Reduced-port robotic anterior resection for left-sided colon cancer using the Da Vinci single-site®platform

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Abstract

Single-Site(®) port plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colorectal cancer, can enable lymphovascular dissection using the Endowrist(®) function; this allows safe rectal transection through an additional port and maintains the cosmetic advantage of single-incision laparoscopic surgery.

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Most cited references 21

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Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus.

S Rajpal, G Piskun (1999)

Laparoscopic cholecystectomy has become the gold standard in the care of patients with cholelithiasis. A standard laparoscopic cholecystectomy employs three trocar incisions outside the umbilicus, which are a source of potential wound complications and an undesirable cosmetic outcome. We describe here a modification of the laparoscopic cholecystectomy which utilizes two transumbilical trocars and two transabdominal gallbladder stay sutures and does not require abdominal wall incisions outside the umbilicus. When technically feasible, this technique results in superior cosmesis and may reduce postoperative wound complications.

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One-trocar appendectomy in pediatric surgery.

Julian C. Esposito (1998)

Laparoscopic appendectomy is a safe alternative to open appendectomy to treat appendicitis. The author reports his experience in performing laparoscopic appendectomy with the use of only one trocar in pediatric patients. Between 1 January 1994 and 30 October 1995 at the Department of General and Pediatric Surgery, Division of Pediatric Surgery of the "Federico II" University of Naples, we performed 51 laparoscopic appendectomies. Patient age varied from 4 to 16 years with a mean age of 7 years. In the last 25 patients of our series we performed the one-trocar appendectomy, positioning only one trocar infraumbilically with the use of a 10-mm operative telescope. The appendix is identified, dissected when necessary, grasped laparoscopically with a 450-mm operative atraumatic instrument introduced through the operative channel of the laparoscope, and then exteriorized through the umbilical cannula. The appendectomy was performed using traditional method outside the abdominal cavity. We had no intra- or perioperative mortality or morbidity. The mean overall hospitalization time was 2 days (1-4 days). At a maximal follow-up of 20 months the children have no clinical problems nor any visible scar related to the laparoscopic appendectomy. In conclusion, the author considers the one-trocar appendectomy an appropriate alternative procedure to other techniques of laparoscopic appendectomy.

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Single-incision, umbilical laparoscopic versus conventional laparoscopic nephrectomy: a comparison of perioperative outcomes and short-term measures of convalescence.

Jeffrey A. Cadeddu, Jay D. Raman, Aditya Bagrodia (2009)

Recent reports have suggested that single-port or single-incision laparoscopic surgery (SILS) is technically feasible. To present a comparison between SILS and conventional laparoscopic nephrectomy with respect to perioperative outcomes and short-term measures of convalescence. This was a case-control study comparing 11 SILS nephrectomies (cases) and 22 conventional laparoscopic nephrectomies (controls) performed from September 2004 to April 2008. The control group was matched in a 2:1 ratio to SILS cases with respect to patient age, surgical indication, and tumor size. A single surgeon performed all SILS nephrectomy cases using three adjacent 5-mm trocars inserted through a single 2.5-cm periumbilical incision. Demographics, operative time, blood loss, perioperative complications, transfusion requirement, decrease in serum hemoglobin, analgesic requirement, length of stay, and final pathology were compared. Mean patient age was 53 yr for both groups, with more females in the SILS cohort (82% vs 41%). Nephrectomy was performed for benign disease in 45% of the cases. Median tumor size was 5.5 cm for both groups, and all but one suspected malignancy was renal cell carcinoma on final pathology. There was no difference between SILS and conventional laparoscopy cases in median operative time (122 min vs 125 min, p=0.78), percent decrease from preoperative hemoglobin (14.1% vs 15.8%, p=0.52), analgesic use (8 morphine equivalents vs 15 morphine equivalents, p=0.69), length of stay (49 h vs. 53 h, p=0.44), or complication rate (0% for both). The SILS group did have a lower recorded median estimated blood loss (20 ml vs 100ml, p=0.001). This study is retrospective and is susceptible to all limitations and biases inherent in such a design. SILS nephrectomy is feasible with perioperative outcomes and short-term measures of convalescence comparable to conventional laparoscopic nephrectomy. Although SILS may offer a subjective cosmetic advantage, prospective comparison is needed to more clearly define its role.