Single-port laparoscopy (SPL), is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.
Technique & equipment
SPL is accomplished through a single 20 mm incision in the navel (umbilicus or belly button), or through only an 11 mm incision in the navel, minimizing the scarring and incisional pain associated with the multiple points of entry used during traditional laparoscopic surgery.
Specialized equipment for SPL surgery falls into two broad categories; access ports and hand instruments. There are a number of different access ports, including GelPOINT system from Applied Medical, the SILS device from Covidien, the TriPort+, TriPort15 and QuadPort+ a from Advanced Surgical Concepts and the Uni-X from Pnavel. Hand instruments come in three configurations – standard, articulating, and pre-bent rigid. A number of factors influence a surgeon’s decision to use standard or articulating hand instruments, including which access port they use, their own surgical skills and cost as articulating instruments are significantly more expensive than standard instruments. SPL is enhanced by the use of specialized medical devices such as the SILS Multiple Instrument Access Port manufactured by Covidien and Laparo-Angle Articulating Instruments made by Cambridge Endoscopic Devices, Inc. The flexible port that can be fitted through a small incision in the navel to allow surgeons to use up to three laparoscopic devices simultaneously. Certain articulating instruments can be inserted through such specialized ports, providing surgeons with maneuverability and access to the target tissue from a single access point. However single port laparoscopic appendectomy has also been performed using a single standard 10 mm “Y” shaped operating telescope having a 5 mm instruments channel also.
Although awareness of single-port surgery is high amongst surgeons, the use of specialized instruments through such limited access requires considerable skill and training. This operative training and experience is currently limited and some negative perceptions regarding increased operating time and complications with this type of surgery remain.
Risks and benefits
When compared with traditional multi-port laparoscopic techniques, benefits of SPL techniques include less postoperative pain, less blood loss, faster recovery time, and better cosmetic results. Despite the potential advantages of SPL techniques, there may also be complications. Potential complications include significant postoperative pain, injury to organs, bleeding, infection, incisional hernia, intestinal adhesions and scarring.