Abstract
Laparoendoscopic single-site surgery (LESS) represents a progression toward decreasing the invasiveness of minimally invasive surgery. By decreasing the number of port site locations to a single access, scars can be readily concealed within the umbilicus or the extraction site. However, such single-site access is associated with loss of triangulation and introduces increased difficulty. The past 5 years has witnessed much advancement in ports, optics, and instruments, altered in an attempt to mitigate such difficulties. Low profile, silicone, and multiport trocars have been developed to decrease internal clashing of instruments. Optic improvements include the introduction of videoscopes that are sufficiently long, articulate, or have the camera and light source streamlined into a single low profile handle. Pre-bent and articulating instruments provide the ability to regain triangulation lost with the single-site access. Advancements in adaptation of the da Vinci robotic surgical system (and novel robots) to LESS has removed the mental challenge of directing a sided instrument with contralateral hand and will likely allow for greater penetration into practice.
Keywords
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Raman JD, Bensalah K, Bagrodia A, Stern JM, Cadeddu JA. Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology. 2007;70(6):1039–42. PubMed.
Rané A, Rao P, Rao P. Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology. 2008;72:260–4.
Autorino R, Kaouk JH, Stolzenburg JU, et al. Current status and future directions of robotic single-site surgery: a systematic review. Eur Urol. 2013;63:266–80.
Kaouk JH, Autorino R, Kim FJ, et al. Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1076 cases. Eur Urol. 2011;60:998–1005.
Autorino R, White WM, Gettman MT, et al. Public perception of “Scarless” surgery: a critical analysis of the literature. Urology. 2012;80:495–502.
Song T, Cho J, Kim TJ, et al. Cosmetic outcomes of laparoendoscopic single-site hysterectomy compared with multi-port surgery: randomized controlled trial. J Minim Invasive Gynecol. 2013;20:460–7.
Kumar CVP. Different types of single incision laparoscopy surgery (SILS) ports. World J Laparosc Surg. 2011;4(1):47–51.
Gill IS, Canes D, Aron M, et al. Single port transumbilical (E-NOTES) donor nephrectomy. J Urol. 2008;180:637–41.
Andonian S, Herati AS, Atalla MA, et al. Laparoendoscopic single-site pfannenstiel donor nephrectomy. Urology. 2010;75:9–13.
Richstone L, Rais-Bahrami S, Waingankar N, et al. Pfannenstiel laparoendoscopic single-site (LESS) vs conventional multiport laparoscopic live donor nephrectomy: a prospective randomized controlled trial. BJU Int. 2013;112:616–22.
Liatsikos E, Kyriazis I, Kallidonis P, Do M, Dietel A, Stolzenburg JU. Pure single-port laparoscopic surgery or mix of techniques? World J Urol. 2012;30:581–7.
Tugcu V, Simsek A, Kargi T, Polat H, Aras B, Tasci AI. Retroperitoneal laparoendoscopic single-site ureterolithotomy versus conventional laparoscopic ureterolithotomy. Urology. 2013;81(3):567–72. doi:10.1016/j.urology.2012.11.033. Epub 2013 Jan 3. PubMed.
Dong J, Zu Q, Shi L, Gao J, Song T, Li H, Sun S, Zhang X, Cai W. Retroperitoneal laparoendoscopic single-site radical nephrectomy using a low-cost, self-made device: initial experience with 29 cases. Surg Innov. 2013;20(4):403–10. doi:10.1177/1553350612460768. Epub 2012 Dec 4. PubMed.
Nozaki T, Watanabe A, Fuse H. Laparoendoscopic single-site surgery for partial nephrectomy without ischemia using a microwave tissue coagulator. Surg Innov. 2013;20(5):439–43. doi:10.1177/1553350612459682. Epub 2012 Sep 10.
Chen Z, Chen X, Wu ZH, et al. Feasibility and safety of retroperitoneal laparoendoscopic single-site dismembered pyeloplasty: a clinical report of 10 cases. J Laparoendosc Adv Surg Tech A. 2012;22(7):685–90. doi:10.1089/lap.2012.0164. Epub 2012 Jul 30.
Wang L, Cai C, Liu B, Yang Q, Wu Z, Xiao L, Yang B, Chen W, Xu Z, Song S, Sun Y. Perioperative outcomes and cosmesis analysis of patients undergoing laparoendoscopic single-site adrenalectomy: a comparison of transumbilical, transperitoneal subcostal, and retroperitoneal subcostal approaches. Urology. 2013;82(2):358–64. doi:10.1016/j.urology.2013.03.060. PubMed.
Soroush Rais-Bahrami, Abhay Rane, Lee Richstone. Chapter 107. Smith’s textbook of endourology, 3rd ed. West Sussex, UK. Wiley-Blackwell; 2012.
Xie XF, Zhu JF, Song CL, et al. Mechanical evaluation of three access devices for laparoendoscopic single-site surgery. J Surg Res 2013;185(2):638–44.
Leppert JT, Breda A, Harper JD, et al. Laparoendoscopic single-site porcine nephrectomy using a novel valveless trocar system. J Endourol. 2011;25(1):119–22. doi:10.1089/end.2010.0199. Epub 2010 Oct 26.
Herati AS, Andonian S, Rais-Bahrami S, et al. Use of the valveless trocar system reduces carbon dioxide absorption during laparoscopy when compared with standard trocars. Urology. 2011;77:1126–32.
