Solo Surgery in Single Incision Laparoscopic Myomectomy

Background The intracorporeal suture during single incision laparoscopic surgery is challengeable. Since laparoscopic myomectomy requires not only one assistant to hold a camera but also other to hold the uterine manipulator, it is difficult to perform solo surgery in single port laparoscopic myomectomy through intracorporeal suture.ResultsThe three patients underwent single incision laparoscopic myomectomy. The size of the largest myoma was 4.8-5.6cm. The operation was performed by the surgeon alone without assistants. The passive camera holder was positioned near the patient's body. Without using uterine manipulator, the uterus was hung from the abdominal wall using a thread. The uterine myoma was enucleated, which was removed from the outside with the umbilicus incision site. The uterine wound was double sutured to avoid any uterine defects. The outer suture of wound was sutured by a method such as simple continuous suture, Lembert suture, or baseball suture. The operation time was 95-105 minutes.There were no specific complications associated with the surgery. The patients were discharged on the second day after surgery.ConclusionsSolo surgery in single incision laparoscopic myomectomy using camera holder was successfully performed without using a uterine manipulator.

A Robotic Camera Holder Controlled by Head Movements: Exploring This New Robot-Surgeon Interface

Background. Most robotic camera steering devices (RCSDs) require active steering by the surgeon and necessarily increase workload. Clinical experience shows that standard laparoscopic procedures can be performed safely as solo surgery aided by RCSDs. No evidence exists concerning exploratory or emergency procedures. We compared the performance during unexpected laparoscopic tasks on surgical simulators aided either by an RCSD controllable by head movements of the surgeon or by a human camera assistant. Methods. Forty-five medical students without previous experience with minimal invasive surgery were randomized in 2 groups, and they performed standard and unexpected laparoscopic tasks requiring complex camera movements on box trainers either using an RCSD or assisted by a human camera assistant. Efficiency and performance parameters were recorded. Results. Performance in simulated standard procedures was equivalent. In simulated exploratory procedures, we saw significantly better performance scores in the conventional group versus the RCSD group. The strongest factor for these differences was the longer camera-adjusting time in the RCSD group versus the conventional group (PEG task = 208 ± 51 seconds vs 170 ± 36 seconds, P = .005; suture task = 563 ± 126 seconds vs 454 ± 201 seconds, P = .041). Conclusion. These results, obtained on surgical simulators, indicate that the solo approach to standard surgical tasks, facilitated by an RCSD controllable by head movements, can most likely be viewed as safe. Exploratory procedures with a relevant chance for complications or procedures that require rapid, often, or complex camera movements should rather be performed with a human camera assistant.