Page 45 - World Journal of Laparoscopic Surgery

Single Port Endolaparoscopic Surgery (SPES) in Double Abdominal Procedures

In our experience, the most important aspect in a double procedure creates and if difficulty arises another
performing single port surgery for double procedures is the port can always be added to ease the operation.
placement of the port. The port must be situated in a position
that provides maximal access to both procedures by REFERENCES
providing an optimal view of the surgical working field,
1. Mühe E Die Erste. Cholecystecktomie durch das laparpskop.
maintaining adequate instrument triangulation and give a (The first laparoscopic cholecystectomy). Langenbecks Arch
suitable ergonomic position for the surgeon. The first case Surg 1986;369:804.
was approached through the umbilicus as both the hernia 2. Lau WY, Lew CK, Li AK. History of endoscopic and
repair and the gastric wedge resection was accessed by a laparoscopic surgery. World J Surg 1987;21:444-53.
simple change in the surgeon’s position. A supraumbilical 3. Mouret P. Celioscopie surgery, Evolution and revolution.
Chirurgie 1990;116(10):829-32.
incision was done for the second case as we wanted our
4. Cheah WK, Lenzi JE, So JBY. Randomized trial of needlescopic
instruments to reach left hemidiaphragm and still maintain vs laparoscopic cholecystectomy. Br J Surg 2001;88(1):
adequate access to the gallbladder. For the third case, placing 45-47.
the port in the the left lower quadrant along the midclavicular 5. Cabral PH, Silva IT, Melo JV, Gimenez FS, Cabral CR, Lima
line provided maintained the triangulation of instruments AP. Needlescopic versus laparoscopic cholecystectomy.
A prospective study of 60 patients. Acta Cir Bras 2008;23(6):
for manipulating the left ovary at the same time does not
543-50.
compromise the working area for the right lower quadrant 6. Sajid MS, Khan MA, Cheek E, Baig MK. Needlescopic versus
incisional hernia. laparoscopic appendectomy: A systematic review. Can J Surg
Choosing which procedure to do first is another factor 2009;52(2):129-34.
to take into consideration. In the first and third case, the 7. Sajid MS, Khan MA, Ray K, Cheek E, Baig MK. Needlescopic
versus laparoscopic cholecystectomy: A meta-analysis. ANZ J
first procedure was chosen based on the technical ease of
Surg 2009;79(6):437-42.
the operation as compared with the second procedure. For 8. Carvalho GL, Silva FW, Silva JS, de Albuquerque PP, Coelho
the second case, cholecystectomy was done first because Rde M, Vilaça TG, Lacerda CM. Needlescopic clipless
any spillage of bile that occurred would affect the decision cholecystectomy as an efficient, safe, and cost-effective
to place a mesh on the diaphragmatic defect. alternative with diminutive scars: The first 1000 cases. Surg
With regards to the instruments, articulating instruments Laparosc Endosc Percutan Tech 2009;19(5):368-72.
9. Langweiler T, Nimmesgern T, Back M. Single-port access
provided the triangulation needed in terms of retraction. In
laparoscopic cholecystectomy. Surg Endosc 2009;23:1138-41.
cholecystectomy, the Roticulator™ grasper was useful in 10. Agrawal S, Shaw A, Soon Y (2009) Single-port laparoscopic
retraction of the Hartmann’s pouch of the gallbladder while totally extraperitoneal inguinal hernia repair with the Triport
16
the fundus was retracted with sutures. Regarding optics, system: Initial experience. Surg Endosc DOI 10.1007/s00464-
a rigid 5 mm 30º scope (Endoeye™, Olympus, Tokyo, 009-0663-4, Sep 3, 2009.
11. Desai M, Aron M, Canes D. Single-port transvesical simple
Japan) was our preference because the light cable is situated
prostatectomy: Initial clinical report. Urology 2008;72(5):
at the end of the camera head and not on top which eliminates 960-65.
clashing of instruments. 12. Remzi F, Kirat H, Kaouk J. Single-port laparoscopy in colorectal
The complication encountered was a small laceration surgery. Colorectal Dis 2008;10(8):823-26.
on the liver that was experienced while suturing the fundus 13. Romanelli J, Earle D. Single port laparoscopic surgery: An
of the gallbladder for retraction and was controlled with overview. Surg Endosc 2009;23(7):1419-27.
14. Yasuda K, Kitano S. Single Incision Laparoscopic Surgery:
cauterization. An additional 5 mm port was placed due to
Review of the literature and our initial experience. Asian J Endo
the increased triangulation needed to suture the diaphragmatic Surg 2009;2:29-35.
defect. 15. Romanelli J, Mark L, Omotosho P. Single port laparoscopic
cholecystectomy with the Triport system: A case report. Surg
CONCLUSION Innov 2008;15:223-28.
16. Lomanto D, De Angelis L, Ceci V. Two-trocar laparoscopic
SPES is a feasible and safe technique for approaching double cholecystectomy: A reproducible technique. Surg Laparosc
procedures. It drastically reduces the number of scars that Endosc Percutan Tech 2001;11(4):248-51.

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