Page 43 - World Journal of Laparoscopic Surgery

WJOLS
Single Port Endolaparoscopic Surgery (SPES) in Double Abdominal Procedures
ORIGINAL ARTICLE
Single Port Endolaparoscopic Surgery (SPES) in

Double Abdominal Procedures

Michael M Lawenko, Javier Lopez-Gutierrez, Alembert Lee-Ong, Davide Lomanto

Minimally Invasive Surgical Center, Department of Surgery, National University Health System, Singapore
Correspondence: Davide Lomanto, Director, Minimally Invasive Center, Department of Surgery, National University Health
System, 5 Lower Kent Ridge Road, Singapore-119074, Phone: +6567722897, Fax: +6567746077, e-mail: surdl@nus.edu.sg

Abstract
Background: Single port endolaparoscopic Surgery (SPES) has gained enthusiasm in the surgical community because of the perceived
better postoperative outcome, namely a single incision. We write this prospective observational study to ascertain the feasibility and
safety of this technique in patients needing two operations.
Methodology: Three patients who underwent double procedures each. Case 1: Transabdominal preperitoneal hernia repair with gastric
wedge resection. Case 2: Cholecystectomy with diaphragmatic hernia repair. Case 3: Oophorectomy with incisional hernia repair.
Patient demographics, type of port used, operating time, complications and scar length were collected.
Results: Operating time for the first case was 250, 210 and 105 minutes respectively. Incision length varied from 2 to 3 cm. Addition of
a 5 mm port and an intraoperative complication of a laceration of the liver after suturing of the gallbladder fundus was noted in the second
case.
Conclusion: SPES is a feasible and safe technique for approaching double procedures. It drastically reduces the number of scars that
a double procedure creates and if difficulty arises another port can always be added to ease the operation.

INTRODUCTION the feasibility and safety of doing two abdominal operations
1-3
Since the first laparoscopic cholecystectomy more than using a single entry.
two decades ago, laparoscopic surgery has evolved from
MATERIALS AND METHODS
basic procedure to most advanced surgical operations. This
is a result of the better clinical outcome compared to
From May to November 2009, three patients underwent
conventional surgery. The success of many procedures like
double abdominal procedures. Informed consent was taken
cholecystectomy, GERD surgery, obesity surgery and more
explaining the possible risk of conversion to conventional
has been driven because of the shorter hospital stay, better
laparoscopy. Data regarding patient demographics, type of
cosmesis and less pain, becoming a gold standard approach
operation, operating time, complications, postoperative pain
for many of them. Subsequently, Laparoscopic surgery has
score was collected.
also evolved by minimizing the size of the wound with the
use of mini-instruments called minilaparoscopic surgery or Case 1: 56 years old male with a 5 × 4 cm gastrointestinal
needlescopic surgery. Several studies showed that stromal tumor (GIST) at the posterior gastric wall near the
procedures with mini-intrumentations were feasible, with lesser curvature and a right indirect inguinal hernia. The
lesser postoperative pain and smaller scar compared to single port device (SILS™, Covidien, Norwalk, USA) was
standard laparoscopic surgery 4-8 but the worldwide inserted through a 2 cm transumbilical incision. Hernia repair
acceptance of this technique was not achieved as expected. was first done using the transabdominal preperitoneal
The advent of single port endolaparoscopic surgery approach (TAPP). The peritoneal flap was created using
(SPES) in the last year seems to address this issue but more articulated instruments (Roticulator™, Covidien, Norwalk,
clinical studies are needed to prove these endpoints. To our USA) and straight conventional graspers and scissors. A
knowledge there is no report yet for single port surgery 15 × 10 cm lightweight polyester mesh (Parietene™,
being done for two abdominal procedures. Covidien, Norwalk, USA) covered the myopectenial orifice
We report our experience in using SPES in patients and fixation with nonabsorbable tackers (Protack™,
undergoing double procedures with the aim of assessing Covidien, Norwalk USA) at the Cooper’s ligament. The

World Journal of Laparoscopic Surgery, January-April 2010;3(1):45-47 45