Transumbilical single-incision laparoscopic intracorporeal anastomosis for gastrojejunostomy: case report

Background  Laparoscopic gastrojejunostomy allows effective palliation and rapid recovery for the patient with limited survival due to advanced pancreatic cancer presenting with gastric outlet obstruction. Transumbilical single-incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain, reduced need for analgesia, and thus accelerated recovery. The authors report the first transumbilical single-incision laparoscopic intracorporeal anastomosis for gastrojejunostomy. Methods  Preliminary experience with transumbilical single-incision, intracorporeal anastomosis for gastrojejunostomy for a patient with gastric outlet obstruction caused by advanced pancreatic cancer is reported. Results  Transumbilical single-incision laparoscopic intracorporeal anastomosis for gastrojejunostomy was performed with a linear endoscopic stapler using an omega loop. The operative time was 117 min. No intra- or postoperative complications were recorded. Conclusion  Transumbilical single-incision laparoscopic intracorporeal anastomoses are feasible using the endoscopic linear stapler. Transumbilical single-incision gastrojejunostomy for gastric outlet obstruction may improve cosmetic results and allow accelerated recovery for patients with limited survival. This anastomosis technique of single-incision laparoscopic surgery for other digestive tract procedures needs further evaluation.     

经脐单孔与多孔法腹腔镜手术治疗贲门失弛缓症及食管裂孔疝的比较研究

目的 探讨经脐单孔腹腔镜手术治疗贲门失弛缓症及食管裂孔疝的安全性和可行性.方法 2008年1月至2011年12月,行腹腔镜手术治疗贲门失弛缓症及食管裂孔疝患者17例.其中,单孔法组7例,多孔法组10例.收集两组围手术期资料进行比较分析.结果 全部患者均顺利完成腹腔镜手术.单孔组手术时间115 ～ 180 min,出血量50～110ml,术后住院时间5～7d;多孔组手术时间100～ 155 min,出血量40～ 90 ml,住院时间5～9d.所有患者均无术后出血、食管漏、发热感染等并发症发生.单孔组患者术后脐部切口愈合良好,美容效果明显.结论 对于有经验的腹腔镜外科医师,单孔腹腔镜手术治疗贲门失弛缓症及食管裂孔疝是安全可行的,并具有极佳的美容效果.其临床应用价值仍需进一步研究证实.     

单孔与多孔法腹腔镜手术治疗腹股沟疝的回顾性对比研究

目的探讨单孔腹腔镜腹股沟疝修补术的安全性和可行性。方法 2009年12月至2011年3月行单孔腹腔镜腹股沟疝修补术11例（单孔组）,其中直疝2例,斜疝9例。10例行单孔腹腔镜完全腹膜外疝修补术（TEP）,1例行经腹腔腹膜前修补术（TAPP）。同期多孔法腹腔镜手术患者18例（多孔组）,其中直疝5例,斜疝13例。16例行TEP,2例行TAPP。收集两组患者围手术期资料进行比较分析。结果两组在术中出血量（P=0.579）和术后住院时间（P=0.839）方面比较差异无统计学意义。在手术时间方面,单孔组长于多孔组（P=0.016）,差异有统计学意义。术后随访3～18个月,两组术中、术后并发症比较差异无统计学意义。结论单孔腹腔镜腹股沟疝修补术安全、有效,具有可行性。其临床应用价值仍需进一步的临床研究证实。     

经脐单孔腹腔镜手术治疗贲门失弛缓症及食管裂孔疝的临床体会

目的：总结经脐单切口腹腔镜手术治疗贲门失弛缓症及食管裂孔疝的经验,提高腹腔镜临床应用的水平。方法：2010年3月—2011年10月分别对3例贲门失迟缓症进行单切口腹腔镜食管Heller肌切开、Dor胃底折叠术,对4例食管裂孔疝患者进行单切口腹腔镜食管裂孔疝修补、Nissen胃底折叠术。结果：7例手术均顺利完成。手术时间115～180 min;出血量50～110 mL;住院时间5～7 d。所有患者均无术后出血、食管漏、发热感染等并发症。患者术后脐部切口愈合良好,美容效果明显。结论：对于有经验的腹腔镜外科医生,单切口腹腔镜手术治疗贲门失弛缓症及食管裂孔疝是安全可行的,并具有极佳的美容效果。     

