Single Port Access (spa) Surgery: Initial 150 Cases Using a Novel Laparoscopic Single Incision Approach

Our initial work with Single Port Access (SPA) Surgery was the application of the technique to cholecystectomy and oopherectomy. We have now developed the SPA technique into a platform that allows multiple abdominal procedures to be accomplished through a single incision, yet in most cases, maintaining the same instrumentation and dissection techniques as standard multiport laparoscopy.

Using a single site as the entry point into the abdominal cavity (most often the umbilicus), we begin with an incision < 2cm in length. We then separate skin and soft tissue flaps from the underlying fascia. This allows placement of one 5mm clear trocar, and two 5mm low profile trocars as well as a fourth single fascial defect for placement of a grasping/retracting instrument. We have applied this to a series of 150 patients undergoing various abdominal surgeries.

A total of 150 cases of Single Port Access surgery have been performed by two surgeons (PGC – General Surgery & SAK – Gynecologic Oncology). The SPA technique of instrument and trocar positioning and placement have been applied similarly in all cases. In our initial experience we utilized articulating instrumentation. In 90% of cases, standard laparoscopic instrumentation has been utilized. The series includes: cholecystectomy, colon resection, GE junction surgery, appendectomy, gastric feeding tube, splenectomy, adrenalectomy, adhesiolysis, omentectomy, hysterectomy, oopherectomy, pelvic node dissections, and ventral hernia repairs.

All cases were successfully completed using this technique. Follow-up ranges from 2 to 18 months. LOS, EBL and postoperative follow-up has been similar to published standard multiport laparoscopic procedures. There has been one umbilical hernia to date. There were three wound infections treated with drainage.

We demonstrate that the technique of Single Port Access (SPA) Surgery is a viable alternative to standard multiport laparoscopy. Utilizing a single incision for access, we are able to offer patients comparable results to multiport procedures requiring three to five incisions. Long term studies are needed to determine further benefits, if any, to Single Port Access Surgery.

Session: Podium Presentation

Program Number: S030