Limits...
Access for laparoendoscopic single site surgery.

Ross SB, Clark CW, Morton CA, Rosemurgy AS - Diagn Ther Endosc (2010)

Bottom Line: We review the options for obtaining access, available instrumentation, common challenges and solutions for access.We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy.LESS surgery should be embraced, as patient demand is rapidly increasing.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, The Department of Surgery, Tampa General Hospital, Digestive Disorders Center, University of South Florida, Tampa, FL 33601, USA.

ABSTRACT
Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo-Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken through a small (<15 mm) incision in the umbilicus, a preexisting scar. The presence of a preexisting scar allows LESS surgery to be essentially scarless, which is the key benefit to LESS operations. Herein, we review our experience with over 500 LESS operations and discuss the key techniques to establishing access to the peritoneal cavity. We review the options for obtaining access, available instrumentation, common challenges and solutions for access. We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy. LESS surgery should be embraced, as patient demand is rapidly increasing.

No MeSH data available.


Related in: MedlinePlus

Obtaining access into the peritoneal cavity by direct cutdown inside the umbilical ring.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2902049&req=5

fig5: Obtaining access into the peritoneal cavity by direct cutdown inside the umbilical ring.

Mentions: Once patients are intubated under general anesthesia they are prepped and draped in a sterile fashion, and local anesthesia is injected into the umbilicus. We use commercially available marcaine mixed with epinephrine. An approximately 1.2 cm long vertical incision is made in the umbilicus with great caution not to cut the umbilical ring, or the skin ring around the umbilicus (Figure 5(a)). Dividing the umbilical ring will result in a permanent deformity of the umbilicus. As the incision is made, the umbilicus is everted (Figure 5(b)). A small fascial defect is frequently, almost always, present at the base of the umbilicus and can be gently dilated to allow placement of a TriPort or a SILS port with copious amount of lubrication (Figure 5(c)). Figure 5 demonstrates the sequence of maneuvers used to obtain access. We use water soluble gel (e.g., KY jelly or Lubifax) to facilitate placement of the multitrocar ports. The TriPort provides two 5 mm trocars, one 12 mm trocar, and two conduits for CO2 insufflation. The SILS port provides for three 5 mm trocars, one of which can be upsized to 12 mm, as well as one conduit for CO2 insufflation. When we use the SILS port, the CO2 insufflation conduit is usually replaced by a 5 mm trocar with CO2 insufflation capabilities. This allows us to gain an extra (i.e., fourth) working trocar. When we use the 12 mm trocar, we use a reusable metal trocar with a rubber stopper for a valve. This consumes less space than commercially available trocars or the 12 mm trocar that accompanies the port. Once pneumoperitoneum is established, the operation begins with the insertion of a 5 mm deflectable tip laparoscope and 5 mm instruments. The instruments used vary according to the specific operation undertaken, while the laparoscope is always the same. A deflectable tip laparoscope is very important.


Access for laparoendoscopic single site surgery.

Ross SB, Clark CW, Morton CA, Rosemurgy AS - Diagn Ther Endosc (2010)

Obtaining access into the peritoneal cavity by direct cutdown inside the umbilical ring.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2902049&req=5

fig5: Obtaining access into the peritoneal cavity by direct cutdown inside the umbilical ring.
Mentions: Once patients are intubated under general anesthesia they are prepped and draped in a sterile fashion, and local anesthesia is injected into the umbilicus. We use commercially available marcaine mixed with epinephrine. An approximately 1.2 cm long vertical incision is made in the umbilicus with great caution not to cut the umbilical ring, or the skin ring around the umbilicus (Figure 5(a)). Dividing the umbilical ring will result in a permanent deformity of the umbilicus. As the incision is made, the umbilicus is everted (Figure 5(b)). A small fascial defect is frequently, almost always, present at the base of the umbilicus and can be gently dilated to allow placement of a TriPort or a SILS port with copious amount of lubrication (Figure 5(c)). Figure 5 demonstrates the sequence of maneuvers used to obtain access. We use water soluble gel (e.g., KY jelly or Lubifax) to facilitate placement of the multitrocar ports. The TriPort provides two 5 mm trocars, one 12 mm trocar, and two conduits for CO2 insufflation. The SILS port provides for three 5 mm trocars, one of which can be upsized to 12 mm, as well as one conduit for CO2 insufflation. When we use the SILS port, the CO2 insufflation conduit is usually replaced by a 5 mm trocar with CO2 insufflation capabilities. This allows us to gain an extra (i.e., fourth) working trocar. When we use the 12 mm trocar, we use a reusable metal trocar with a rubber stopper for a valve. This consumes less space than commercially available trocars or the 12 mm trocar that accompanies the port. Once pneumoperitoneum is established, the operation begins with the insertion of a 5 mm deflectable tip laparoscope and 5 mm instruments. The instruments used vary according to the specific operation undertaken, while the laparoscope is always the same. A deflectable tip laparoscope is very important.

Bottom Line: We review the options for obtaining access, available instrumentation, common challenges and solutions for access.We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy.LESS surgery should be embraced, as patient demand is rapidly increasing.

View Article: PubMed Central - PubMed

Affiliation: Division of General Surgery, The Department of Surgery, Tampa General Hospital, Digestive Disorders Center, University of South Florida, Tampa, FL 33601, USA.

ABSTRACT
Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo-Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken through a small (<15 mm) incision in the umbilicus, a preexisting scar. The presence of a preexisting scar allows LESS surgery to be essentially scarless, which is the key benefit to LESS operations. Herein, we review our experience with over 500 LESS operations and discuss the key techniques to establishing access to the peritoneal cavity. We review the options for obtaining access, available instrumentation, common challenges and solutions for access. We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy. LESS surgery should be embraced, as patient demand is rapidly increasing.

No MeSH data available.


Related in: MedlinePlus