Single Incision Laparoscopic Sleeve Gastrectomy (SILS): A Novel Technique

Background  Laparoscopic sleeve gastrectomy is an emerging bariatric procedure that typically necessitates five to seven small skin incisions to place five to seven trocars. The senior author (Saber) has developed a single umbilical incision approach to laparoscopic sleeve gastrectomy. Methods  Seven patients underwent single access transumbilical laparoscopic sleeve gastrectomy between March 2008 and July 2008. The same surgeon performed all surgical interventions. The umbilicus was the sole point of entry for all patients, and the same operative technique and perioperative protocol were used in all patients. Results  A total of seven single-incision laparoscopic sleeve gastrectomies were performed. The procedure was successfully performed in all patients. Mean operating time was 125 min. None of the patients required conversion to an open procedure. There were no mortalities or postoperative complications noted during the mean follow-up period of 3.4 months. Conclusion  Single-incision transumbilical laparoscopic sleeve gastrectomy is safe, technically feasible, and reproducible.     

A Novel Technique for Liver Retraction in Laparoscopic Bariatric Surgery

During bariatric surgery in morbidly obese patients, the surgeon’s operative view is often obscured by the hypertrophic fatty left lobe of the liver. The use of a conventional liver retractor mandates an additional subxiphoid wound, resulting in pain and scar formation, in addition to the risk of iatrogenic liver injury during retractor insertion. To overcome these limitations, we developed a simple, rapid, and safe technique for liver retraction—V-shaped liver suspension technique (V-LIST)—by using a Penrose drain and laparoscopic stapler. A silicone Penrose drain was inserted into the peritoneal cavity and stapled to the pars condensa of the lesser omentum and parietal peritoneum using a laparoscopic stapler. The left lobe of the liver was retracted by the V-shaped suspension. At the end of the surgery, the drain could be easily removed. In October 2009–February 2010, 14 patients underwent liver retraction with the use of this technique. We performed 12 Roux-en-Y gastric bypasses and 2 sleeve gastrectomies. This series also included three cases of single incision transumbilical laparoscopic surgery. The mean time required to complete the liver retraction was 8 min 21 s (range, 2–18 min 40 s). Retraction was appropriate in all patients, without the need for additional retractors or conversion. There were no V-LIST-related perioperative complications. Our V-LIST technique using a Penrose drain is safe and simple. It has potential applications in single incision laparoscopic bariatric procedures.     

单切口经脐腹腔镜减重手术

目的近来,人们将单一切口腹腔镜胃减重手术的方法,视为除经自然腔道内镜手术之外的另一种选择。单一切口经脐腹腔镜胃减重手术的优势在于能隐藏手术瘢痕,获得较好的美容效果。然而,由于器械操作空间有限及肝脏牵引困难,此项技术一直受到很大限制,仅被认为适用于简单胃减重手术。本研究中,通过采用特殊技术和操作以期改善手术的安全及有效性,使其应用于更广泛的领域。方法自2008年12月起,我院采用LST装置（liver-suspension tape）及′Ω形脐孔成形术成功开展单一切口经脐胃减重手术。至2009年7月,共完成40例患者45例次手术,包括5例次胆囊切除术,2例胃束缚带放置,6例次胃袖状切除,32例次Roux-en-Y胃转流术（Roux-en-Y gastric bypass,RYGB）,记录术后住院天数及并发症情况。结果平均手术时间89.9min,平均术后住院1.15d。无一例发生术中或术后并发症,无死亡病例。所有病人均满意手术的美容效果。结论采用本技术施行单一切口经脐胃减重手术是安全、可行的,有进一步推广应用于更多外科手术的价值。     

