Single-incision surgery with SILS port for anterior mediastinal lesions: initial experience

Infrasternal mediastinoscopic single-incision surgery is a minimally invasive surgical option for patients with anterior mediastinal lesions. The main drawback of the procedure is difficult when handling the endoscopic instruments through the small infrasternal incision. Herein, we report our initial experience with use of the procedure in 2 patients with bronchogenic cysts in the anterior mediastinum. We found that use of an SILS Port, now widely available for single-incision laparoscopic surgery, can decrease the difficulty of this approach.     

Single-incision laparoscopic surgery in children: initial single-center experience

Background

In continued efforts to further improve the advantages of minimally invasive surgery to patients, surgeons have developed single-incision laparoscopic techniques. We report our initial experience in children with a variety of single-site procedures.

Method

A retrospective chart review was performed on patients who underwent a single-site procedure from April 2009 to April 2010.

Results

There were 142 consecutive procedures: 24 cholecystectomies, 103 appendectomies for nonperforated appendicitis, 2 splenectomies, 1 combined splenectomy/cholecystectomy, 8 ileocecectomies, 2 Meckel diverticulectomies, 1 small bowel duplication resection, and 1 jejunal stricture resection. There were 12 conversions to conventional laparoscopy: 10 during appendectomy and 2 during cholecystectomy. Mean operative time was 34 minutes for appendectomy, 73 minutes for cholecystectomy, 90 minutes for splenectomy, 116 minutes for combined splenectomy/cholecystectomy, 86 minutes for ileocecectomy, and 43 minutes for the small bowel procedures. The only complications were umbilical surgical site infections after appendectomy in 6 patients.

Conclusion

This institution's preliminary experience suggests that single-incision laparoscopic surgery in children has at least comparable outcomes to conventional laparoscopic surgery. However, prospective data are needed to prove that single-incision laparoscopic surgery is superior to conventional laparoscopy.     

Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases

Background and objective  

Single-incision laparoscopic surgery (SILS) is a new advance wherein laparoscopic surgery is carried out through a single small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation. The objective of this study is to describe the short-term outcomes of SILS cholecystectomy in a single community-based institution.     

Single-incision laparoscopic surgery: initial urological experience and comparison with natural-orifice transluminal endoscopic surgery

Laparoscopic approaches have increasingly assumed a central role in the management of benign and malignant surgical diseases. While laparoscopy is less morbid than open surgery, it still requires several incisions, each > or =1-2 cm long. Each incision risks morbidity from bleeding, hernia and/or internal organ damage, and incrementally decreases cosmesis. An alternative to conventional laparoscopy is single-incision laparoscopic surgery (SILS), in which articulating or bent instrumentation with specialized multi-lumen ports is used. These technical innovations obviate the need to externally space trocars for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen. Laboratory and early clinical series showed the feasibility as well as safe and successful completion of SILS. Natural-orifice transluminal endoscopic surgery (NOTES) is another exciting development in minimally invasive urology, but existing flexible endoscopes and instruments are limited in providing a platform for this form of advanced surgery, resulting in the slow adoption of NOTES. Future work is needed to improve existing instrumentation, increase clinical experience, assess the benefits of both surgical approaches, and explore other potential applications for these novel techniques.     

Minilaparotomy approach for colonic cancer: initial experience of 54 cases

Background The early outcomes of minilaparotomy for resection of colonic cancer were evaluated.Methods In this study, 54 patients (34 Dukes’ A, 15 Dukes’ B, and 5 Dukes’ C) successfully underwent curative resection of colonic cancer via minilaparotomy (skin incision, =7 cm). The major exclusion criteria for this approach required a body mass index greater than 25 kg/m², a tumor size exceeding 7 cm, a preoperative ileus, and tumor invading the adjacent organs. Patients (n = 54) who had undergone conventional open surgery before the introduction of this technique served as the control group by matching several clinicopathologic factors including body mass index.Results The passage of flatus (p < 0.01) and the beginning of oral intake (p = 0.02) were earlier, analgesic requirements were lower (p < 0.01), and postoperative serum C-reactive protein levels were lower in the minilaparotomy group (p < 0.01). The blood loss and frequency of postoperative complications did not differ between the groups.Conclusion A minilaparotomy approach is a feasible, minimally invasive, and attractive alternative to conventional laparotomy for selected patients with colonic cancer.     

Single-incision laparoscopic appendectomy using conventional instruments: an initial experience using a novel technique

Background  

Laparoscopic appendectomy has gained wide acceptance. This study aimed to evaluate the feasibility, safety, and cosmetic results of a novel technique: single incision laparoscopic (SIL) appendectomy.     

