An Insertion Method of Ports Toward the Target Organ with Being Conscious of Coaxial Set-Up Using Single Port Laparoscopic Surgery

Hidenori Fujii, MD, Yoshiyuki Kawakami, MD, Toshiharu Aotake, MD, Naoki Nagayooshi, MD, Hisashi Shirai, MD, Atsushi Ikeda, MD, Kei Hirose, MD, Makoto Yoshida, MD, Koji Doi, MD, Fumie Tanaka, MD, Yuki Hirose, MD. Department of Surgery , Fukui Red Cross Hospital, JAPAN

When we started to perform single incision laparoscopic surgery, three trocars inserted by Mickey Mouse shaped. Now we report here an insertion method of a working port toward the target organ with being conscious of coaxial set-up. A 2- to 2.5-cm vertical skin incision is made just above the umbilicus and the subcutaneous tissue is stripped. A XCEL (5 mm in diameter and 15 cm in length; ETHICON ENDO-SURGERY, Pittberg, USA) port is inserted from the fascia defect at the center of the umbilicus into the abdominal cavity by an optical method, and a 30?-oblique hard scope (5 mm in diameter and 50 cm in length) is inserted toward the target and a straight line is marked on the abdominal wall. Next, another line was assumed perpendicular to the straight line at the camera-insertion point, a hook is inserted along the perpendicular line and an EndoTIP cannula (6 mm in diameter, and 6.5 cm or 10.5 cm in length; Karl Storz GmbH & Co., Tuttlingen, Germany) as a working trocar is inserted while twisting toward the hook without skin incision. In addition, vertical insertion increases the safety because the process of insertion of EndoTIP cannulas can be monitored through the transparent side wall of the XCEL. Since all of the devices can be inserted without skin incision, as mentioned above, this method can minimize the injury of the insertion site. In addition, as devices can be tightly inserted, there is no need to be worried about leakage of pneumoperitoneum. Then, an isosceles triangle centered on the line of the camera heading toward the target is formed. This method secures sufficient distance between the port and enables us coaxial set-up. We performed trans-umbilical single incision laparoscopic surgery in 51 cases with this method (2 cases for colectomy, 2cases for parcial gastrectomy, 24cases for cholecystectomy and 23 cases for appendectomy). The port insertion time was significantly shorter (13.4±3.2min vs. 18.0±4.7min ; p<0.01), and the distance between working ports was significantly longer than former method (37.0±3.0mm vs. 22.6±3.1mm; p<0.01). This method was convenient and no trouble related the insertion took place. And this method was also considered about economic efficiency without using a disposable small-head port or multi ports access device.