Transumbilical endoscopic surgery: a preliminary clinical report

Objective  There has been great interest in natural orifice transluminal endoscopic surgery (NOTES) in recent years. We report another new approach—transumbilical endoscopic surgery (TUES)—which we have performed in 40 cases for liver cysts (3), bleeding ascites (1), chronic appendicitis (10), and gallbladder diseases (26). Methods  Transumbilical endoscopic liver cyst fenestration, abdominal cavity exploration, appendectomy, and cholecystectomy were performed in a total of 40 patients. Results  All the operations were completed successfully except one case of intraoperative bleeding in TUES cholecystectomy which was converted to routine laparoscopic surgery. The operating times for TUES cholecystectomy, appendectomy, and liver cyst fenestration were 30–150 min,15–40 min, and 30–90 min, respectively. No postoperative bleeding or bile leakage occurred in this group of patients. Conclusions  Transumbilical endoscopic surgery is feasible, and would be another option for scarless abdominal surgery. TUES cholecystectomy is technically challenging. Careful selection of patients is important in the initial period of this technique.     

A new approach to hand-assisted laparoscopic liver surgery

Background  The best type of laparoscopic approach in solid liver tumours (SLTs), whether total laparoscopic surgery or hand-assisted laparoscopic surgery (HALS), has not yet been established. Our objective is to present our experience with laparoscopic liver resections in SLTs performed by HALS using a new approach. Methods  We performed 35 laparoscopic resections in SLTs, of which 26 were carried out using HALS (in 25 patients) and 21 patients had liver metastases of a colorectal origin (LMCRC) (1 patient had 2 resections), 1 metastasis from a neuroendocrine tumour of the pancreas, 1 hepatocarcinoma on a healthy liver, 1 primary hepatic leiomyosarcoma and 1 giant haemangioma. Mean follow-up was 22 months. Operation  One right hemihepatectomy, one left hemihepatectomy, five bisegmentectomies II–III, three bisegmentectomies VI–VII and 16 segmentectomies (five of S. VI, three of S. VIII; three of S. V; two of S. IVb; one of S. II; one of S. IV; and in the remaining case resection of S. III and VI plus resection of a metastasis in S. VIII). Main outcome measures  Morbidity and mortality, conversion to open procedure, intraoperative blood loss, intra- and postoperative transfusion, length of stay and survival. Results  There were no intra- or postoperative deaths, nor were there any conversions. One patient presented with morbidity (3.8%) (liver abscess). Mean blood loss was 200 ml (range 0–600 ml). One patient required transfusion (3.8%). Mean operative time was 180 min (range 120–360 min). Mean length of hospital stay was 4 days (range 2–5 days). The actuarial survival rate of the patients at 36 months with liver metastases from colorectal carcinoma (LMCRC) was 80%. Conclusions  Liver resection with HALS reproduces the low morbidity and mortality rates and effectiveness (3-year survival) of open surgery in SLTs when indicated selectively.     

Transumbilical Single-Incision Laparoscopic Resection of Focal Hepatic Lesions

Background and Objectives:

Transumbilical single-incision laparoscopic surgery (SILS) is gaining in popularity as a minimally invasive technique. The reduced pain and superior cosmetic appearance it affords make it attractive to many patients. For this study, we focused on SILS, analyzing the outcomes of transumbilical single-incision laparoscopic liver resection (SILLR) achieved at our institution between January 2010 and February 2013.

Patients and Methods:

Pre- and postoperative data from 17 patients subjected to transumbilical SILLR for various hepatic lesions (8 hemangiomas, 2 hepatocellular carcinomas, 2 metastases, 2 calculi of left intrahepatic duct, and 3 adenomas) were assessed. Altogether, eight wedge resections, seven left lateral lobectomies, a combination wedge resection/left lateral lobectomy, and a proximal left hemihepatectomy segmentectomy were performed, as well as four simultaneous laparoscopic cholecystectomies. In each instance, three ports were installed through an umbilical incision. Once vessels and bleeding were controlled, the lesion(s) were resected with 5-mm margins of normal liver. Resected tissues were then bagged and withdrawn through the umbilical incision. The follow-up period lasted for a minimum of 6 months.

