Single-Incision Laparoscopic Multivisceral Resection

Abstract

Since Philippe Mouret’s first video-assisted cholecystectomy in 1987 (Kaiser and Corman, Surg Oncol Clin N Am 10:483–492, 2001), fundamental changes have occurred in laparoscopic surgery making it one of the most significant advances of twentieth century surgery. There is increasing evidence that laparoscopy provides better cosmetic results, less incision pain and shorter hospital stay when compared with open surgery. With the laparoscopic technique developing so fast in the last decade, surgeons are seeking a surgical method to reduce operative trauma. Single-incision laparoscopic surgery (SILS) has come into being on the base of this notion. This technique is well described in literature for appendectomy, nephrectomy, adrenalectomy, cholecystectomy, and colectomy (Ateş et al., J Pediatr Surg 42:1071–1074, 2007; Ponsky et al., J Endourol 22:663–665, 2008; Castellucci et al., J Endourol 22:1573–1576, 2008; Wu et al., J Laparoendosc Adv Surg Tech A 21:25–28, 2011; Tian et al., J Gastrointest Surg 14:1429–1433, 2010; Kaouk and Palmer, BJU Int 102:97–99, 2008). But there are only a few sporadic reports of SILS combined procedures (Mantke and Wicht, Surg Laparosc Endosc Percutan Tech 20:e28–e30, 2010; Cai et al., Hepatogastroenterology 59:986–989, 2012). Beginning in May 2009, we performed over 1,000 transumbilical single-incision cholecystectomies. During the period, SILS combined procedures were attempted using conventional instruments with satisfied outcomes. Combined SILS, based on combined laparoscopic surgery but not needing to add extra trocars, operates on two or more target organs in one anesthesia. Considering the procedure itself, SILS combined surgery brought no new advance to technique indeed. But with the fact that patients with coexisting pathologies at different sites are common clinically, this technique will be performed in a gradually widening field of application.