Single Access Disposable Endoscopic Surgery For Laparoscopy Surgery

Disposable Single-access endoscopic surgery for Laparoscopy surgery

Introduction

Laparoscopic surgery has become the standard of care for many abdominal and pelvic surgeries. Several studies have proved that the laparoscopic approach to various benign and malignant conditions has resulted in decreased morbidity, shorter hospital stay, improved surgical outcomes, and improved quality of life when compared with conventional surgeries. Although laparoscopy has decreased the morbidity directly related to a surgical approach, each working port carries an inherent risk of bleeding, infection, concomitant organ damage, hernia formation, and decreased cosmetic outcome. Advances in surgical instrumentation and design have allowed minimal-access surgery to become even more minimal.

One of the more recent advances in the field of minimally invasive surgery is the increasing use of single-incision laparoscopic surgery (SILS) in various gynecologic procedures. SILS is an advanced minimally invasive approach that allows laparoscopic surgery through a single incision in the umbilicus, the preexisting scar. By using a single multichannel port access system, SILS is an attempt to further enhance the cosmetic benefits of minimally invasive surgery while minimizing the potential risks and morbidity associated with multiple working ports. Data from the general surgery and urology literature have demonstrated technical feasibility and reproducibility of this technique when used for a variety of procedures, including cholecystectomy, appendectomy, nephrectomy, and hemicolectomy.These early reports from urology, surgery, and oncology studies designate that SILS is a potential surgical innovation that not only has aesthetic superiority, but also leads to decreased postoperative morbidity, early convalescence, and decreased postoperative analgesia requirements when compared with conventional laparoscopic approaches.

Advantages and Indications

Beyond the obvious better cosmetic results, advantages of LESS include reduced postoperative pain, reduced operative complications related to trocar insertion (e.g. wound infections, epigastric vessel injury and organ herniation), and easier specimen removal through a larger incision (specimens may be fragmented in the laparoscopic bag). Those benefits are especially relevant in pediatric and young populations in whom the esthetic outcome is crucial.

Application

Almost all body cavities can be entered through a small skin incision, therefore, the theoretical applications of LESS seem to be unlimited. However in a practical way, this statement is not entirely correct. Although LESS has successfully been proved for almost all diagnostic, extirpative and reconstructive surgery, there are limitations inherent to patient selection, surgical skills of the team, operative time, setup of the operating room, and availability of devices. In urology, LESS has been principally described for renal, ureteral, and prostatic surgery. In the most specialized centers it is now used for adrenal, bladder and testicular minimally invasive surgery as well. Despite the slower introduction of LESS in the pediatric population, today various LESS procedures have been described in pediatric urology with apparently good results.Nephrectomy for nonfunctioning kidney is a good example.

Another usual application of LESS in pediatric urology is varicocelectomy.As reported three consecutive adolescent patients who underwent transumbilical varicocelectomy without lacement of any additional ports or conversion to open surgery. The mean operative duration was < 1 h and all patients were discharged on the same day as their surgery and none required rehospitalization. There was no varicocele recurrence, or intraoperative or postoperative complications including

wound infection, hydrocele, or incision site herniation.