Fundamentals of the Currently Available Single Port Abdominal Laparoscopic Gynecologic Systems and Utility in Minor Gynecologic Surgery

Single incision laparoscopic surgery encompasses a plethora of techniques and styles. Single incision laparoscopy has demonstrated outcomes comparable to traditional multiport laparoscopy with the added benefit of improved cosmesis. This book chapter will review single incision surgery for minor gynecologic surgery, including adnexal surgical procedures and myomectomy. The chapter reviews available data in regard to outcomes in single incision laparoscopy. It also discusses the commercially available single incision surgical access systems, laparoscopes, and accessory instruments. Surgical techniques beneficial in single incision laparosocpy, including uterine manipulation, are also reviewed.

IS THERE A FUTURE FOR SINGLE PORT LAPAROSCOPIC SURGERY?

Aim. To identify a perspectives for using a single incision laparoscopic technologies in surgery.Materials and methods: Today we have a several questions relating to a single incision laparoscopic surgery such as the possible spectrum of their application, safety and economic efficiency. The main is: does this technologies have a perspectives in future.In paper was performed a retro and prospective analysis of the data of modern literature and authors own experience in surgical treatment using a single incision laparoscopic technologies.Results: The study included 74 patients who underwent: cholecystectomy – 64 (86,5%), nephrectomy – 4 (5,4%), ovarian cyst removal – 4 (5,4%), kidney resection – 2 (2,7 %), using various kind of ports: “X-Cone Karl Storz” (28), “Covidien” (18), “PPP” (7), and 21 cases of multi-trocar access.Conclusions: Our opinion that the perspectives for the development of single incision laparoscopy, is the further development of endoscopic devices, including robotic ones, and we believe that it will be a real future and endoscopic surgeons should be ready for this.

Foreign body perforation of the distal ileum: an unusual cause of right iliac fossa pain managed via single incision laparoscopic surgery (SILS) approach

A 61-year-old woman was seen by the emergency general surgical team with a 2-week history of right iliac fossa pain. Imaging revealed the possibility of a distal ileum perforating foreign body. Using a single incision laparoscopy surgery (SILS) approach, this diagnosis was confirmed at operation. This emerging technique meant a much smaller incision could be used than traditional exploratory laparotomy, with the benefit of less postoperative pain and a faster recovery. This case highlights an uncommon cause for abdominal pain and the importance of close liaison with radiologists and the low threshold for use of laparoscopy as a diagnostic tool. We advocate the use of SILS in the emergency setting for appropriate cases.

Portal Vein Thrombosis Following Splenectomy in Children: Is There a Higher Rate When Using Single-Incision Laparoscopy?

Background Portal vein thrombosis can be a life-threatening complication associated with a splenectomy. Laparoscopic splenectomy has been suggested to cause an increased rate of portal vein thrombosis. Our study evaluated the rate of portal vein thrombosis in pediatric patients who underwent a splenectomy via single-site laparoscopy. Methods A retrospective chart review was performed for all patients undergoing laparoscopic splenectomy from November 2012 to July 2019. Demographic data, operative details, postoperative imaging, and patient outcomes were obtained for analysis. Patients were contacted to determine if they had any complications for which they sought medical care elsewhere. Results There were 78 pediatric patients who underwent laparoscopic splenectomy over the 7-year period. The most common indication was sickle cell disease (70.5%). Single-incision laparoscopy was performed in 61.5% of the cases. Eight were converted to open. Eleven patients (14.1%) had a laparoscopic cholecystectomy performed during the same operation. The overall complication rate was 8.9%. A quarter of our patients had imaging within 1 year of surgery; no portal vein thrombosis was identified. In addition, over half of the patients were recontacted for follow-up questioning. None of the patients surveyed sought medical care elsewhere for a surgery-related complication or sequela of a portal vein thrombus. Discussion Single-incision laparoscopic splenectomy is a safe approach in children. Using the single-site platform allows the flexibility to perform additional operations, such as cholecystectomy, without the placement of additional ports. This analysis shows that patients undergoing single-incision laparoscopic splenectomy do not have a higher rate for portal vein thrombosis.

Single Incision Laparoscopy Performance and Current Status in Surgical Practice

The techniques of single-incision laparoscopic surgery (SILS) is developed and based on that of conventional laparo-endoscopic surgery. At first, surgeons wanted to devise a method for visceral surgery with no incision on body’s surface, which is called natural orifice transluminal endoscopic surgery (NOTES). As early as the 1970s, Dr. Raimund Wittmoser, the “father” of modern thoracoscopic surgery of the autonomic nervous system, used a single-intercostal incision through which he inserted a multifunctional port which contained all the instruments and optics. Another example of SILS in early times is the application of laparoscopic instrumentation to resect lesions in the rectum or sigmoid colon. Using the anus as the portal of entry, trans- anal endoscopic microsurgery (TEMS) employs a specialized multichannel trocar to reach lesions located 8 to 18 cm away from the anal verge. Compared to NOTES, SILS is easier, safer, more applicable and convenient for surgeons to master and the main reason is that physicians, but not surgeons always use endoscopes. However, laparoscope has been a tool for surgeons for a long time.