Results:

All 17 patients were successfully treated through a single umbilical incision. The procedures required 55 to 185 minutes to complete, with blood loss of 30 to 830 mL. Subjects regained bowel activity 0.8 to 2.3 days postoperatively and were discharged after 3 to 10 days. There were few complications (23.5%), limited to pleural effusion, wound infection, and incisional hernia.

Conclusions:

Transumbilical SILLR is challenging to perform through conventional laparoscopic instrumentation. The risk of bleeding and technical difficulties is high for lesions of the posterosuperior hepatic segment. Surgical candidates should be carefully selected to optimize the benefits of this technique.     

经脐单孔腹腔镜手术212例报告

目的:总结经脐单孔腹腔镜手术的早期应用经验,探讨其安全性及可靠性。方法:回顾分析2009年3月至2011年6月为212例患者行经脐单孔腹腔镜手术的临床资料。结果:176例成功施行经脐单孔腹腔镜胆囊切除术,其中7例因显露困难或需放置引流管中转两孔或三孔法腹腔镜手术,1例术后毛细胆管漏行开放手术。17例成功施行经脐单孔腹腔镜阑尾切除术,其中3例因粘连严重中转三孔法手术。3例行单孔腹腔镜小儿斜疝高位结扎术,4例行腹腔镜胆囊联合阑尾切除术,4例行单孔腹腔镜胆囊联合肝囊肿开窗术3,例行单孔腹腔镜精索静脉曲张高位结扎术,3例行经脐单孔腹腔镜肾囊肿去顶术2,例行经脐单孔腹腔镜胆囊联合卵巢囊肿切除术。术后脐部切口均I期愈合,脐部无可见手术瘢痕,术后随访3～27个月,无胆道损伤、胆囊床感染、出血等相关并发症发生。结论:经脐单孔腹腔镜手术安全可行,具有疼痛更轻、微创及美容效果更好等优点,是现阶段最具可行性的"No scar"技术。     

Single-port access in laparoscopic cholecystectomy

Background  Single-port access cholecystectomy is a new laparoscopic procedure using only one, transumbilical-placed port. The method has been denominated by some authors as “scarless.” We report one of the initial clinical experiences in Europe with this new technique. Methods  Fourteen patients underwent laparoscopic cholecystectomy using the ASC TriPort. In all cases, a small transumbilical incision was used to insert two 5-mm rigid laparoscopic instruments and a 5-mm 30° telescope via the Triport. Hemostasis control was obtained by using an ultrasonic cutting device (SonoSurg, Olympus), Endo Clips (Covidien), and Lapro-Clips (Covidien). Results  All cases were completed successfully. There were no perioperative port-related or surgical complications. No extra skin incisions were needed. Operative time was longer than in common laparoscopic cholecystectomy. Conclusions  Transumbilical single-port access cholecystectomy (SPACE) is a feasible technique for operating with less scars and reducing postoperative discomfort at the same time. The transumbilical single-port access for laparoscopic cholecystectomy has multiple benefits, such as better cosmetic results, less wound infections, and less incisional hernias. That is why SPACE is even more appropriate for obese patients. Using one-hand specialized instruments, which are curved at the shaft, and a semiflexible laparoscopic camera (LTFVH, Olympus) will make SPACE more comfortable and more time-saving.     

