Single Port Laparoscopic Surgery for Achalasia – A Case Report

Hisae Aoki, MD, Toshiyuki Mori, MD, Nobutsugu Abe, MD, Osamu Yamagida, MD, Tadahiko Masaki, MD, Masanori Sugiyama, MD. Department of Surgery, Kyorin University

 

Background & Object:
Recently Single port surgery (SPS) has been widely accepted worldwide. Indication of SPS started with appendectomy and cholecystectomy, extending the stomach surgery, colon surgery and liver surgery.Laparoscopic operation is undoubtedly the gold standard treatment for GERD and achalasia. Laparoscopic Heller myotomy and Dor fundoplication usually required 5 ports. It may be performed with single port surgery or single port surgery + an additional port, namely reduced port surgery.

Methods: We present a case of patients with achalasia . a 81 year-old male, was diagnosed as achalasia. For umbilical access, a 4cm vertical incision was made at the umbilicus and an EZ access port was placed.The scope, two working ports for forceps were inserted through the EZ access.An additional port was then inserted in the left upper quadrant. The scope was 30 degree oblique view scope. Dissection was performed using two instrument from EZ access port.When making fundoplication, suturing and knot tying was needed.At the time of suturing, instrument through the additional port was manipulated by right hand. The instrument through EZ access was manipulated by left hand

Result: The operation was concluded safely. Operating time was 2 hours 51 minutes and blood loss was negligible . The postoperative course was uneventful.
 

Discussion: Dissection around the esophagus was easy and was entirely possible with single port surgery. The technique becomes demanding for suturing and knot tying for fundoplication. To cope with this difficulty additional port was good option, restoring triangular formation.

Conclusion:
Single port surgery with one additional port (reduced port approach) could be the method of choice for benign esophageal disorders.
 


Session Number: Poster – Poster Presentations
Program Number: P262
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