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Single-Access Surgery: Less Is More?

  • Tahar Benhidjeb
  • Michael Stark
  • Jakob R. Izbicki
  • Oliver Mann
Chapter

Abstract

Laparoscopic surgery achieved high standards during the twentieth century. It is associated with lower morbidity, less pain, faster recovery, and a shorter hospital stay than open surgery. Is it, despite this achievement, still possible to make abdominal surgery simpler and safer, because it is the goal of every surgeon to minimize patient morbidity while maximizing the beneficial outcomes of the planned procedure? Most of the discomfort and complications associated with open and laparoscopic surgery are caused by the abdominal incisions: The longer is the incision, the stronger is the pain intensity and the higher is the risk for wound infection and hernia. To avoid this, it is necessary to perform surgical procedures without cutting the surface of the body and use natural openings as an entry to the abdomen or other parts of the body. Theoretical advantages of this natural orifice surgery (NOS) include less invasiveness by eliminating abdominal incisions, postoperative abdominal wall pain, wound infection, and hernia. Anthony Kalloo was the first to report an experimental transgastric peritoneoscopy [1]. When the gastroenterologists reached the intraperitoneal cavity through the wall of the stomach, the term natural orifice transluminal endoscopic surgery (NOTES) was introduced to describe procedures performed through natural body openings. As soon as other body openings became the target, this term became irrelevant because the vagina, for example, cannot be described as a lumen.

