Modified technical protocol for single-port laparoscopic appendectomy using needle-type grasping forceps for acute simple appendicitis:A case report

BACKGROUND Because of the mild inflammatory status in acute uncomplicated appendicitis,our team developed a novel technical protocol for single-port laparoscopic appendec-tomy using needle-type grasping forceps(SLAN)and achieved positive clinical outcomes.However,the intraoperative procedure lacked stability and fluency due to a series of problems highlighted by the small incision design of the proto-col(only 1 cm long).Therefore,there is a growing clinical demand to further opti-mize the SLAN protocol.CASE SUMMARY An adult male patient was admitted for persistent right lower abdominal pain with preoperative computed tomography findings suggestive of appendicitis accompanied by localized peritonitis.A modified technical protocol for SLAN based on minimally invasive surgical principles was used,and the patient was confirmed to have acute simple appendicitis by postoperative pathological ana-lysis.Postoperative recovery was uneventful,and no postoperative complications,such as incision infection or severe incision pain,were observed.The patient was discharged successfully on postoperative day 2.CONCLUSION The modified technical protocol of SLAN may be a new minimally invasive surgical alternative for patients with acute simple appendicitis.

Overview of single-port laparoscopic surgery for colorectal cancers: Past, present, and the future

Single-port laparoscopic surgery (SPLS) is implemented through a tailored minimal single incision through which a number of laparoscopic instruments access. Introduction of operation-customized port system, utilization of a camera without a separate external light, and instruments with different lengths has brought the favorable environment for SPLS. However, performing SPLS still creates several hardships compared to multiport laparoscopic surgery; a single-port system inevitably leads to clashing of surgical instruments due to crowding. To overcome such difficulties, investigators has developed novel concepts and maneuvers, including the concept of inverse triangulation and the maneuvers of pivoting, spreading out dissection, hanging suture, and transluminal traction. The final destination of SPLS is expected to be a completely seamless operation, maximizing the minimal invasiveness. Specimen extraction through the umbilicus can undermine cosmesis by inducing a larger incision. Therefore, hybrid laparoscopic technique, which combined laparoscopic surgical technique with natural orifice specimen extraction (NOSE) - i.e., transvaginal or transanal route-, has been developed. SPLS and NOSE seemed to be the best combination in pursuit of minimal invasiveness. In the near future, robotic SPLS with natural orifice transluminal endoscopic surgery’s way of specimen extraction seems to be pursued. It is expected to provide a completely or nearly complete seamless operation regardless of location of the lesion in the abdomen.

Single-port laparoscopic cholecystectomy vs standard laparoscopic cholecystectomy:A non-randomized,agematched single center trial

AIM: To compare the safety of single-port laparoscopic cholecystectomies with standard four-port cholecystectomies.METHODS: Between January 2011 and December 2012 datas were gathered from 100 consecutive patients who received a single-port cholecystectomy. Patient baseline characteristics of all 100 single-port cholecystectomies were collected(body mass index, age, etc.) in a database. This group was compared with 100 age-matched patients who underwent a conventional laparoscopic cholecystectomy in the same period. Retrospectively, per- and postoperative data were added. The two groups were compared to each other using independent t-tests and χ2-tests, P values below 0.05 were considered significantly different.RESULTS: No differences were found between both groups regarding baseline characteristics. Operating time was significantly shorter in the total single-port group(42 min vs 62 min, P < 0.05); in procedures performed by surgeons the same trend was seen(45 min vs 59 min, P < 0.05). Peroperative complications between both groups were equal(3 in the single-port group vs 5 in the multiport group; P = 0.42). Although not significant less postoperative complications were seen in the single-port group compared with the multiport group(3 vs 9; P = 0.07). No statistically significant differences were found between both groupswith regard to length of hospital stay, readmissions and mortality. CONCLUSION: Single-port laparoscopic cholecystectomy has the potential to be a safe technique with a low complication rate, short in-hospital stay and comparable operating time. Single-port cholecystectomy provides the patient an almost non-visible scar while preserving optimal quality of surgery. Further prospective studies are needed to prove the safety of the single-port technique.

Technical and instrumental prerequisites for single-port laparoscopic solo surgery:state of art

With the aid of advanced surgical techniques and instruments, single-port laparoscopic surgery(SPLS) can be accomplished with just two surgical members: an operator and a camera assistant. Under these circumstances, the reasonable replacement of a human camera assistant by a mechanical camera holder has resulted in a new surgical procedure termed singleport solo surgery(SPSS). In SPSS, the fixation and coordinated movement of a camera held by mechanicaldevices provides fixed and stable operative images that are under the control of the operator. Therefore, SPSS primarily benefits from the provision of the operator's eye-to-hand coordination. Because SPSS is an intuitive modification of SPLS, the indications for SPSS are the same as those for SPLS. Though SPSS necessitates more actions than the surgery with a human assistant, these difficulties seem to be easily overcome by the greater provision of static operative images and the need for less lens cleaning and repositioning of the camera. When the operation is expected to be difficult and demanding, the SPSS process could be assisted by the addition of another instrument holder besides the camera holder.