Thyroid cancer: surgical experience with 322 cases

From November 1970 to July 1983, a total of 322 thyroid cancers were treated surgically in our clinic. Total thyroidectomy was the treatment of choice. In 131 patients, modified neck dissection (unilaterally in 23 and bilaterally in 108) was added. Of the latter patients, 33 also required upper mediastinal lymph node dissection. There were no operative deaths. No recurrent laryngeal nerve iatrogenic palsy was observed. Permanent parathyroid insufficiency developed in only about 4% of patients. The low morbidity and good long-term results justify the use of this procedure in all patients with thyroid malignancies. Despite conservative arguments in the controversial issue of lobectomy versus total thyroidectomy, skilled surgeons should be able to perform total thyroidectomy safely. It is recommended as the treatment of choice because of the well-documented multicentricity of thyroid cancers and the good prognosis of differentiated cancers associated with a near-normal life expectancy, to permit radioactive iodine therapy of possibly functioning metastases and the easier control of hypothyroidism with thyroid supplement medication.     

手助腹腔镜手术与腹腔镜手术治疗结直肠癌的Meta分析

目的:系统评价手辅助腹腔镜手术(HALS)与腹腔镜辅助手术(LAS)治疗结直肠癌的临床疗效。方法:计算机检索国内外多个数据库,收集有关比较HALS与LAS治疗结直肠癌疗效的随机对照试验与非随机对照研究,按纳入标准筛选后进行质量评分,提取数据,采用Rev Man 5.3软件行Meta分析。结果:最终纳入27篇研究,共3 347例患者,其中HALS组1 626例,LAS组1 721例。Meta分析结果显示,与LAS组比较,HALS组手术时间短(WMD=-24.18,95%CI=-31.61~-16.75)、中转率(OR=0.57,95%CI=0.41~0.81)和术中损伤率低(OR=0.48,95%CI=0.29~0.78)、使用Trocar少,但切口长度增加(WMD=1.07,95%CI=0.64~1.50),差异均有统计学意义(均P0.05)。两组在术后恢复、术后并发症、肿瘤学指标、随访结果、术后疼痛以及住院费用等方面的差异均无统计学意义(均P0.05)。结论:HALS结合了LAS微创和开腹手术直观的优点,可作为结直肠癌微创手术的一个选择。     

Single-incision laparoscopic right colectomy for cancer: a single-centre preliminary experience

The rationale for single-incision laparoscopic surgery (SILS) is minimizing morbidity, as well as improving cosmetic results of laparoscopic approach. This technique has been used for a variety of procedures and has recently been proposed for colonic resections as well. We report our preliminary experience of right colectomy, performed through a SILS approach. Five patients (3 males, 2 females, mean age 81.6 years) were selected to undergo SILS right colectomy for cancer. The procedure was carried out through a SILS multi-port device (SILS? Port, Covidien Ltd, Norwalk, CT, USA), with either conventional or specially designed instruments. A medial-to-lateral approach and an extra-corporeal anastomosis were performed. In three cases, the procedure was completed through the SILS technique; in two of these cases a combined procedure was carried out (right colectomy plus cholecystectomy, right colectomy plus cholecystectomy plus i.o. colonoscopy and polypectomy). In one case, a switch to standard laparoscopy was necessary because of the large dimension of the tumour, while in the other case an intolerance of pneumoperitoneum was registered, thus requiring a conversion to open surgery. SILS procedures proved to be oncologically correct. No major complications occurred. In selected patients, SILS right colectomy for cancer appears to be feasible and oncologically safe. Beyond the cosmetic advantage, the procedure may reduce postoperative morbidity. Further studies are needed, with larger series and a longer follow-up, to determine the incidence of possible long-term complications and to evaluate possible cost-effectiveness of the procedure.     

Portless endoscopic adrenalectomy via a single minimal incision using a retroperitoneal approach: Experience with initial 30 cases

AIM: To assess the feasibility of portless endoscopic adrenalectomy via a single minimum incision that narrowly permits extraction of the specimen. METHODS: For 30 cases of adrenal tumor, portless endoscopic surgery through a single flank incision (3-9 cm; mean, 5.6 cm) was performed without gas inflation or trocar port placement. All of the instruments used during surgery were reusable. The cases included primary aldosteronism (12), Cushing's syndrome (6), preclinical Cushing's syndrome (3), pheochromocytoma (1), non-functioning cortical adenoma (6), adrenocortical carcinoma (1) and adrenocortical hemorrhage (1). RESULTS: Resection of the tumor was successfully completed, without complications, in all of the cases. Operative time was between 83 and 240 min (mean, 147 min). Estimated blood loss was 5-470 mL (mean, 139 mL). None of the patients required blood transfusion. Postoperative course was uneventful. Wound pain was mild and walking and full oral feeding were resumed on the first and second postoperative day, respectively, in the majority of cases. CONCLUSIONS: Adrenal tumors are good candidates for portless endoscopic surgery, which is safe, cost-effective, minimally invasive and matches favorably with laparoscopic surgery.     

