Single Port Access (spa) Surgery – Initial Experience of a Novel Minimal Access Approach Applied Across Surgical Specialties

We have developed a minimal access surgical technique in which the entire procedure can be performed through a single incision within the umbilicus. This Single Port Access (SPA) surgical technique developed in May 2007 has been utilized for a number of general surgical procedures including cholecystectomy, gastric surgery, omental surgery and hernia surgery. Utilizing High Dexterity instrumentation (RealHand ™. – Novare Surgical, Inc), handheld articulation allows us to place the working ports and instruments within the same skin incision used for the 5mm camera. Given the seven degrees of freedom with which the 5 mm RealHand™ instrumentation articulates, we are able to perform dissection through one incision in the umbilicus and apply the same principles of dissection utilized by the corresponding standard multiple port procedures. Adaptation of this new technique across surgical specialties is one factor in determining its usefulness.
We presented the SPA technique to surgeons in gynecologic oncology (SAK), gynecology (GH) and urology (JAC) to assess its adaptability across specialties. Each surgeon then performed their specialty related SPA procedures. Three cholecystectomies, one oopherectomy, four bilateral oopherectomies, one laparoscopic vaginal hysterectomy and three nephrectomies were successfully accomplished with the SPA technique in patients. All procedures were performed through a single umbilical incision using one or two 5 mm High Dexterity Instruments, a 5mm laparoscope, and one rigid instrument, either a grasper or tissue sealing device. We reviewed the initial experience with the first of these procedures performed by each specialty, including our own (PGC).
All procedures were successfully completed using the SPA technique in average times of 60 minutes (cholecystectomy), 45 minutes (oopherectomy), 90 minutes (LAVH) and 126 minutes (nephrectomy). All incisions were placed in the umbilicus and measured an average of 16 mm (cholecystectomy), 16 mm (oopherectomy and hysterectomy) and 32 mm (nephrectomy). Patient recovery and discharge were comparable to standard laparoscopic surgery and there were no complications.
An important component of any new procedure is its applicability to other surgical disciplines. Application of the SPA surgery technique across these fields within three months of its development demonstrates that this new technique can rapidly be applied to several subspecialties with success.

Session: Podium Presentation

Program Number: S073

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