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Single-incision Laparoscopic Surgery An initial experience from Tung Wah Hospital

Single-incision Laparoscopic Surgery An initial experience from Tung Wah Hospital. Dr. Michael CO Division of Hepatobiliary Surgery Department of Surgery University of Hong Kong Tung Wah Hospital. Introduction. Laparoscopic surgery

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Single-incision Laparoscopic Surgery An initial experience from Tung Wah Hospital

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  1. Single-incision Laparoscopic Surgery An initial experience from Tung Wah Hospital Dr. Michael CO Division of Hepatobiliary Surgery Department of Surgery University of Hong Kong Tung Wah Hospital

  2. Introduction • Laparoscopic surgery • Gold standard of treatment of many major abdominal operations • Less morbidity and hasten post-operative recovery • Minimally invasive surgery (MIS)

  3. Ways to minimize surgical trauma • Needlescopic surgery • Reducing the size of the incisions • 2-3mm ports and instruments • Single-incision laparoscopic surgery • Reducing the numbers of incision

  4. Single Incision Laparoscopic Surgery (SILS) • Acronyms • Single Port Access (SPA) Surgery • Single Incision Laparoscopic Surgery (SILS) • Laparoscopic Endoscopic Single-port Surgery (LESS) • Embryonic Natural Orifice Transumbilical Endoscopic Surgery (E-NOTES)

  5. Applications • First described in urologic operations Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. Desai, Mihir M et. al. BJU International. 101(1):83-88, January 2008 • Then being applied in general surgery • Cholecystectomy • Appendicectomy • Colectomy Single-port laparoscopy in colorectal surgery. Remzi et. al. Colorectal Disease. 10(8):823-826, October 2008. Single port acces (SPA) Surgery – Initial experience of a novel minimal access approach applied across surgical specialties. Surg Endosc 2008; 22: S172.

  6. Instruments Tri-port system • One 10 mm camera port • Two 5 mm instrument ports

  7. Problems • Crowded space for multiple instruments • Lack of triangulation of instruments • Lack of adequate organ retraction • Learning curve for surgeon • Limited evidence of benefits from literature Initial experience with single-incision laparoscopic cholecystectomy. Carr AM, Bhavaraju, A Goza, J Wilson R. Am Surg. 2010 Jul;76(7):703-7.

  8. Lack of literature • Only a numbers of case reports / case series Transumbilical single-port laparoscopic cholecystectomy: a case report. Guo Wei et al. CMJ, 2008, Vol 121. No. 23: 2463-2464 Single port laparoscopic cholecystectomy with the TriPort system: a case report Romanelli JR et al. Surg Innov. 2008 Sep;15(3):223-8 Single Incision Laparoscopic Cholecystectomy: Is it more than a challenge? Ersin S et al. Surg Endosc 2010:24:68-71

  9. Started to perform SILS since May 2009 • First operation was laparoscopic cholecystectomy • 44 operations performed (till July 2010) • 31 Female / 13 Male • Mean age 56.7 years old (Range 32-72)

  10. Types of operation

  11. Conversion to conventional laparoscopic surgery • Cholecystectomy group • 1/32 need one extra port (3.1%) • 2/32 need three extra ports (6.2%) • None had conversion to open surgery • Splenectomy group • 1/2 need two extra ports (50%) • None had conversion to open surgery • Overall conversion rate • 4/44 (9%) had extra-ports

  12. Conversion Rate

  13. Operating Time • Cholecystectomy • Mean 120 minutes (Range 33 to 299 minutes) • Marsupialisation of liver cyst • Mean 125 minutes (Range 45 - 180 minutes) • Splenectomy • Mean 129 minutes (Range 60 - 198 minutes) • Wedge resection of small HCC • 135 minutes • Indirect inguinal hernia repair • 60 minutes

  14. Length of stay • Cholecystectomy • 1.6 days (Range 0-6 days) • Liver cyst marsupialisation • 2.3 days (Range 1-3 days) • Splenectomy • 1.5 days (Range 1-2 days) • Wedge resection • 4 days • Hernia repair • 1 day

  15. Mean Blood Loss • Cholecystectomy • 25ml (Range 0-200ml) • Liver cyst marsupialisation • 30ml (Range 0-100ml) • Splenectomy • 35ml (Range 20-50ml) • Wedge resection • 200ml • Hernia repair • Minimal

  16. Post-op complications • Cholecystectomy group • 1 had retained cystic duct stone • Overall complication rate 3.1% (n = 1)

  17. Limitations of our case series • Relatively small sample size • Not a comparative trial • All cases were elective • Only one patient had malignant condition

  18. 1. Single-incision laparoscopic cholecystectomy: A surgeon's initial experience with 56 consecutive cases and a review of the literature Roberts KE, Solomon D, Duffy AJ, Bell RL J Gastrointest Surg. 2010 Mar;14(3)

  19. Conclusion • Single-port surgery • Feasible procedure • Advances in technology will enable us to perform SILS in difficult cases in the future • Need more evidence from literature

  20. SINGLE PORT LAPAROSCOPIC CHOLECYSTECTOMY

  21. SINGLE PORT LAPAROSCOPIC MARSUPIALISATION OF LIVER CYST

  22. Special thanks to my supervisorsDr. W. K. YuenDr. W. K. IpDr. K. Y. Wong

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