Early experience with laparoscopic approach for solid liver tumors: initial 16 cases

OBJECTIVE: To evaluate the feasibility and outcome of laparoscopic hepatectomy in patients with solid liver tumors. SUMMARY BACKGROUND DATA: Although the laparoscopic approach has become popular in the surgical field, the value of laparoscopy in liver surgery is unknown. METHODS: Fifteen patients with solid liver tumors underwent 16 consecutive laparoscopic resections at the authors' institution between 1994 and 1999. Indications were symptomatic hemangioma, focal nodular hyperplasia, liver cell adenoma, isolated metastasis from a colon cancer, and hepatocellular carcinoma. The laparoscopic procedure was performed using four to seven ports (four 10-mm, two 5-mm, and one 12-mm). RESULTS: One patient underwent a major hepatic resection (right lobectomy); the others underwent minor hepatic resections (left lateral segmentectomies, IVb subsegmentectomies, segmentectomy, and nonanatomical excisions). The laparoscopic procedure was uneventful in 15 patients; one patient required conversion to open laparotomy because of inadequate free surgical margins. CONCLUSION: Laparoscopic surgery of the liver is feasible. The use of this new technical approach offers many advantages but requires extensive experience in hepatobiliary surgery and laparoscopic skills. The authors' experience suggests that laparoscopic procedures should be reserved for benign tumors in selected cases. Its application must be verified by further studies.     

基层医院开展腹腔镜辅助直肠癌根治术的体会

目的:探讨基层医院开展腹腔镜辅助直肠癌根治术的安全性与可行性。方法:回顾分析2010年1月至2012年12月采用腹腔镜辅助直肠癌根治术治疗32例直肠癌患者的临床资料。其中男19例,女13例;平均(56±22)岁,中位年龄56.8岁;Dukes分期A期2例、B期13例、C期17例。结果:30例顺利完成腹腔镜辅助手术,其中Miles术6例,Dixon术24例,中转开腹2例。手术时间平均(180±50)min;术中出血量平均(200±100)ml;术后肠蠕动恢复时间平均(48±12)h;术后无出血、切口感染等并发症发生,6例患者出现轻度尿潴留,4例发生吻合口漏,无死亡病例;术后平均住院(8±2)d。结论:熟悉解剖结构,腹腔镜操作技术熟练,基层医院开展腹腔镜辅助直肠癌根治术操作安全、患者创伤小、术后康复快。     

Single-incision laparoscopic surgery: a promising approach to sigmoidectomy for diverticular disease

Background

Laparoscopic sigmoidectomy has become the standard procedure in elective surgery for recurrent diverticular disease. To realize further benefits of this minimal invasive procedure and to offer less postoperative pain, shorter recovery time, reduced complications, and improved cosmetic results, attempts are being made to minimize the number of necessary skin incisions for trocar positioning. One method is to use only one port for laparoscopic access to perform diverticular-related elective sigmoidectomies.

Methods

Between 7 July and 4 August 2009, 10 consecutive patients were referred for partial left colon resection due to multiple episodes of diverticulitis. In all cases, access to the abdomen was achieved through a 2- to 2.5-cm single incision via the umbilicus followed by insertion of the single-incision laparoscopic surgery (SILS?) port system. Outcomes such as change in the procedural method, operative time, postoperative complications, and length of stay were recorded.

Results

Of the 10 consecutive sigmoidectomies, 9 were performed successfully with the SILS? procedure using only one incision in the umbilicus. No mortalities or major complications were noted. The median operating time was 120 min, and the median postoperative hospital stay was 7 days.

Conclusion

As an alternative to the standard laparoscopic procedure, single-incision laparoscopic sigmoidectomy via the umbilicus is technically feasible and effective. This attractive procedure aims to increase the patient’s comfort further after abdominal surgery.     