“吊线法”经脐单孔腹腔镜胆囊切除术120例报告

目的:探讨"吊线法"经脐单孔腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的可行性、安全性、经济性及美容性。方法:回顾分析120例"吊线法"经脐单孔腹腔镜胆囊切除术的临床资料,术中均使用普通腹腔镜器械。结果:116例手术获得成功,成功率96.7%,3例因胆囊三角解剖不清、1例因术中胆囊动脉出血中转为两孔法LC。手术时间30~110 min,平均(52.39±11.74)min。术中出血量10~80 ml,平均(17.71±8.30)ml。术中均未放置腹腔引流管。术后均无出血、胆管损伤、胆漏、胆管狭窄及脐疝等并发症发生。脐部切口小且隐蔽,美容效果满意,几乎无瘢痕。结论:"吊线法"经脐单孔LC是经济、安全、可行的手术方法,美容效果明显。对于初学者而言,应严格把握手术适应证,明确手术关键步骤,术中准确辨认解剖标志及解剖间隙,以提高手术的成功率及安全性,缩短学习曲线。术中将患者的安全放在首位,解剖层次不清、炎症较重、操作困难时应及时中转开放手术。     

Incisional hernia after open versus laparoscopic sigmoid resection

Background  Incisional hernia after open surgery is a well-known complication with an incidence of up to 20% after a 10-year period. Data regarding the long-term hernia risk after laparoscopic colonic surgery are lacking in the literature. In the present study we compared the long-term hernia incidence after laparoscopic versus open sigmoid resection. Methods  The study included patients undergoing laparoscopic sigmoid resection in the period January 1995 to December 2004 in the eastern part of Denmark. This group was matched with a consecutive group of patients undergoing open surgery in our department in the same period. Patients were contacted by telephone, and a questionnaire was completed for each patient. If the patient was believed to have a hernia or if there was any suspicion of a hernia, a consultant surgeon examined the patient and completed the questionnaire. Factors related to the primary operation, the hernia and general risk factors were registered for all patients. Results  A total of 201 patients answered the questionnaire (95.3%). The laparoscopy group was comprised of 58 patients and 143 patients were included in the laparotomy group. The patients had a median follow-up of 4.6 years (range 2.4–11.7 years) and 4.9 years (range 2.4–8.5 years) after laparoscopic and open surgery, respectively (P = 0.326). Incisional hernia was found in two of 58 patients (3.4%, 95% CI -1.4–7.4) in the laparoscopic surgery group compared with 21 of 143 patients (14.7%, 95% CI 8.9–20.5) in the open surgery group (P = 0.026). There were no significant differences in demographic data or the occurrence of risk factors between the two groups. Conclusion  Laparoscopic sigmoid resection leads to a significantly lower incidence of incisional hernia compared with the open surgical technique.     

Single-Incision Sleeve Gastrectomy Using a Novel Technique for Liver Retraction

Introduction:Laparoscopic sleeve gastrectomy has rapidly gained popularity in the field of bariatric surgery, mainly due to its low morbidity and mortality. Traditionally, 4 to 6 trocars are used. Single-access surgery has emerged as an attempt to decrease incisional morbidity and enhance cosmetic benefits. We present our initial 7 patients undergoing single-incision laparoscopic sleeve gastrectomy using a novel technique for liver retraction.Methods:Patients who underwent single-incision laparoscopic sleeve gastrectomy between March 2009 and May 2009 were analyzed. A 4-cm left paramedian incision was used. Laparoscopic sleeve gastrectomy was performed in a standard fashion using a 40 French bougie.Results:Seven patients underwent single-incision sleeve gastrectomy at the University of Illinois at Chicago. They were all female with a mean age of 34 years. Preoperative BMI was 49kg/m² (range, 39 to 64). There were no intraoperative complications. Mean operative time was 103 minutes. Estimated blood loss was minimal. All 7 patients were discharged on postoperative day 2 and were doing well without any complications at 3.1±0.7 months after surgery.Conclusion:Single-incision laparoscopic sleeve gastrectomy is safe and feasible and can be performed without changing the existing principles of the procedure. Our technique for internal liver retraction provides adequate exposure and is reproducible. Development of improved standard instrumentation is required for this technique to become popular.     

