“Reply from authors re: Jens J. Rassweiler. Is less/notes really more? Eur Urol 2011;59:48-50.”
Autorino, R., J. A. Cadeddu, et al. (2011).
European Urology59(1): 48-50.
“Single incision laparoscopic surgery hysterectomy.”
Ciancio, F. and F. Cannone (2010).
Prima esperienza europea: Isterectomia totale laparoscopica Mono Trocar22(2): 65-70.
The single incision laparoscopic surgery starts to belong to our daily practice. In our service of gynecologic surgery from June 2009, 83 patients have been operated of hysterectomy. We have identified two groups; group A; 40 patients operated with traditional laparoscopic approach, and the group B; 43 patient submitted to the single incision laparosocpic surgery approach; SILS of “covidien.”. The patients admitted to the study had an uterus with ultrasound measured dimensions among: 7/16cm longitudinal, 3.5/6cm transversal, 2.5/5cm front rear. The aim of the study was to evaluate the advantage of the use of this new approach to the gynecological laparoscopic surgery, applied to the hysterectomy, analyzing the operating time, the cost of the technique, use of drugs, the hospitalization and the pain. In conclusion the belonging patients to the group B take advantage of a precocious discharge 33% less, of an important reduction of the pain score. The operating time seems to be of little superior to the classical laparosocopic surgery, with a learning curves of 4 interventions. The single incision laparoscopic surgery, finds frankly the place in the conventional gynecologic surgery. © 2010, CIC Edizioni Internazionali, Roma.
“Laparoendoscopic single-site partial nephrectomy without ischemia.”
Cindolo, L., F. Berardinelli, et al. (2010).
Journal of Endourology24(12): 1997-2002.
Background and Purpose: Nephron-sparing surgery (NSS) ensures excellent oncologic and functional outcomes in small renal masses. Laparoendoscopic single-site surgery (LESS) is one of the major advances in the evolution of minimally invasive surgery. We describe our initial surgical experience and assess the feasibility of LESS unclamp-NSS. Patients and Methods: From April to September 2009, all consecutive patients with solitary, exophytic, enhancing, small (≤4.0cm) renal masses and normal contralateral kidney were selected to receive LESS unclamp-NSS. A multichannel port provided intra-abdominal transperitoneal access. Rigid and articulable instruments were used for dissection, tumor exposure, and excision under normal renal perfusion. Perioperative, pathologic, hematologic data together with a subjective evaluation of pain and scar were collected and evaluated. Results: Six patients underwent LESS unclamp-NSS (mean operative time, 148min; mean blood loss, 201mL; mean renal masses size, 2.1cm). One patient needed conversion to standard laparoscopy because of excessive bleeding. Postoperatively, a cerebrovascular accident developed in one patient. No transfusion was necessary. Pathologyic examination revealed two clear-cell carcinoma, three benign cysts, and one angiomyolipoma (surgical margin positive). A 2.7g/dL hemoglobin level decrease was recorded with minimal pain and great patient satisfaction. Mean length of stay was 6 days. Conclusion: LESS unclamp-NSS in selected renal masses is feasible, provides postoperative outcomes overlapping the standard counterpart, and ensures subjective satisfaction. Additional trocars should be considered for the hemostatic stitches and for liver retraction. A wider experience and longer follow-up are necessary to establish the role of this technique. Copyright © 2010, Mary Ann Liebert, Inc.
“Laparoendoscopic single-site and natural orifice surgery in gynecology.”
Escobar, P. F., D. Starks, et al. (2010).
Fertility and Sterility94(7): 2497-2502.
Objective: To evaluate the current literature on the use of single port and natural orifice surgery in gynecology. Design: Appraisal of articles published on the use of this technology in gynecology. Result(s): Most reports on single port and natural orifice surgery are case reports or case series. However, most have reported successful outcomes such as diagnostic or extirpative gynecologic procedures. The main limitation is the availability of instrumentation to successfully accomplish the task. Conclusion(s): Single port and natural orifice surgery offers the potential for advancing the minimally invasive approach to gynecologic surgery. Copyright © 2010 American Society for Reproductive Medicine, Published by Elsevier Inc.
“Video. Chopstick surgery: a novel technique enables use of the Da Vinci Robot to perform single-incision laparoscopic surgery.”
Joseph, R. A., N. A. Salas, et al. (2010).
Surgical Endoscopy24(12): 3224.
INTRODUCTION: Single-incision laparoscopic surgery (SILS) is limited by the coaxial arrangement of the instruments. A surgical robot with “wristed” instruments could overcome this limitation but the “arms” collide when working coaxially. This video demonstrates a new technique of “chopstick surgery,” which enables use of the robotic arms through a single incision without collision. METHODS: Experiments were conducted utilizing the da Vinci S(R) robot (Sunnyvale, CA) in a porcine model with three laparoscopic ports (12 mm, 2-5 mm) introduced through a single “incision.” Pilot work conducted while performing Fundamentals of Laparoscopic Surgery (FLS) tasks determined the optimal setup for SILS to be a triangular port arrangement with 2-cm trocar distance and remote center at the abdominal wall. Using this setup, an experienced robotic surgeon performed a cholecystectomy and nephrectomy in a porcine model utilizing the “chopstick” technique. The chopstick arrangement crosses the instruments at the abdominal wall so that the right instrument is on the left side of the target and the left instrument on the right. This arrangement prevents collision of the external robotic arms. To correct for the change in handedness, the robotic console is instructed to drive the “left” instrument with the right hand effector and the “right” instrument with the left. RESULTS: Both procedures were satisfactorily completed with no external collision of the robotic arms, in acceptable times and with no technical complications. This is consistent with results obtained in the box trainer where the chopstick configuration enabled significantly improved times in all tasks and decreased number of errors and eliminated instrument collisions. CONCLUSION: Chopstick surgery significantly enhances the functionality of the surgical robot when working through a small single incision. This technique will enable surgeons to utilize the robot for SILS and possibly for intraluminal or transluminal surgery.
