The desire to continually improve our minimal access surgical approach to disease is clearly evidenced by the focus on reducing incisions required for laparoscopic cholecystectomy and other procedures. With this in mind, we have developed a Single Port Access (SPA) surgical procedure that has allowed us to perform a number of varying minimal access procedures through a single umbilical incision less than twenty millimeters in length. Included in our series are a growing number of laparoscopic cholecystectomies. However, in order for a new approach to be universally beneficial, it needs to be easily learned and applied such that it is not limited in its availability to patients or surgeons. Our desire was to test this approach in a porcine model with independent surgeons to assess these concerns.
Single Port Access (SPA) cholecystectomy is performed through a single umbilical incision measuring < 18mm in our series of patients. Skin flaps are used to extend the sub dermal planes and allow independent insertion of 3 – 4 5mm trocars . The addition of High Dexterity Instrumentation (RealHand ™. – Novare Surgical, Inc) to the SPA procedure facilitates dissection. These handheld articulating instruments allow insertion “in line” with the laparoscope through the additional trocars. The instruments' effector ends can articulate with seven degrees of movement into view for the standard cholecystectomy dissection procedure.
A group of four (4) surgeons from different institutions nationally, with varying degrees of laparoscopic training and exposure were invited to a symposium at the Drexel University Minimally Invasive Training Center to learn and apply the SPA cholecystectomy procedure. The course included a one hour didactic portion explaining the approach and procedure, a one hour dry lab to gain familiarity with the RealHand ™ instrumentation and an animate lab in which each surgeon was to independently perform a Single Port Access Cholecystectomy in a porcine model assisted only by a surgical resident from our institution.
All four physicians completed the SPA cholecystectomy with survival in less than 45 minutes (30’, 35’, 40’ 45’). One physician (RD) successfully placed a cholangiogram catheter, and one physician (LD) successfully placed a fourth rigid instrument through the same incision to aid in retraction of the liver.
Based on our initial training lab and symposium, the SPA cholecystectomy procedure has been successfully shown to be an approach that is easily learned and readily performed following a dedicated training course.
Program Number: S110 / P362