High Quality Single port access for Laparoscopy surgery
Single-port laparoscopy (SPL), is a recently developed technique in
laparoscopic surgery. It is a minimally invasive surgical procedure
in which the surgeon operates almost exclusively through a single
entry point, typically the patient's navel. Unlike a traditional
multi-port laparoscopic approach, SPL leaves only a single small
scar.
SPL is accomplished through a single 20 mm incision in the navel
(umbilicus or belly button), or through only an 11 mm incision in
the navel, minimizing the scarring and incisional pain associated
with the multiple points of entry used during traditional
laparoscopic surgery.
Laparoendoscopic single-site surgery (LESS) has been developed to
benefit patients by enabling surgeons to perform scarless surgery.
Clinical data demonstrate that LESS is safe and effective in many
pediatric urology settings. As clinical experience increases,
expanding indications are expected, along with improved efficacy.
Prospective randomized studies are awaited to determine whether
LESS procedures will be established as routine and will be able to
stand the test of time. Technological advances hold promise to
minimize the challenging technical nature of scarless surgery.
Advantages of SILS
The putative benefits of SILS over conventional laparoscopy include
better cosmesis due to relatively hidden umbilical scar, less
postoperative pain, rapid convalescence, decreased morbidity
related to visceral and vascular injury during trocar placement,
risk reduction of postoperative wound infection and hernia
formation, and elimination of multiple trocar site closures.
Studies have also suggested that women who undergo SILS reported
improved postoperative pain profiles when compared with those
receiving conventional laparoscopic surgery.This may be due to the
utilization of the umbilicus, which is one of the thinnest regions
on the abdominal wall containing few blood vessels, muscle, or
nerves, as the single site of the incision.
Application
The SPL technique has been used to perform many types of surgery,
including adjustable gastric banding,appendectomy cholecystectomy,
colectomy, hernia repair, hysterectomy, sleeve
gastrectomy,nephrectomy, and sacrocolpopexy. Although a number of
single-incision techniques use specialized instrumentation, most
SPL operations in the United States and Europe have used standard
instrumentation. The Single port can be inserted with its
introducer through a 15 mm incision at the umbilicus. This device
allows four instruments to be used simultaneously. During LESS
cholecystectomy a fourth instrument becomes essential to gain
critical view. Up until now surgeons have been inventive in how to
retract the infundibulum; sutures and other novel means of
retraction have all been reported. The instrument's channel allows
for a fixed curved infundibular grasper to be added; this helps
replicate the methodology currently being practised in traditional
four-port laparoscopic cholecystectomy.
