Ronan A Cahill, MD, Roel Hompes, MD, Richard Guy, MD, Oliver Jones, MD, Ian Lindsey, MD, Chris Cunningham, MD, Neil J Mortensen, MD. Oxford Radcliffe Hospitals, Oxford, UK
Introduction: For the Single Incision Laparoscopic Surgery to become a useful entity for colorectal surgeons, the utility of the device should be separated from consideration of cost. A simple glove access device can allow the concept and modality to be applied to a wider range of patients and procedures (including during multiport procedures) and allow surgeons begin to utilize the potential advance inherent in the approach into their routine practice.
Methods: A surgical glove port is constructed by applying a standard glove onto the rim of wound protector/retractor used during laparoscopic resectional colorectal surgery. To illustrate its usefulness, we detail the use of this access in a series of twenty patients (14 males, BMI range 24-57) presenting for a range of elective colorectal surgery over the past eight weeks.
Results: The surgical glove port was readily constructed in conjunction with either a small or extra small sized wound protector/retractor (ALEXIS, Applied Medical) placed into the site intended for specimen extraction (n=15) or stoma location (n=5). We thereby have found this approach to readily allow successful performance of single port laparoscopic-assisted right hemicolectomy (n=6) as well as pure single port laparoscopic ileo-rectal anastomosis (n=2), and anterior resection (n=3) and total colectomy (n=1). In addition, the glove port was a useful adjunctive portal as a part of conventional multiport laparoscopic-assisted right hemicolectomy (being employed to regain port access after extracorporeal anastomosis, n=4) and laparoscopic anterior resection (being used similarly after specimen extraction to check formation of end to end colorectal anastomosis [n=6] and in this way has facilitated refashioning of the anastomosis in two specific cases where the staple line appeared ischemic [n=1] or had a positive air leak test [n=1]). In addition, it has been used for adhesiolysis at the time of loop ileostomy closure [n=1] and loop ileostomy formation in a super-obese patient (BMI 57)[n=1].
Conclusions: This simple, efficient technique can allow use of single incision laparoscopic working across a broader spectrum of patients either in isolation or in combination with multiport surgery than may be otherwise possible for economic reasons. We endorse the creative innovation inherent in this approach as surgical practice continues to evolve for ever greater patient benefit.
Program Number: P173