Universidad de
Málaga, Málaga, España
Eur Urol. 2008 Jun;53(6):1204-9. Epub 2008 Mar 18.
Single port access renal cryoablation (SPARC): a new approach.
Goel RK, Kaouk JH.
Section of Laparoscopic and Robotic Surgery, Glickman Urological and Kidney
Institute Cleveland Clinic, Cleveland, OH 44195, USA.
BACKGROUND: Cryoablation has been performed laparoscopically for small
Cleveland Clinic Surgeons Perform First Single-Port Laparoscopic Colon Resection 14 Dec 2007
Feza Remzi, M.D. and Daniel Geisler, M.D.,
Surgeons at Cleveland Clinic and pioneers of a Single-Port Laparoscopic (SPL) method in the field of Colo-Rectal
Surgery, recently performed the world's first colon resection (partial removal of the colon) entirely through a single
incision in the navel.
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Methods
-TRIPORT System
-GelPort System
-Uni-X Single Port System
-AirSeal Technology
-R-Port System
-Three umbilicus trocar
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
SILS
Laparoscopic Cholecystectmy
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
MATERIALS
5-mm trocars
?
Roticulated instruments
??
5-mm laparoscope
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Important Tricks
Distended gallbladder (hydrops):
punction with Veress needle
One percutaneous stitch used for gallbladder suspension
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
CONVERSION
STANDARD LAPAROSCOPIC PROCEDURE
Other/s accessory port INSIDE the umbilicus
Other/s accessory port OUTSIDE the umbilicus
OPEN TECHNIQUES
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
Advantages in SILS Cholecystectomy
To Conventional Lap Chol
Cosmesis
Wound infection
Postoperative pain
Comparable cost
Any New Instruments
Any Specific Competence
Any Training
but
More operative time
More difficult
To NOTES
In NOTES
Highly specialized
Sophisticated instruments
Access to peritoneal cavity
vagina
stomach
bladder
colon
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
Institut J Martí Ragué – A Sáenz
Experience with SILS: > July-2008
Patients
No.
Accessory ports
1 outside *
2 outside *
Cholecystectomy
18
4
0
Appendectomy
5
1
0
Right Adrenalectomy
1
1
0
* outside of the umbilicus
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
SILS Cholecystectomy: Conclusions
The surgeon can perform SILS without any new instruments,
specific competence, or training.
The conversion is to standard laparoscopic technique with
one (or two) outside port
The percutaneous stitches used for gallbladder suspension,
are NONVISIBLE SCARS but not INVISIBLE SCARS
Is time consuming and technically difficult
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
NAME OF THE PROCEDURE
SILS Single Incision Laparoscopic Surgery
SPA Single Port Access
TUES Transumbilical Endoscopic Surgery
TUFES Transumbilical Flexible Endoscopic Surgery (Cuesta MA)
NOTUS Natural Orifice Transumbilical Surgery (Speranza J)
OPUS One Port Umbilicus Surgery
Institut J Martí Ragué – A Sáenz
Clínica Sagrada Familia
Barcelona
for love
SINGLE-PORT LAPAROSCOPIC SURGERY
The Umbilicus
for center of the world
for exploration
for tatoo
for piercing
for SILS