Laparoscopic vs open inguinal hernia repair

Background: The role of laparoscopic inguinal hernia repair is controversial. The aim of this study was to find out whether it is justified to switch from the predominantly modified Bassini repair which the authors had been using to laparoscopic repair. Methods: Randomized controlled trial in 120 eligible patients admitted for elective hernia repair in a university hospital. Results: Sixty patients underwent laparoscopic transabdominal preperitoneal mesh repair; the other 60 patients had an open repair, mostly with the modified Bassini technique. Operative time for laparoscopic repair was significantly longer, mean (s.d.) 95 (28) min vs 67 (27) min (p < 0.001). The mean analogue pain score during the first 24 h after surgery was 36.2 (20.2) in the laparoscopic group and 49.3 (24.9) in the open group (p= 0.006). The requirement for narcotic injections and postoperative disability in walking 10 m and getting out of bed were also significantly less following laparoscopic repair. The postoperative hospital stay was not significantly different, mean 2.6 (1.2) days for laparoscopic repair and 3.0 (1.5) days for open repair (p= 0.1). Patients were able to perform light activities without pain or discomfort sooner after laparoscopic repair, median interquartile range 8 (5–14) days vs 14 (8–19) days (p= 0.013). Patients also resumed heavy activities sooner, but not significantly, after laparoscopic repair, median 28 (17–60) days vs 35 (20–56) days (p= 0.25). The return to work was not significantly different, median 14 (8–25) days after laparoscopic repair and 15 (11–21) days after open repair (p= 0.14). After a mean follow-up of 32 months one patient developed a recurrent hernia 3 months after a laparoscopic repair. Laparoscopic repair was more costly than open repair by approximately $400. Conclusions. Laparoscopic inguinal hernia repair was associated with less early postoperative pain and disability and earlier return to full activities than open repair, but there were no benefits regarding postoperative hospital stay and return to work; laparoscopic repair was also more costly. Received: 23 May 1997/Accepted: 1 August 1997     

Single-Incision Laparoscopic Surgery Versus Standard Laparoscopic Surgery for Unroofing of Hepatic Cysts

Background and Objectives:

The aim of this report is to document the feasibility and safety of umbilical single-incision laparoscopic liver cyst unroofing in the treatment of simple hepatic cysts in a retrospective case-control study. We also introduce some operative skills for single-incision laparoscopic surgery.

Methods:

From May 2009 to July 2011, 15 patients underwent umbilical single-incision laparoscopic liver cyst unroofing. All the clinical data were retrospectively analyzed. Another 15 simple liver cyst patients who received standard laparoscopic liver cyst unroofing at our hospital during the same period—with a similar age, nature of the cyst, and position to the single-incision group—were selected to undergo a case-control study. The operative time, blood loss, recovery time of gastrointestinal function, volume of postoperative drainage, postoperative drainage time, postoperative hospitalization time, and postoperative recurrence rate were compared between the two groups.

Results:

There was no significant difference between the single-incision group and standard group in operative time (58.3 ± 7.43 minutes vs 58.7 ± 6.14 minutes), blood loss (17.0 ± 3.19 mL vs 14.7 ± 1.86 mL), recovery time of gastrointestinal function (2.5 ± 0.22 days vs 2.4 ± 0.22 days), volume of postoperative drainage (408.0 ± 119.5 mL vs 450.0 ± 89.5 mL), postoperative drainage time (2.6 ± 0.55 days vs 3.7 ± 0.59 days), or postoperative hospitalization time (4.8 ± 0.44 days vs 5.2 ± 0.56 days) (P > .05). The postoperative follow-up period was 1 to 24 months.

Conclusions:

Compared with standard laparoscopic liver cyst unroofing, single-incision laparoscopic liver cyst unroofing shows no significant difference during the overall treatment process. In addition to the advantages of less trauma, more rapid recovery, and shorter hospital stay, single-incision laparoscopic surgery can reach the effect of “no scar” and can be safely and effectively carried out.     

