The recent development of minimally invasive surgery is characterized by the search for ways of further reducing access trauma for example through the use of natural orifices (NOTES) or the concentration of several individual accesses on a single incision (Single Port Surgery, SPS). Meanwhile, commercially marketed instruments have proven the technical and clinical feasibility of the SPS concept.
The idea of the concentration of one optical and multiple working ports in confined space is not new. About 25 years ago the technique of Transanal Endoscopic Microsurgery (TEM) was developed in which one angled lens and three surgical instruments can be inserted into the rectum through a 40 mm operating rectoscope. Thus in conjunction with the Richard Wolf Company the project arose to develop this principle and make it available for SPS procedures in the abdomen with access through the abdominal wall (e.g. the umbilicus). For this purpose the access diameter had to be reduced and the degrees of freedom of movement of the instruments had to be improved to meet the requirements of laparoscopic surgery.
The new system is based on a 20-mm trocar, which is screwed to minilaparotomy in the abdominal wall and through which completely new optics and up to three surgical instruments can be introduced into the abdomen. The optics ensure the free movement of the surgeon`s hands by a multiple bend and an excellent overview of the operating field by the aerial view and the distance to the surgical area. In addition, the also angled instruments have two rotation axes. The whole instrument can be rotated with the distal portion bent around the instrument axis, whereby the possibilities of train, turn, and angulation are given. After switching the jaw alone rotates, which is concluded as always in an ideal position to the tissue. The entire system can be mounted on a movable arm, whose position is varied and fixed in one-hand operation. This is in addition the possibility to carry out the intervention as a solo surgery.
After intensive testing in animal models, the instrument is in clinical trials. We have run up to the current time 15 cholecystectomies completely with the new instruments without additional trocars through the umbilical access. There were no intra- or postoperative complications. The patients are almost completely pain-free and mobile after the procedure.
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