[Introduction] Pneumoperitoneum creates a sufficient workspace,but we have many disadvantage about crowding and clashing of instruments and air-tight trocars in Single Port Laparoscopic Surgery (SPS). For the purpose of avoiding difficulties concerning about pneumoperitneum, we developed SPS under abdominal wall lifting method. We performed single port laparoscopic appendectomy, hernia repair, cholecystectomy under abdominal wall lifting using Nagai’s lift-up apparatus (LIFT-SPS). We report here the surgical procedures of LIFT-SPS.
[Patients and Methods] Thirty patients underwent LIFT-SPS between April and September, 2009. The surgical procedure was as follows. Under general anesthesia, the patient was placed in the supine position. The surgeon stood on the left side of the patient and the assistant stood on the right side of the patient. 2.0 cm intra-umbilical vertical skin incision and fasciotomy were made into the peritoneal cavity. An extra-small wound retractor (ALEXIS wound retractor XS, Applied Medical) was set up through the incision. We could use passage of several instruments through one small incision. An abdominal wall lifting retractor was set up on the right side.
1.2 Kirschner wire (K-wire) was inserted into subcutaneous of bilateral inguinal region for appendectomy and inguinal hernia repair or bilateral hypochondral region for cholecystectomy. And also K-wire was inserted at the under umbilicus for appendectomy and inguinal hernia repair or upper umbilicus lesion for cholecystectomy. Area lifting of abdominal wall could provide a wide visual field. Nine cases of appendectomy were performed with sealing mesoappendix using Laparoscopic ultrasonic coaguration shears (SonoSurg,Olympus) and Endocutter ETS Flex45(Ethicon Endo-Surgery). Eight cases of totally extraperitoneal inguinal hernia repair (TEP) were performed with transumbilical skin incision. Thirteen cases of cholecystectomy were performed with dissection, ligation and division of cystic artery and cystic duct using an Roticulator Endo Grasp (COVIDIEN) and cross- hand technique.
[Results] LIFT-SPS was successfully completed in all 30 patients without conversion to standard laparoscopic surgeries. No major complication was recognized.
[Conclusion] SPS was less invasive and safety by abdominal wall lifting method. Moreover, it reduced overall costs because of using reusable instruments and no trocar.
Program Number: P494