Stein RJ, White WM, Goel RJ, et al. Robotic laparoendoscopic single-site surgery using GelPort as the access platform. Eur Urol. 2010;57:132–7.
Han WK, Park YH, Jeon HG, et al. The feasibility of laparoendoscopic single-site nephrectomy: initial experience using home-made single-port device. Urology. 2010;76:862–5.
Jeon HG, Jeong W, Oh CK, et al. Initial experience with 50 laparoendoscopic single site surgeries using a homemade, single port device at a single center. J Urol. 2010;183:1866–72.
Cáceres F, Cabrera PM, García-Tello A, et al. Safety study of umbilical single-port laparoscopic radical prostatectomy with a new DuoRotate system. Eur Urol. 2012;62(6):1143–9. doi:10.1016/j.eururo.2012.04.043. Epub 2012 May 5.
Haber GP, Autorino R, Laydner H, et al. SPIDER surgical system for urologic procedures with laparoendoscopic single-site surgery: from initial laboratory experience to first clinical application. Eur Urol. 2012;61:415–22.
Tanagho YS, Andriole GL, Paradis AG, et al. 2D versus 3D visualization: impact on laparoscopic proficiency using the fundamentals of laparoscopic surgery skill set. J Laparoendosc Adv Surg Tech A. 2012;22(9):865–70. doi: 10.1089/lap.2012.0220. Epub 2012 Oct 16.
Goldsmith ZG, Astroza GM, Wang AJ, et al. Optical performance comparison of deflectable laparoscopes for laparoendoscopic single-site surgery. J Endourol. 2012;26:10.
Terry BS, Schoen J, Mills Z, et al. Single port access surgery with a novel Port Camera system. Surg Innov. 2012;19(2):123–9. doi:10.1177/1553350611418988. Epub 2011 Sep 13.
Cadeddu J, Fernandez R, Desai M, et al. Novel magnetically guided intra-abdominal camera to facilitate laparoendoscopic single-site surgery: initial human experience. Surg Endosc. 2009;23(8):1894–9. doi:10.1007/s00464-009-0459-6. Epub 2009 May 9.
Arain NA, Cadeddu JA, Best SL, et al. A randomized comparison of laparoscopic, magnetically anchored, and flexible endoscopic cameras in performance and workload between laparoscopic and single-incision surgery. Surg Endosc. 2012;26:1170–80.
Han WK, Tan YK, Olweny EO, et al. Comparison between magnetic anchoring and guidance system camera-assisted laparoendoscopic single-site surgery nephrectomy and conventional laparoendoscopic single-site surgery nephrectomy in a porcine model: focus on ergonomics and workload profiles. J Endourol. 2013;27:4.
Cabrera PM, Caceres F, Garcıa-Tello A. Initial experience of umbilical laparoendoscopic single-site nephron-sparing surgery with KeyPort and DuoRotate system. J Endourol. 2013;27:5.
Miernik A, Schoenthaler M, Lilienthal K, et al. Pre-bent instruments used in single-port laparoscopic surgery versus conventional laparoscopic surgery: comparative study of performance in a dry lab. Surg Endosc. 2012;26:1924–30.
Stolzenburg JU, Kallidonis P, Oh MA, et al. Comparative assessment of laparoscopic single-site surgery instruments to conventional laparoscopic in laboratory setting. J Endourol. 2010;24:2.
Martinec DV, Gatta P, Zheng B, et al. The trade-off between flexibility and maneuverability: task performance with articulating laparoscopic instruments. Surg Endosc. 2009;23:2697–701.
Jeong CW, Kim SH, Kim HT, et al. Insufficient joint forces of first-generation articulating instruments for laparoendoscopic single-site surgery. Surg Innov. 2013;20(5):466–70. doi: 10.1177/1553350612468961. Epub 2012 Dec 14.
Jung JW1, Cha WH, Lee BK, et al. Laparoendoscopic single-site surgery using innovative articulating instruments: preclinical evaluation of the prototype. J Endourol. 2014;28(3):281–5. doi: 10.1089/end.2013.0510. Epub 2013 Nov 22.
Joseph RA, Goh AC, Cuevas SP, et al. “Chopstick” surgery: a novel technique improves surgeon performance and eliminates arm collision in robotic single-incision laparoscopic surgery. Surg Endosc. 2010;24:1331–5.
Haber GP, White MA, Autorino R, et al. Novel Robotic da Vinci instruments for laparoendoscopic single-site surgery. Urology. 2010;76:1279–82.
Kaouk JH, Autorino R, Laydner H, et al. Robotic single-site kidney surgery: evaluation of second-generation instruments in a cadaver model. Urology. 2012;79:975–9.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2017 Springer Science+Business Media New York
About this chapter
Cite this chapter
Elsamra, S.E., Rais-Bahrami, S., Richstone, L. (2017). LESS: Ports, Optics, and Instruments. In: Kaouk, J., Stein, R., Haber, GP. (eds) Atlas of Laparoscopic and Robotic Single Site Surgery. Current Clinical Urology. Humana Press, New York, NY. https://doi.org/10.1007/978-1-4939-3575-8_4
Download citation
DOI: https://doi.org/10.1007/978-1-4939-3575-8_4
Published:
Publisher Name: Humana Press, New York, NY
Print ISBN: 978-1-4939-3573-4
Online ISBN: 978-1-4939-3575-8
eBook Packages: MedicineMedicine (R0)