经脐单孔腹腔镜完全腹膜外腹股沟疝修补术95例

目的总结经脐单孔腹腔镜下完全腹膜外腹股沟疝修补术手术技巧。 方法回顾分析2018年10月至2019年6月,宁波大学医学院附属医院开展的95例经脐单孔腹腔镜全腹膜外腹股沟疝修补术（SILS-TEP）的临床资料,总结手术技巧。 结果95例SILS-TEP手术,2例中转为常规三孔TAPP手术。单侧手术时间（66.74±10.95）min。术后发生血清肿3例,脐部切口感染2例,无阴囊血肿、慢性疼痛、补片感染和脐部切口疝,随访期间无复发。主要技巧包括：对常规单孔Port进行改良/造和带吸引电钩有助操作;脐下缘弧形切口有利于隐匿瘢痕;左右手交叉操作;疝囊用电钩分离或分离钳接电后分离。 结论熟练掌握单孔条件下的手术技巧及规范操作的TEP是安全可行的。     

Single-incision laparoscopic surgery for gallstone ileus: An alternative surgical procedure

INTRODUCTION

Gallstone ileus (GI) results from the passage of a stone through a cholecystoenteric fistula, subsequently causing a bowel obstruction. The ideal treatment procedure for GI remains controversial.

PRESENTATION OF CASE

A 63-year-old female was admitted to our hospital following persistent nausea and vomiting for 7 days. Computed tomography revealed a partially calcified 4-cm circular object in the jejunum, and the proximal intestine was dilated, with concomitant pneumobilia. Based on the preoperative diagnosis of GI, enterotomy with stone extraction by single-incision laparoscopic surgery (SILS) was performed. The patient''s postoperative course was uneventful, and the cholecystoduodenal fistula closed spontaneously 4 months after the surgery.

DISCUSSION

Recent studies have reported that enterotomy with stone extraction alone is associated with better outcomes than with more invasive techniques. This case also suggests that enterotomy with stone extraction alone and careful postoperative follow-up is feasible for the management of GI. Although the use of laparoscopy in the management of GI has been described previously, laparoscopic surgery has not been widely performed, and SILS is not generally performed. When only this less demanding procedure is required, laparoscopic surgery, including SILS, can be a viable option.

CONCLUSION

SILS can be an alternative surgical procedure for the management of GI.     

达芬奇外科系统在胆道疾病手术中的应用体会

目的:总结达芬奇外科系统在胆道疾病手术中的经验,并探讨其优越性。方法:2010年2月至2011年10月应用达芬奇外科系统为24例胆道疾病患者施术。分析总结分别以肝十二指肠韧带、肝脏为视野的两组患者手术过程及术后康复情况。结果:24例患者中1例中转开腹,无一例死亡。以肝十二指肠韧带为术野的17例患者手术时间平均(342.4±37.4)min,术中出血量平均(168.8±39.5)ml,术后平均住院(11.6±1.5)天。以肝脏为术野的7例患者手术时间平均(438.5±33.9)min,术中出血量平均(292.9±67.6)ml,术后平均住院(10.1±1.2)天。结论:达芬奇外科系统不仅可独立完成胆道疾病手术,使患者受益,而且受到外科医师的青睐,将会推动腹腔镜外科的进程。     

Single-incision laparoscopic-assisted anorectoplasty using conventional instruments for children with anorectal malformations and rectourethral or rectovesical fistula

BackgroundThis study aims to evaluate the safety and efficacy of single-incision laparoscopic-assisted anorectoplasty (SILAARP) for children with anorectal malformations (ARM) and rectourethral or rectovesical fistula.MethodsChildren with ARMs and rectourethral or rectovesical fistula who underwent SILAARP between May 2011 and December 2012 were reviewed. The operative time, early postoperative and follow-up results were analyzed.ResultsThirty-one patients (ARM with rectovesical vs. rectoprostatic fistula vs. rectobulbar fistula: 9/6/16) successfully underwent SILAARPs without conversions. Mean ages at operation were similar in 2 groups (ARM with rectovesical or rectoprostatic fistula vs. ARM with rectobulbar fistula: 4.94 months vs. 5.67 months, p = 0.46). Average operative time in ARM children with rectobulbar fistula was 1.94 hours, which did not differ from 1.78 hours in ARM children with rectovestical or rectoprostatic fistula (p = 0.39). All patients resumed feeding on postoperative day 1. The median follow-up period was 20 months. No injuries of vessels, urethral or vas deferens occurred in operations. No mortality or morbidities of wound infection, rectal retraction, recurrent fistula, urethral diverticulum, anal stenosis, or rectal prolapse was encountered.ConclusionsSILAARP is safe, feasible and effective for ARM with rectourethral or rectovesical fistula. One-stage SILAARP may offer a viable alternative treatment for ARM children with rectourethral or rectovesical fistula.