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J Korean Med Assoc > Volume 53(9); 2010 > Article
Lee: Single port laparoscopic surgery

Abstract

Minimally invasive surgery and laparoscopic surgery have been used for more than 30 years, and are now popular even for some malignant diseases. There have been two developments in technology; one is robotic surgery and the other is less minimally invasive surgery like natural orifice transluminal endoscopic surgery (NOTES) and single port laparoscopic surgery. NOTES, using the current platform of a conventional fiberscope and side channel instruments for surgery, suffers many limitations, including image quality, flexibility of the fiberscope, size of the side channel, and difficulty of closing the opening. Due to the above-mentioned limitations, single port laparoscopic surgery has many advantages over. This review aims to define single port laparoscopic surgery and describe its terminology and technology. To perform single port laparoscopic surgery efficiently, new instruments (e.g., a laparoscopic camera, ports, laparoscopic instruments) and combining other innovative methods into surgery are both helpful. Even though there have been many developments in laparoscopic cameras, ports, and laparoscopic instruments to enhance single port laparoscopic surgery, further improvements are needed. Motorized instruments or using a robotic platform in combination with single port laparoscopic surgery will be another way to overcome the limitations of current single port laparoscopic surgery. Single port laparoscopic surgery is a technique that has recently emerged, but will be performed in a wider range of surgical procedures based on developments in laparoscopic cameras, ports and laparoscopic instrument technology.

References

1. Kalloo AN, Singh VK, Jagannath SB, Niiyama H, Hill SL, Vaughn CA, Magee CA, Kantsevoy SV. Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointes Endosc 2004;60:114-117.

2. Kim HJ, Lee JI, Lee YS, Kang WK, Lee SK, You YK, Oh ST. A case of single port laparoscopic appendectomy and cholecystectomy in a fresh cadaver: A feasible procedure. J Korean Soc Coloproctol 2009;25:59-62.

3. Jung YW, Kim SW, Kim YT. Recent advances of robotic surgery and single port laparoscopy in gynecologic oncology. J Gynecol Oncol 2009;20:137-144.

4. Goel RK, Kaouk JH. Single port access renal cryoablation (SPARC): a new approach. Eur Urol 2008;53:1204-1209.

Figure 1
Picture of 45 cm 45° angled bariatric length laparoscope with right angle light cable adapter and Instrument (upper) and 34 cm Standard 45° angled laparoscope and instrument.
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Figure 2
Picture of making Glove port with Wound retracter and globe and conventional trocars (A, B, C) and (D) Outside view of single port laparoscopic cholecystectomy.
jkma-53-793-g002-l.jpg
Figure 3
Picture of OCTO™ Port (Dalim SurgNET Corp, Korea: www.octo-port.com/).
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Figure 4
Picture of TriPort™ (ASC port, Olympus: www.advancedsurgical.ie/).
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Figure 5
Picture of SILS™ Port (Covidien Inc, Norwalk, CT, USA: www.sils.com).
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Figure 6
Uni-X™ Single Port Access with three working channels (Pnavel System, Inc).
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Figure 7
Picture of AirSeal™ Port and Insufflator (SurgiQuest, Orange, CT, USA: www.surgiquest.com).
jkma-53-793-g007-l.jpg
Figure 8
Picture of Glove Port (Nelis, Seoul, Korea).
jkma-53-793-g008-l.jpg
Figure 9
(A) Picture of outer view during Single Port Laparoscopic Cholecystectomy using Glove port with 45°, 45 cm bariatric laparoscope and two 45 cm long instrument for retraction of GB fundus and Hartman's pouch and one Laparoangle instrument for dissection. (B) Picture of inner view during same operation.
jkma-53-793-g009-l.jpg
Figure 10
Picture of Roticulator™ (Covidien, Norwalk, CT, USA : www.sils.com).
jkma-53-793-g010-l.jpg
Figure 11
(A) Picture of Handle of Autonomy Laparoangle and (B) Picture of Slim Handle Model for Single Port Laparoscopic Surgery (CambridgeEndo, MA, USA: www.cambridgeendo.com).
jkma-53-793-g011-l.jpg
Figure 12
Picture of Realhand (Novare Surgical, CA, USA: www.novaresurgical.com) idgeEndo, MA, USA: www.cambridgeendo.com).
jkma-53-793-g012-l.jpg
Figure 13
HiQ LS curved 5 mm Hand Instruments (Olympus, Japan; www.olympus-global.com/en/news/2009b/nr091013lesse.html).
jkma-53-793-g013-l.jpg
Table 1
The acronyms single port laparoscopic surgery
jkma-53-793-i001-l.jpg

a)NOTES: Natural Orifice Transluminal Endoscopic Surgery

Table 2
Common problems of single port laparoscopic surgery
jkma-53-793-i002-l.jpg
Table 3
Technical tip of using instrument for easy single port laparoscopic surgery
jkma-53-793-i003-l.jpg


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