Introduction: Single-incision laparoscopic surgery (SILS) has emerged as a promising way to perform laparoscopic surgery less invasively. Currently, most SILS procedures are performed using standard laparoscopic instruments. This video demonstrates the use of novel powered articulating instruments to perform a SILS cholecystectomy in a cadaver.
Methods: SILS cholecystectomy was performed through an umbilical incision in a cadaver. We used a Covidien SILS Port ™, with two working ports for instruments and one port to accommodate a flexible-tipped 5mm laparoscope. A standard 5mm laparoscopic grasper was used along with an 8mm Terumo instrument for dissection. An additional 5mm instrument through a separate incision, not seen in the video, was used to aid in retracting the fundus of the gallbladder. Powered instruments included a Maryland dissector, scissors, and hook cautery. Video during the procedure was recorded with the laparoscopic camera.
Results: The powered, articulating instruments add an additional 2 degrees of freedom (pitch at the distal articulating joint and roll of the instrument tip, independent of the shaft) to the 4 degrees of freedom allowed by standard laparoscopic instruments (pitch, yaw, roll, and surge). The instruments allowed efficient, fine adjustment of dissecting instrument angle while maintaining an ergonomic user interface. The entire procedure was completed with the powered instruments in the right hand, and did not require switching ports. Limitations identified during the procedure included a learning curve with the articulating controls, and the larger external profile of the instruments compared to standard laparoscopic instruments.
Conclusions: The powered, articulating instruments add additional degrees of freedom compared to standard laparoscopic instruments, facilitating the adjustment of instrument angles while performing SILS cholecystectomy. However, these advantages are realized after a learning curve, and at the expense of a larger external profile compared to standard laparoscopic instruments. Prospective studies should be conducted to compare powered
Session: Video Channel
Program Number: V078