Laparoscopic left lateral sectionectomy in pediatric living donor liver transplantation by single-port approach:A case report

BACKGROUND Single-port laparoscopy has been used in a variety of abdominal operations.We report the first case of single-port laparoscopic left lateral sectionectomy in pediatric laparoscopic living donor liver transplantation.CASE SUMMARY A 28-year-old man volunteered for living liver donation to his daughter who was diagnosed with liver cirrhosis and portal hypertension after the Kasai procedure for biliary atresia.His body mass index was 20.5 kg/m2.Liver dynamic computed tomography showed:(1)Left lateral graft volume of 232.76 cm3 with a graft-torecipient weight ratio of 2.59%;and(2)Right hepatic artery derived from the superior mesenteric artery.A single-port access system was placed through a transumbilical incision,including four trocars:two 12-mm ports for a camera and endoscopic stapler and two 5-mm working ports.Liver parenchyma was dissected by a Harmonic and Cavitron Ultrasonic Surgical Aspirator,while bipolar was used for coagulation.The bile duct was transected above the bifurcation by indocyanine green fluorescence cholangiography.The specimen was retrieved from the umbilical incision.The total operation time was 4 h without blood transfusion.The final graft weight was 233.6 g with graft-torecipient weight ratio of 2.60%.The donor was discharged uneventfully on postoperative day 4.CONCLUSION Single-port laparoscopic left lateral sectionectomy is feasible in pediatric laparoscopic living donor liver transplantation in an experienced transplant center.

Single-port laparoscopic surgery for sigmoid volvulus

AIM:To report our experience with single-port laparoscopic surgery(SPLS)for sigmoid volvulus(SV).METHODS:Between October 2009 and April 2013,10patients underwent SPLS for SV.SPLS was performed transumbilically or through a predetermined stoma site.Conventional straight and rigid-type laparoscopic instruments were used.After intracorporeal,segmental resection of the affected sigmoid colon,the specimen was extracted through the single-incision site.Patientdemographics and perioperative data were analyzed.RESULTS:SPLS for SV was successful in all 10 patients(4,resection and primary anastomosis;6,Hartmann’s procedure).The median operative time and postoperative hospitalization period were 168(range,85-315)min and 6.5(range,4-29)d,respectively.No intraoperative complications were noted;there were 2 postoperative complications,including 1 anastomotic leak.CONCLUSION:SPLS was a safe and feasible therapeutic approach for SV,when performed by a surgeon experienced in conventional laparoscopic surgery.

Evaluation of the Single-Port Laparoscopic Right Hemicolectomy Learning Curve

Background: The use of single-port laparoscopy has gained popularity within recent years. Part of the appeal in learning this approach is that it draws heavily from concepts mastered through conventional laparoscopy. Various studies have shown the efficacy and feasibility of the single-port laparoscopic approach, but there are few that examine the learning curve in adopting this new technique. Objective: Our goal was to better define the learning curve in performing a single-port laparoscopic right hemicolectomy. Design: A review of prospectively gathered operative data was performed to analyze the results of single-port laparoscopic right hemicolectomies performed within our institution by experienced laparoscopic surgeons. The first 100 cases were divided into quintiles. Comparisons were made among the cohorts regarding patient demographics, operative time, length of stay, conversions, and complications. Results: There was no difference among quintiles with regard to age, sex, BMI, or ASA class. Operative time, conversions, length of stay, and number of complications did not significantly vary among each group of patients. There was a significant difference in estimated blood loss and length of stay between the fifth cohort and the others due to one patient’s poor outcome. Conclusions: The single-port laparoscopic right hemicolectomy learning curve for surgeons already skilled in laparoscopy is short. There are few differences in various outcome measures among groups at any stage in the learning curve. The skills utilized to perform conventional laparoscopic colorectal surgery readily translate to the single-port approach and result in proficiency from nearly the start.

