Eugenio Cocozza, MD, Mattia Berselli, MD, Lorenzo Livraghi, MD, Lorenzo Latham, MD, Alberto Mangano, MD, Luca Farassino, MD, Veronica Bianchi, MD
AZIENDA OSPEDALIERA OSPEDALE DI CIRCOLO E FONDAZIONE MACCHI, VARESE -ITALY-
Aim: to evaluate the perioperative and long-term results in the use of an abdominal wall retractor and a single glove as devices in Single Incision Laparoscopic Surgery (SILS).
Description of the technology and method of its use: in a case series a particular surgical tecnique was applied in SILS. A wound retractor was inserted in the periumbilical incision and a latex free glove (Size 6) was applied around the outer ring on the retractor; a tear on the first glove finger was created for the pneumoperitoneum induction. The optical view and the others instruments were introduced via additional tears on the glove’s fingers. The surgical operation was then carried out via the use of ultrasound or bipolar dissection.
Preliminary results: from 2010 to 2012, 53 glove tecnique SILS surgical procedures has been performed: 30 appendectomies, 21 cholecystectomies and 2 right colectomies. No conversion to standard laparoscopy or laparotomy has been required. The median operative time has been 30, 45 and 67,5 minutes for appendectomy, cholecystectomy and right colectomy respectively. The postoperative course has been uneventful for every patients; the pain has been assessed via the Visual Assessment Scale (VAS) and no patient experienced any residual surgical-procedure-related abdominal pain 30 days after surgery and in the long-term follow-up. The median post-operatory in-hospital stay was 2, 2 and 6 days for appendectomy, cholecystectomy and right colectomy respectively. The cost of a single wound retractor is 50 euros, the cost of a glove pair is 0.50 euro.
Conclusions and future directions: via the glove technique, the potential advantages of SILS (post-operative pain reduction, shorter in-hospital stay and better aesthetic result) can be fulfilled beside optimal surgical results (low morbidity, no mortality) and cost contraction . Moreover, using the wound protector, this approach is applicable to high Body Mass Index patients and the subcutaneous emphysema, parietal bleeding and surgical site infections can be reduced. Several instruments can be introduced with no diameter limit and a wide range of possible angular multiaxial movements. However there are some drawbacks: there are no triangular movements and the glove doesn’t guarantee the same rigidity of other SILS devices; a good laparoscopic experience is required.
In high volume laparoscopic centres the glove technique SILS can be applied in selected patients; good surgical results with the use of low cost surgical devices are achievable.
Session: Poster Presentation
Program Number: ETP037