Keywords

Laparoscopic Surgery Laparoscopic Appendectomy Conventional Laparoscopic Surgery Port Site Hernia Natural Orifice Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kalloo AN, Singh VK, Jagannath SB, et al. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc. 2004;60:114–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Stark M, Benhidjeb T. Transcolonic endoscopic cholecystectomy: a NOTES survival study in a porcine model. Gastrointest Endosc. 2007;66:208–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Rattner D, Kalloo A. ASGE/SAGES working group on natural orifice transluminal endoscopic surgery. Surg Endosc. 2006;20:329–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Stark M, Benhidjeb T. Natural orifice surgery: transdouglas surgery—a new concept. JSLS. 2008;12:295–8.PubMedGoogle Scholar
  5. 5.
    Zorrón R, Filgueiras M, Maggioni LC, et al. NOTES transvaginal cholecystectomy: report of the first case. Surg Innov. 2007;14:279–83.PubMedCrossRefGoogle Scholar
  6. 6.
    Bessler M, Stevens PD, Milone L, et al. Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc. 2007;66:1243–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Marescaux J, Dallemagne B, Perretta S, et al. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg. 2007;142:823–6; discussion 826–27.PubMedCrossRefGoogle Scholar
  8. 8.
    Swanstrom LL, Whiteford M, Khajanchee Y. Developing essential tools to enable transgastric surgery. Surg Endosc. 2008;22:600–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Gill IS, Canes D, Aron M, Haber GP, Goldfarb DA, Flechner S, et al. Single-port transumbilical (E-NOTES) donor nephrectomy. J Urol. 2008;180:637–41; discussion 641.PubMedCrossRefGoogle Scholar
  10. 10.
    Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008;54:1020–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Desai MM, Stein R, Rao P, Canes D, Aron M, Rao PP, et al. Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology. 2009;73:182–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE. Laparoscopic transumbilical cholecystectomy without visible abdominal scars. J Gastrointest Surg. 2009;13:1125–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Rao P, Rao S, Rané A, Bondaio F, Rao P. Evaluation of the R-port for single laparoscopic port procedures (SLAPP): a study of 20 cases. Surg Endosc. 2008;22 Suppl 1:S279.Google Scholar
  14. 14.
    Remzi FH, Kirat HT, Kaouk JH, Geisler DP. Single-port laparoscopy in colorectal surgery. Colorectal Dis. 2008;10:823–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaouk JH, Goel RK, Haber GP, Crouzet S, Desai MM, Gill IS. Single-port laparoscopic radical prostatectomy. Urology. 2008;72:1190–3.PubMedCrossRefGoogle Scholar
  16. 16.
    Nguyen NT, Hinojosa MW, Smith BR, Reavis KM. Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg. 2008;18:1628–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Wittmoser R. Thorakoskopische operationen am mediastinalen vagus. Langenbecks Arch Klin Chir. 1957;287:230–3.Google Scholar
  18. 18.
    Wittmoser R. Endoskopische sympathicotomie bei hyperhidrosis und raynaud-syndrom. Langenbecks Arch Chir. 1973;334:971–2.CrossRefGoogle Scholar
  19. 19.
    Wheeless CR. A rapid, inexpensive, and effective method of surgical sterilization by laparoscopy. J Reprod Med. 1969;5:255.Google Scholar
  20. 20.
    Pelosi MA. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med. 1991;88:721–6.PubMedGoogle Scholar
  21. 21.
    Pelosi MA, Pelosi 3rd MA. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med. 1992;37:588–94.PubMedGoogle Scholar
  22. 22.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84:695.PubMedCrossRefGoogle Scholar
  23. 23.
    Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc. 1998;12:177–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Piskun G. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 1999;9:361–4.PubMedCrossRefGoogle Scholar
  25. 25.
    Kagaya T. Laparoscopic cholecystectomy via two ports using the “Twin-Port” system. J Hepatobiliary Pancreat Surg. 2001;8:76–80.PubMedCrossRefGoogle Scholar
  26. 26.
    Ahmed K, Wang TT, Patel VM, Nagpal K, Clark J, Ali M, et al. The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc. 2011;25:378–96.PubMedCrossRefGoogle Scholar
  27. 27.
    Box G, Averch T, Cadeddu J, Cherullo E, Clayman R, Desai M, et al. Nomenclature of Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Laparoendoscopic Single-Site Surgery (LESS) procedures in urology. J Endourol. 2008;22:2575–81.PubMedCrossRefGoogle Scholar
  28. 28.
    Gill IS, Advincula AP, Aron M, Caddedu J, Canes D, Curcillo 2nd PG, et al. Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc. 2010;24:762.PubMedCrossRefGoogle Scholar
  29. 29.
    McCloy R, Randall D, Schug SA, Kehlet H, Simanski C, Bonnet F, et al. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes. Surg Endosc. 2008;22:2541–53.PubMedCrossRefGoogle Scholar
  30. 30.
    Hasson HM, Rotman C, Rana N, et al. Open laparoscopy: 29 year experience. Obstet Gynecol. 2000;96:763–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Gaynes RP, Culver DH, Horan TC, et al. Surgical site infection rates in the United States, 1992–1998: the National Nosocomial Infections Surveillance System basic SSI risk index. Clin Infect Dis. 2001;33 Suppl 2:S69–77.PubMedCrossRefGoogle Scholar
  32. 32.
    Hamzaoglu I, Baca B, Böler DE, Polat E, Özer Y. Is umbilical flora responsible for wound infection after laparoscopic surgery? Surg Laparosc Endosc Percutan Tech. 2004;14:263–7.PubMedCrossRefGoogle Scholar
  33. 33.
    Schwenk W, Haase O, Neudecker JJ, Müller JM. Short term benefits for laparoscopic colorectal resection. Cochrane Database Syst Rev. 2005;3:CD003145.PubMedGoogle Scholar
  34. 34.
    Voitk AJ, Tsao SG. The umbilicus in laparoscopic surgery. Surg Endosc. 2001;15:878–81.PubMedCrossRefGoogle Scholar
  35. 35.
    Bowrey DJ, Blom D, Crookes PF, et al. Risk factors and the prevalence of trocar site herniation after laparoscopic fundoplication. Surg Endosc. 2001;15:663–6.PubMedCrossRefGoogle Scholar
  36. 36.
    Susmallian S, Ezri T, Charuzi I. Laparoscopic repair of access port site hernia after Lap-Band system implantation. Obes Surg. 2002;12:682–4.PubMedCrossRefGoogle Scholar
  37. 37.
    Barry M, Winter C. Laparoscopic port site hernias: any port in a storm or a storm in any port? Ann Surg. 2008;248:687–8.PubMedCrossRefGoogle Scholar
  38. 38.
    Nassar AH, Ashkar KA, Rashed AA, et al. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997;84:630–3.PubMedCrossRefGoogle Scholar
  39. 39.
    Khanna R, White MA, Autorino R, Laydner HK, Isac W, Yang B, et al. Selection of a port for use in laparoendoscopic single-site surgery. Curr Urol Rep. 2011;12(2):94–9.PubMedCrossRefGoogle Scholar
  40. 40.
    Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc. 2009;23:1419–27.PubMedCrossRefGoogle Scholar
  41. 41.
    Burgos JB, Flores JA, de la Vega JS, et al. Early experience in laparoscopic radical prostatectomy using the laparoscopic device for umbilical access SILS port. Actas Urol Esp. 2010;34:495–9.CrossRefGoogle Scholar
  42. 42.
    Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate health care interventions: explanation and elaboration. BMJ. 2009;339:b2700.PubMedCrossRefGoogle Scholar
  43. 43.
    EBM Oxford centre for evidence-based medicine 2009. www.cebm.net/levels_of_evidence.
  44. 44.
    Boni L, Dionigi G, Cassinotti E, Di Giuseppe M, Diurni M, Rausei S, et al. Single incision laparoscopic right colectomy. Surg Endosc. 2010;24:3233–6.PubMedCrossRefGoogle Scholar
  45. 45.
    Ramos-Valadez DI, Patel CB, Ragupathi M, Bartley Pickron T, Haas EM. Single-incision laparoscopic right hemicolectomy: safety and feasibility in a series of consecutive cases. Surg Endosc. 2010;24:2613–6.PubMedCrossRefGoogle Scholar
  46. 46.
    Vestweber B, Alfes A, Paul C, Haaf F, Vestweber KH. Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease. Surg Endosc. 2010;24:3225–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Gash KJ, Goede AC, Chambers W, Greenslade GL, Dixon AR. Laparoendoscopic single-site surgery is feasible in complex colorectal resections and could enable day case colectomy. Surg Endosc. 2011;25:835–40.PubMedCrossRefGoogle Scholar
  48. 48.
    Wheeless Jr CR, Thompson BH. Laparoscopic sterilization. Review of 3600 cases. Obstet Gynecol. 1973;42:751–8.PubMedGoogle Scholar
  49. 49.
    Park HS, Kim TJ, Song T, Kim MK, Lee YY, Choi CH, et al. Single-port access (SPA) laparoscopic surgery in gynecology: a surgeon’s experience with an initial 200 cases. Eur J Obstet Gynecol Reprod Biol. 2011;154:81–4.PubMedCrossRefGoogle Scholar
  50. 50.
    Jung YW, Lee M, Yim GW, Lee SH, Paek JH, Kwon HY, et al. A randomized prospective study of single-port and four-port approaches for hysterectomy in terms of postoperative pain. Surg Endosc. 2011;25(8):2462–9. doi: 10.1007/s00464-010-1567-z.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Tahar Benhidjeb
    • 1
    • 2
  • Michael Stark
    • 2
    • 3
  • Jakob R. Izbicki
    • 1
  • Oliver Mann
    • 1
  1. 1.Department of General, Visceral and Thoracic SurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.The New European Surgical Academy (NESA)BerlinGermany
  3. 3.The USP Hospital Palmaplanas of MallorcaMallorcaSpain

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