Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
Alex Sáenz CorominaMarc Martí GallostraJoan Martí Ragué
SINGLE-PORT LAPAROSCOPIC SURGERYDecember-2008
E-mail : [email protected]
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
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
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.
20 years later ????
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
Paul G Curcillo, MDDrexel University, Philadelphia, Pennsylvania
In May 2007, Dr. Paul Curcillo became the first in the world to removea gallbladder through a single incision in the patient’s belly button.The single port access (SPATM) surgery left only a hidden scar.
First
and with Drexel University multidisciplinary surgical team,performed laparoscopic SPA:
Laparoscopic cholecystectomyGynecologic proceduresUrologic proceduresLeft Adrenalectomies (n=2)Spleen surgeryColorectal proceduresHernia repair...
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
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.
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
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.
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
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
-TRIPORT System -GelPort System-Uni-X Single Port System-AirSeal Technology-R-Port System-Three umbilicus trocar
SINGLE-PORT LAPAROSCOPIC SURGERY
Methods
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
SILSLaparoscopic Cholecystectmy
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
MATERIALS
5-mm laparoscope
5-mm trocars
Roticulated instruments
??
?
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Distended gallbladder (hydrops):punction with Veress needle
One percutaneous stitch used for gallbladder suspension
Important Tricks
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
CONVERSION
STANDARD LAPAROSCOPIC PROCEDUREOther/s accessory port INSIDE the umbilicusOther/s accessory port OUTSIDE the umbilicus
OPEN TECHNIQUES
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Advantages in SILS CholecystectomyTo Conventional Lap CholCosmesisWound infectionPostoperative painComparable costAny New InstrumentsAny Specific CompetenceAny Training
To NOTES
In NOTES Highly specializedSophisticated instrumentsAccess to peritoneal cavity vagina
stomachbladdercolon
butMore operative timeMore difficult
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
Institut J Martí Ragué – A SáenzExperience with SILS: > July-2008
Patients Accessory portsNo. 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 SáenzClínica Sagrada FamiliaBarcelona
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 withone (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 SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
NAME OF THE PROCEDURE
SILS Single Incision Laparoscopic SurgerySPA Single Port AccessTUES Transumbilical Endoscopic SurgeryTUFES Transumbilical Flexible Endoscopic Surgery (Cuesta MA)NOTUS Natural Orifice Transumbilical Surgery (Speranza J)OPUS One Port Umbilicus Surgery
Institut J Martí Ragué – A SáenzClínica Sagrada FamiliaBarcelona
SINGLE-PORT LAPAROSCOPIC SURGERY
The Umbilicusfor love
for exploration
for SILSfor piercing
for tatoo
for center of the world