Single Port Access Laparoscopy via the Glove Port for Planned and Urgent Colorectal Surgery

Mohamed Moftah, Dr, Ronan A Cahill, Dr. Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland

Introduction: Single access laparoscopic surgery is a recent compliment to the field of minimally invasive colorectal surgery. While selected series have indicated feasibility, we have prospectively examined its usefulness across the full spectrum of elective and urgent colorectal procedures over the past twelve months including its use in a consecutive “all comers’ series of segmental proximal colonic resection. Procedural familiarity and expertise has been enabled and greatly advanced by our employment of the most ergonomically and economically favorable access device, the “Surgical Glove Port”.

Methods: All patients undergoing laparoscopic colorectal resection over the study period were considered for a single access approach by a single surgical team in a university hospital. The ‘Glove’ port is constructed by snapping the cuff of a standard sterile surgical glove onto the outer ring of a conventional wound protector/retractor (ALEXIS, Applied Medical) placed via a 3-5 cm transumbilical or stomal site incision. Standard trocars and normal rigid laparoscopic instrumentation are used to complete the procedure.

Results: Of 90 planned laparoscopic colorectal procedures over the last 12 months, 40 (44%) were performed by this single incision laparoscopic modality without disruption of theatre list efficiency or surgical training obligations. These included 31 consecutive pure colonic resections comprising 15 right hemicolectomies (14 for neoplasia, 1 for volvulus), 8 total colectomies (including 7 urgent operations for either ulcerative colitis or Crohn’s disease), 6 ileocaecal resections (five for Crohn’s disease) and 2 transverse colectomies. The remaining nine cases were diagnostic mesenteric or peritoneal biopsies (n=2), ileal resections (n=2), laparoscopic-assisted polypectomy (n=2), construction of defunctioning stoma (n=2, one loop ileostomy, one loop colostomy) and one anterior resection. In addition, four other patients undergoing emergency surgery had their operation commenced and partially completed via a single port approach before conversion to a limited midline laparotomy encompassing extension of the same incision. The mean (range) age and BMI of the single access patient group was 58 (22-82) years and 23.9 (18.6-36.2) kg/m2 respectively. One extra port was required in two cases. There were no unexpected conversions to open surgery. Four patients did need extension of the incision site beyond 3cm however to facilitate specimen extraction due to either a bulky tumor or adhesions along the distal transverse colon due to previous laparotomy. The modal postoperative day of discharge was 4. For right sided resections, the mean (range) post-op stay in those undergoing surgery for benign disease (n=7, mean age 32 years) was 4, while for those undergoing operation for neoplasia (n=14, mean age 71 years) it was 5.8 days. The average lymph node harvest for oncological resections was 13. Use of the glove port reduced trocar cost by 58% (€60) by allowing use of trocar sleeves alone without obturators.

Conclusion: Single incision laparoscopic surgery is an effective option for abdominal surgery and seems especially suited for laparoscopic-assisted right-sided colonic resections. The Glove port technique facilitates procedural frequency and familiarity. Its use together with avoidance of specialised instrumentation prevents cost inflation undermining this access modality.

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