Single Hole Surgery For Gall Bladder Stones - Other Procedure
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Single port laparoscopy
From Wikipedia, the free encyclopedia

Single port laparoscopy (SPL), also known as single port access surgery (SPA), single port incisionless conventional equipment-
utilizing surgery (SPICES), single incision laparoscopic surgery (SILS), Single access endoscopic surgery (SAES), laparo-
endoscopic single-site surgery (LESS), natural orifice transumbilical surgery (NOTUS), and one port umbilical surgery (OPUS), is a
recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates
almost exclusively through a single entry point, typically the patient’s navel. Unlike a traditional multi-port laparoscopic approach,
SPL leaves only a single small scar.

  1 Technique and equipment
  2 Applications
  3 Risks and benefits
  4 History
  5 See also
  6 References

Technique and equipment

SPL is accomplished through a single 20 mm incision in the navel (umbilicus or belly button),[1] minimizing the scarring and
incisional pain associated with the multiple points of entry used during traditional laparoscopic surgery.[2]

Specialized equipment for SPL surgery falls into two broad categories; access ports and hand instruments. There are a number of
different access ports including GelPOINT system from Applied Medical, the SILS device from Covidien, the TriPort+, TriPort15 and
QuadPort+ a from Advanced Surgical Concepts and the Uni-X from Pnavel. Hand instruments come in two configurations - standard
or articulating. Standard hand instruments are rigid in design and were developed over the last 30 years for use in laparoscopy.
Articulation is designed to overcome one of the challenges inherent in SPL, decreased triangulation of instrument. A number of
factors influence a surgeon's decision to use standard or articulating hand instruments including which access port they use, their
own surgical skills and cost as articulating instruments are significantly more expensive than standard instruments.[citation needed]
SPL is enhanced by the use of specialized medical devices such as the SILS Multiple Instrument Access Port manufactured by
Covidien and Laparo-Angle Articulating Instruments made by Cambridge Endoscopic Devices, Inc. The flexible port that can be
fitted through a small incision in the navel to allow surgeons to use up to three laparoscopic devices simultaneously. Certain
articulating instruments can be inserted through such specialized ports, providing surgeons with manueverability and access to the
target tissue from a single access point.[3]

The SPL technique has been used to perform many types of surgery, including adjustable gastric banding,[4] appendectomy,[5]
cholecystectomy,[6][7] colectomy,[8] hernia repair,[9] hysterectomy,[10] sleeve gastrectomy,[11] nephrectomy,[12][13] and
sacrocolpopexy.[14] SPL has been employed by surgeons at Cleveland Clinic for clinical trials[14] and in the Geneva University
Hospital in Switzerland.[7][8] Although a number of single incision techniques use specialized instrumentation, most SPL operations
in the United States and Europe have used standard instrumentation.[15]
Risks and benefits

When compared with traditional multi-port laparoscopic techniques, benefits of SPL techniques include less postoperative pain,
less blood loss, faster recovery time, and better cosmetic results.[citation needed] Despite the potential advantages of SPL
techniques, there may also be complications. Potential complications include significant postoperative pain, injury to organs,
bleeding, infection, incisional hernia, intestinal adhesions and scarring.[16]

The first documented procedures of significance occurred in the late 1990s.[17][18][19][20] This approach has recently seen more
publicity and excitement as surgeons continue to develop techniques to evolve surgery to less invasive approaches. The first
described SPL procedure was a gallbladder removal in 1997. Since that time, thousands of SPL procedures have been
successfully performed in the United States, from general surgery to urologic, gynecologic and bariatric surgery applications.[21]
See also

  Natural orifice translumenal endoscopic surgery


  ^ Raman JD, Cadeddu JA, Rao P, Rane A (2008). "Single-incision laparoscopic surgery: initial urological experience and
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x. PMID 18325059.
  ^ "UCSF Surgeons Perform First Single-Incision Gallbladder Removal". Emax Health. 2009-06-06. Retrieved 2011-07-23.
  ^ "Hartford Business". Retrieved 2011-07-23.
  ^ Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008). "Single laparoscopic incision transabdominal (SLIT) surgery-adjustable
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  ^ Ates O, Hakguder G, Olguner M, Akgur FM (2007). "Single-port laparoscopic appendectomy conducted intracorporeally with the
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  ^ Tacchino R, Greco F, Matera D (2009). "Single-incision laparoscopic cholecystectomy: surgery without a visible scar". Surgical
Endoscopy 23 (4): 896–9. DOI:10.1007/s00464-008-0147-y. PMID 18815836.
  ^ a b Bucher P, Pugin P et al. (2009). "Single Port Access Laparoscopic Cholecystectomy (with video)". World J Surgery 33 (5):
1015–9. DOI:10.1007/s00268-008-9874-4. PMID 19116734.
  ^ a b Bucher P, Pugin P, Ph Morel (2008). "Single port access laparoscopic right hemicolectomy". Int J Colorectal Dis 23 (10):
1013–6. DOI:10.1007/s00384-008-0519-8. PMID 18607608.
  ^ Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M (2009). "Single-incision laparoscopic surgery (SILS) for totally
extraperitoneal (TEP) inguinal hernia repair: first case". Surgical Endoscopy 23 (4): 920–1. DOI:10.1007/s00464-008-0318-x. PMID
  ^ "Healthcare Sales & Marketing Network News: Novare's Line of Articulating Surgical Tools Allow Full Mobility for 'Keyhole'
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  ^ Saber AA, Elgamal MH, Itawi EA, Rao AJ (2008). "Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique".
Obesity Surgery 18 (10): 1338–42. DOI:10.1007/s11695-008-9646-0. PMID 18688685.
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