“Laparoendoscopic single-site surgery for renal malignancies.”
Khanna, R., H. K. Laydner, et al. (2010).
Expert Review of Anticancer Therapy10(12): 1861-1863.
“Trans-vaginally assisted single incision laparoscopic right hemicolectomy.”
Navarra, G. and G. Currò (2010).
ANZ Journal of Surgery80(12): 872-873.
“Is less/notes really more?”
Rassweiler, J. J. (2011).
European Urology59(1): 46-48.
“Single-incision laparoscopic sleeve gastrectomy versus conventional multiport laparoscopic sleeve gastrectomy: Technical considerations and strategic modifications.”
Saber, A. A., T. H. El-Ghazaly, et al. (2010).
Surgery for Obesity and Related Diseases6(6): 658-664.
Background: Since its inception, minimal access surgery has been a dynamic field, experiencing successive leaps in technique and instrumental design. Each improvement in minimal access surgery must demonstrate that patients benefit from the change in approach, without compromising the outcome. The present study presents the technical considerations and strategic modifications for single-incision laparoscopic sleeve gastrectomy. We also compared the newly adopted single-incision laparoscopic approach with conventional multiport laparoscopic sleeve gastrectomy. Methods: Of the 26 patients included in the present study, 14 underwent single-incision laparoscopic sleeve gastrectomy and 12 underwent conventional multiport sleeve gastrectomy. All procedures were performed by the same surgeon (A.A.S.) during a 12-month period from September 2008 to August 2009 at Michigan State University Kalamazoo Center for Medical Studies. Results: The Mann-Whitney U tests showed with 95% confidence that the difference in pain scores and length of hospital stay in the single-incision laparoscopic sleeve gastrectomy group were statistically significant. A modest increase occurred in the operative time in the single-incision laparoscopic sleeve gastrectomy group. This difference was the least statistically significant of all variables (P = .055). Conclusion: Single-incision laparoscopic sleeve gastrectomy was associated with less postoperative pain, a lower need for analgesia, and a decreased length of hospital stay compared with conventional multiport laparoscopic sleeve gastrectomy. This was achieved without decreasing the quality of surgery or the outcomes offered by the conventional multiport counterpart. © 2010 American Society for Metabolic and Bariatric Surgery.
“Transcervical Heller Myotomy Using Flexible Endoscopy.”
Spaun, G. O., C. M. Dunst, et al. (2010).
Journal of Gastrointestinal Surgery14(12): 1902-1909.
Introduction: Esophageal achalasia is most commonly treated by laparoscopic myotomy. Transesophageal approaches using flexible endoscopy have recently been described. We hypothesized that using techniques and flexible instruments from our NOTES experience through a small cervical incision would be a safer and less traumatic route for esophageal myotomy. The purpose of this study was to evaluate the feasibility, safety, and success rate of using flexible endoscopes to perform anterior or posterior Heller myotomy via a transcervical approach. Methods: This animal (porcine) and human cadaver study was conducted at the Legacy Research and Technology Center. Mediastinal operations on ten live, anesthetized pigs and two human cadavers were performed using standard flexible endoscopes through a small incision at the supra-sternal notch. The esophagus was dissected to the phreno-esophageal junction using balloon dilatation in the peri-esophageal space followed by either anterior or posterior distal esophageal myotomy. Success rate was recorded of esophageal dissection to the diaphragm and proximal stomach, anterior and posterior myotomy, perforation, and complication rates. Results: Dissection of the esophagus to the diaphragm and performing esophageal myotomy was achieved in 100% of attempts. Posterior Heller myotomy was always extendable onto the gastric wall, while anterior gastric extension of the myotomy was found to be more difficult (4/4 and 2/8, respectively; P = 0.061). Conclusion: Heller myotomy through a small cervical incision using flexible endoscopes is feasible. A complete Heller myotomy was performed with a higher success rate posteriorly possibly due to less anatomic interference. © The Society for Surgery of the Alimentary Tract 2010.
Lehman, A. C., N. A. Wood, et al. (2011).
Surgical Endoscopy25(1): 119-123.
This study demonstrates the feasibility of using a miniature robot to perform complex, single-incision, minimal access surgery. Instrument positioning and lack of triangulation complicate single-incision laparoscopic surgery, and open surgical procedures are highly invasive. Using minimally invasive techniques with miniature robotic platforms potentially offers significant clinical benefits. A miniature robot platform has been designed to perform advanced laparoscopic surgery with speed, dexterity, and tissue-handling capabilities comparable to standard laparoscopic instruments working through trocars. The robotic platform includes a dexterous in vivo robot and a remote surgeon interface console. For this study, a standard laparoscope was mounted to the robot to provide vision and lighting capabilities. In addition, multiple robots could be inserted through a single incision rather than the traditional use of four or five different ports. These additional robots could provide capabilities such as tissue retraction and supplementary visualization or lighting. The efficacy of this robot has been demonstrated in a nonsurvival cholecystectomy in a porcine model. The procedure was performed through a single large transabdominal incision, with supplementary retraction being provided by standard laparoscopic tools. This study demonstrates the feasibility of using a dexterous robot platform for performing single-incision, advanced laparoscopic surgery.