Single port access surgery

Single Port Access (SPA^TM) surgery, also known as Single Incision Laparoscopic Surgery (SILS^TM) or One Port Umbilical Surgery (OPUS) or Natural Orifice TransUmbilical Surgery (NOTUS), is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anesthesia, insufflated and laparoscopic visualization is utilized.

SPA was adopted by surgeons in Cleveland Clinic for clinical trialsCite web|url=http://www.ncbi.nlm.nih.gov/pubmed/18242353|title=Initial experience in single port surgery|accessdate=2008-06-29] . SPA surgery can be done with standard instrumentation. Although a number of other single incision techniques use new instrumentation, most of the SPA surgeries so far in the USA have used standard instrumentation [http://drexelmed.edu/About/NewsandAnnouncements/tabid/134/ctl/Details/mid/471/ItemID/129/Default.aspx34/ctl/Details/mid/471/ItemID/82/Default.aspx News and Announcements ] ] . The SPA technique has been used to perform various surgeries like cholecystectomy, nephrectomy, [ [http://www.biospace.com/news_story.aspx?NewsEntityId=67739 Novare Surgical Systems, Inc. Announces First Ever Single Port Laparoscopic Kidney Removal (Nephrectomy) Using RealHand(TM) HD Instruments - News, Search Jobs, Events ] ] appendectomy, hysterectomy, [ [http://salesandmarketingnetwork.com/news_release.php?ID=2009130 Healthcare Sales & Marketing Network News: Novare's Line of Articulating Surgical Tools Allow Full Mobility for 'Keyhole' Hysterectomy ] ] oophorectomy, adrenalectomy, gastric bypass, nissen fundoplication, hernia repair, splenectomy, colon resection, liver resection, cryoablation, and more. Since the entire surgery is performed through the navel, it does not leave any visible scar like a traditional multi-port laparoscopic approach. Surgeons employing this technique contend that patients should benefit from less post-operative pain, less blood loss, faster recovery time, fewer complications, and better cosmetic results.

Although these claims of "the first" procedures come from Drexel University, references in the literature indicate procedures have been reported as early as 1997. In fact, although the Espiosito report was published in 1998, the data and procedures were performed from 1994-1995, a full 12 years prior to the "Drexel Firsts". [Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997 May; 84(5):695] [Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc. 1998 Feb;12(2):177-8.] [Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 1999; 9:361-364] [Bresadola F., Pasetto A., et al Elective Transumbilical Compared with Standard Laparoscopic Cholecystectomy. European J of Surg. 1999 Feb; 165(1): 29-34(6)] In contrast to these ealier procedures, the procedures performed at Drexel University have been accomplished entirely through the umbilicus without the need for additional transabdominal sutures or suture traction placed through the gallbladder or through other sites in the abdominal wall as many of these prior reported procedures have required.

Although SPA surgery is through one incision, no new instruments are necessary for SPA surgery. This has been demonstrated in surgery of the esophagus, stomach, liver, colon, hysterectomy, ovaries and gallbladder just to mention a fewFact|date=July 2008. A number of procedures e.g. nissen fundoplication for which other single incision approaches (ie not SPA surgery) may have been too difficult in the past, have since become possible for the other majority surgeons that do require new devices and instruments. Since some of these other procedures are through one incision, the instruments differ from those for minimally invasive surgery. The instruments for some single port/incision procedures have to be curved and flexible to accommodate for the space restriction and the range of motion. The two main components for these instrumentation are the port and the surgical instruments. The port holds open the incision and provides an air tight environment for the graspers and scope. Two companies that manufacture these ports are Advanced Surgical Concepts, who makes the R-port, and Pnavel Systems, who makes Uni-x. Two companies that manufacture the surgical instruments are Novare Surgical, who makes RealHand and Cambridge Endo, who makes Autonomy Laparo-Angle.

References

See also

* Laparoscopic surgery
* Adjustable gastric band
* Natural orifice transluminal endoscopic surgery

External links

* [http://www.drexelmed.edu/SPAsurgery Single Port Access (SPA^TM) surgery information, Drexel University College of Medicine]
* [http://www.cambridgeendo.com/ Laparoscopic Articulating Hand-held Instruments]
* [http://pnavel.com/doctors.html Physician information on Single Port Laparoscopy]
* [http://www.novaresurgical.com/patients/single-port-surgery/ Single Port Access Technique and Technology] http://www.advancedsurgical.ie http://www.understandsingleportsurgery.com