经脐单孔腹腔镜阴式肾切除术2例报告并文献复习

目的：报告经脐单孔腹腔镜阴式肾切除术的经验与体会,初步探讨其临床应用价值.方法：1例右侧输尿管上段结石并右肾重度积水、右肾无功能和1例左侧输尿管下段结石并左肾重度积水、左肾无功能患者均行经脐单孔腹腔镜阴式肾切除术.患者取截石位,患侧腰部垫高,取脐缘弧形切口长约3 cm,分别置入Trocar及腹腔镜、操作器械.按照普通腹腔镜方法,充分游离肾脏后将其完整切除,装入自制标本袋,于阴道后穹窿分别切开长约3 cm、4 cm切口,将标本自阴道取出.结果：2例手术均顺利完成,手术时间分别为160 min、260 min,术中失血量分别为150 ml、280 ml.均于术后第1天下床活动.例1于术后第2天肛门通气并进饮食,术后腹腔引流管引出淡红色液体较少,术后第6天尤液体引出予拔除;术后第7天脐部切口拆线痊愈出院.例2术后肠道功能恢复延迟,腹胀.经对症治疗于术后第11天肛门通气并进饮食;术后第12天拔除腹腔引流管并拆线痊愈出院.脐部切口均不明显,阴道切口愈合良好.结论：对有手术指征的患者行经脐单孔腹腔镜阴式肾切除术,脐部切口术后恢复后被周围的皱褶所遮蔽,美容效果良好,且能有效预防脐部切口疝形成,值得临床选用.     

Preliminary Surgical Results of Single-Incision Transumbilical Laparoscopic Bariatric Surgery

Background  

Recently, single-incision laparoscopic surgery (SILS) has been used for bariatric procedures, and this surgery is considered a type of minimally invasive surgery. When SILS is performed via the transumbilical route, the resultant abdominal wound is hidden and the cosmetic outcome is better. However, because of the small angle of manipulation and difficulty in liver traction, this technique is not used to perform complex bariatric surgery. In this prospective study, we used our novel technique, which involves the use of a liver-suspension tape and umbilicoplasty of an omega-shaped incision (omega umbilicoplasty), to perform laparoscopic bariatric surgery via the single-incision transumbilical (SITU) approach. We then assessed the safety and effectiveness of our surgical technique.     

Transumbilical single-port laparoscopic cholecystectomy

Background  Many laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. We performed transumbilical single-port laparoscopic cholecystectomy (TUSPLC) in 15 patients with cholelithiasis by using a special “single-port” with virtually no scar. Methods  We used an extra-small wound retractor and a surgical glove as the “single-port.” The wound retractor was set up through the small umbilical incision and the surgical glove attached with one trocar and two pipes was then fixed to the outer ring of the wound retractor. The commonly used trocar and two slim pipes attached to the surgical glove served as three working channels. Using this single-port and conventional laparoscopic instruments, such as a straight 5-mm dissector, grasper, scissors, and a 30-degree 5-mm rigid laparoscope, we performed TUSPLC in 15 patients with cholelithiasis. The overall procedure was similar to three-port laparoscopic cholecystectomy. Results  Fifteen well-selected patients with cholelithiasis underwent TUSPLC (4 males and 11 females; mean age, 39 (range, 29–63) years). Body mass index ranged from 20 to 34 (mean, 25.2). No case required extra-umbilical skin incisions or conversion to standard laparoscopy. The mean operative time was 79 (range, 35–165) min. Blood loss was minimal in all cases. The mean postoperative hospital stay was 1.6 (range, 1.0–2.5) days. No postoperative complications were observed. Conclusions  The results of our initial experience of TUSPLC in 15 well-selected patients with cholelithiasis are encouraging. All procedures were completed successfully within a reasonable time. No extra-umbilical incisions were used and virtually no scar remained. TUSPLC could be a promising alternative method for the treatment of some patients with symptomatic gallstone disease as scarless abdominal surgery.