Clinical Research of Transumbilical Singleport Laparoscopic Treatment For Pediatric Intussusception

Objective:To explore the feasibility and clinical efficacy of single port laparoscopic surgery through the umbilical cord for the treatment of pediatric intussusception.Method:Clinical data of 38 cases of pediatric intussusception treated with umbilical single port laparoscopic surgery from December 2017 to June 2019 were collected.The surgical method involves placing Trocar through the umbilical incision to establish pneumoperitoneum,inserting a single hole with a 0°laparoscopic operating channel,exploring intussusception,and performing non-invasive forceps to completely reduce it.After the reduction of intussusception,if intestinal malformation is found,the umbilical incision can be expanded to lift the diseased intestinal tract out of the abdominal cavity for resection.At the same time,clinical data of 24 children who underwent traditional porous laparoscopic intussusception surgery during the same period were collected,and the surgical time,intraoperative blood loss,postoperative hospital stay,and satisfaction score of incision aesthetics were compared between the two groups of children.Result:Both groups of patients successfully completed the surgery,and compared with the porous laparoscopic group,the single hole laparoscopic group had a shorter surgical time[(32.4±8.6)minutes vs.(40.6±9.8)minutes,P<0.05],decreased bleeding volume[(5.5±1.5)mL vs.(8.6±2.2)mL,P<0.05],significantly shortened postoperative hospital stay[(4.6±1.2)d vs.(6.2±1.4)d,P<0.05],and significantly increased satisfaction score with incision aesthetics[(4.2±0.8)points vs.(3.2±0.7)points,P<0.05].Follow up for 6 months to 2 years showed no recurrence of intussusception.Conclusion:Transumbilical single port laparoscopic surgery is a safe and effective method for children with intussusception,which is characterized by small trauma,fast recovery,short operation time,and better aesthetic effect.

Single-port laparoscopy-assisted vaginal repair of a cesarean scar defect: a single-center retrospective study

Background:The incidence of uterine cesarean scar defect(niche)is high,and some patients require surgery.Single-port laparoscopy can reduce post-operative pain,and provide better cosmetic effects.This study was performed to evaluate the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scar defect(niche)in women after cesarean section.Methods:This study included 74 patients who were diagnosed with uterine cesarean niche at the Shanghai First Maternity and Infant Hospital from January 2013 to June 2015.Thirty-seven patients underwent single-port laparoscopy-assisted vaginal surgery as the case group,and the remaining patients underwent vaginal repair surgery as the control group.We collected data from the inpatient and follow-up medical records.The clinical characteristics of these two groups were compared.The odds ratios and 95%confidential intervals were calculated for each variable by univariate and multivariate analyses.Results:Patients who underwent single-port laparoscopy-assisted vaginal repair had a significantly longer operation time(2.3[2.0-2.7]vs.2.0[1.6-2.3]h,P=0.015),shorter gas passage time(1.2[1.0-1.5]vs.1.7[1.0-2.0]days,P=0.012),shorter hospital stay(3.1[3.0-4.0]vs.4.5[4.0-6.0]days,P=0.019),and fewer complications(0 vs.4 cases).Univariate analysis showed that depth of the niche(P=0.021)the mild adhesiolysis score(P=0.035)and moderate adhesiolysis score(P=0.013)were associated with the bladder injury.Multivariate analysis showed that the moderate adhesiolysis score(P=0.029;95%confidence interval,1.318-3.526)was the strongest independent predictor of bladder injury.Conclusion:This study confirmed the safety and superiority of single-port laparoscopy-assisted vaginal repair of uterine cesarean scars.

New trends in colorectal surgery: Single port and natural orifice techniques

Single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) have rapidly gained pace worldwide, potentially replacing conventional laparoscopic surgery (CLS) as the preferred colorectal surgery technique. Currently available data mainly consist of retrospective series analyzed in four meta-analyses. Despite conflicting results and lack of an objective comparison, SILS appears to offer cosmetic advantages over CLS. However, due to conflicting results and marked heterogeneity, present data fail to show significant differences in terms of operative time, postoperative morbidity profiles, port-site complications rates, oncological appropriateness, duration of hospitalization or cost when comparing SILS with conventional laparoscopy for colorectal procedures. The application of &#x0201c;pure&#x0201d; NOTES in humans remains limited to case reports because of unresolved issues concerning the ideal access site, distant organ reach, spatial orientation and viscera closure. Alternatively, minilaparoscopy-assisted natural orifice surgery techniques are being developed. The transanal &#x0201c;down-to-up&#x0201d; total mesorectum excision has been derived for transanal endoscopic microsurgery (TEM) and represents the most encouraging NOTES-derived technique. Preliminary experiences demonstrate good oncological and functional short-term outcomes. Large-scale randomized controlled trials are now mandatory to confirm the long-term SILS results and validate transanal TEM for the application of NOTES in humans.