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Laparoendoscopic Single-Site (LESS) Combined Cholecystectomy and Hysterectomy
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Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S52eS102 Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:42 PM d 3:50 PM)
Single Incision Laparoscopic Hysterectomy e Step by Step Stepp KJ. Ob/gyn, MetroHealth Medical Center/Case Western University, Cleveland, OH Study Objective: This video illustrates new instrumentation and the step-by-step techniques for performing single incision laparoscopic hysterectomy. Two most common multichannel ports are shown.
of instrument mobility and an unfamiliar visual perspective. Conversely, it offers tremendous benefits to the patient, including less pain, more rapid recovery, and superior cosmesis. As with any advanced laparoscopic technique, it should be attempted only by surgeons who are experienced laparoscopists. Although there is not a difficult learning curve, there are several aspects requiring adjustments in surgical approach that are not inherently intuitive. In this video, the technique is described and demonstrated, providing tips for performance based on initial experience with a variety of trocars, cameras, and instruments.
266 263
Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:51 PM d 3:58 PM)
Single Port Transumbilical Myomectomy and Ovarian Cystectomy Kim Y-W. The Catholic University of Korea, Incheon St. Mary’s Hospital, Republic of Korea Study Objective: Single port transumbilical myomectomy and ovarian cystectomy had been hardly performed due to technical difficulties. The author has successfully performed single port myomectomy and ovarian cystectomy since 2008. One laparoscope and 2 instruments were inserted into 3 cannulas of the port that was created by a wound retractor and a surgical glove. During the operation, only conventional laparoscopic instruments (straight and rigid) were used. The author was able to remove the myomas through the umbilical port by cutting the myomas into smaller pieces with a knife. All procedures were completed without any complications. There were no postoperative complications or visible scars. The author reports cases of single port transumbilical myomectomy and ovarian cystectomy.
264
Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:59 PM d 4:06 PM)
Laparoendoscopic Single-Site (LESS) Combined Cholecystectomy and Hysterectomy Hart S,1 Ross SB,2 McFarlin K,2 Rosemurgy AB.2 1Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL; 2 Department of General Surgery, University of South Florida, Tampa, FL Study Objective: To present a video of a combined Laparoendoscopic SingleSite (LESS) cholecystectomy and hysterectomy Materials and Methods: A 37 year old G2P2 presented with combined complaints of a symptomatic fibroid uterus and symptomatic cholelithiasis. Evaluation demonstrated a 12 week size uterus which was globular in appearance consistent with adenomyosis and a non-mobile hyperechoic focus in the neck of the gallbladder consistent with cholelithiasis. The patient underwent a combined Laparoendoscopic Single-Site (LESS) cholecystectomy and hysterectomy procedure. The procedure utilized a combination of articulating instruments including a thermal ligation device and an articulating digital 5 mm camera. The procedure was completed without complications in approximately three hours. Post-operatively, the patient had a rapid recovery and return of normal activity. Conclusion: A combined single site surgical procedure can safely and effectively be performed.
265
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:07 PM d 4:15 PM)
Single-Site Access Surgical Endoscopy (SSASE) Scheib SA, Anderson TL. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN Study Objective: Single-site access surgical endoscopy (SSASE) is an advanced laparoscopic technique in which the camera and all instrumentation is introduced through a single skin incision. This approach creates unique challenges for the surgeon, including limitations
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:16 PM d 4:21 PM)
SPA with NOTES for the Excision of a Dermoid Cyst Della Badia C. OB/GYN, Drexel University College of Medicine, Philadelphia, PA Study Objective: This is a 5 minute 20 second video that demonstrates the technique of Single Port Access (SPA) to excise a dermoid cyst and it also demonstrates the technique of Natural Orifice Transluminal Endoscopy (NOTES) using the vagina to remove large amounts of tissue with having to expand the abdominal port sites. Traditional laparoscopy would utilize three ports in the abdomen and one of the ports would have to be enlarged to remove the 9 cm dermoid. This technique shows how the three incisions are hidden in the umbilicus and the dermoid cyst is removed through the posterior cul-de-sac.
267
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:22 PM d 4:30 PM)
Laparo Endoscopic Single Site Surgery (L.E.S.S.) in the Management of Ovarian Benign Disease Fagotti A,1 Fanfani F,1 Rossitto C,1 Marocco F,1 Ercoli A,2 Gagliardi ML,1 Gallotta V,1 Scambia G.1 1Gynecologic Oncology, Policlinc Gemelli-Catholic University of the Sacred Heart, Rome, Italy; 2Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Campobasso, Italy Study Objective: A video is planned to show ovarian cystectomy and bilateral adnexectomy performed by a transumbilical single access utilizing a multi-port trocar. The largest diameter of the trocar is 2 cm, and it is composed by 1 port for CO2 insufflation, and 3 operative accesses (2 of 5 mm and 1 of 12 mm). To introduce the trocar, the distal ring is passed into the abdominal cavity utilizing the introducer, by classic laparoscopic open access technique with a cutaneous and fascial 2 cm - incision. Once achieved (12 mmHg) pneumoperitoneum, intra-abdominal visualization is obtained thanks to 5mm 30 high-definition telescope. Working instruments are inserted into the remaining 2 ports, choosing among graspers, cold scissors, suction/ irrigation and bipolar coagulator. All the specimens are removed by an endobag. The purpose of the video was to demonstrate how adnexal benign disease can be managed through this new approach.
268
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:31 PM d 4:38 PM)
Single-Port Transumbilical Total Laparoscopic Hysterectomy: Kim’s PA (Posterior-to-Anterior) Round Method Kim Y-W. Department of Obstetrics and Gynecology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Republic of Korea Study Objective: Total hysterectomy is the most common operation in gynecology. However, single-port total laparoscopic hysterectomy (TLH) had been hardly performed due to technical difficulties. In 2008, the author successfully performed the first single-port transumbilical TLH in Korea. One laparoscope and 2 instruments were inserted into 3 cannulas of the port created by a wound retractor and a surgical glove. Laparoscopic suturing
Abstracts / Journal of Minimally Invasive Gynecology 16 (2009) S52eS102 Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:42 PM d 3:50 PM)
Single Incision Laparoscopic Hysterectomy e Step by Step Stepp KJ. Ob/gyn, MetroHealth Medical Center/Case Western University, Cleveland, OH Study Objective: This video illustrates new instrumentation and the step-by-step techniques for performing single incision laparoscopic hysterectomy. Two most common multichannel ports are shown.
of instrument mobility and an unfamiliar visual perspective. Conversely, it offers tremendous benefits to the patient, including less pain, more rapid recovery, and superior cosmesis. As with any advanced laparoscopic technique, it should be attempted only by surgeons who are experienced laparoscopists. Although there is not a difficult learning curve, there are several aspects requiring adjustments in surgical approach that are not inherently intuitive. In this video, the technique is described and demonstrated, providing tips for performance based on initial experience with a variety of trocars, cameras, and instruments.
266 263
Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:51 PM d 3:58 PM)
Single Port Transumbilical Myomectomy and Ovarian Cystectomy Kim Y-W. The Catholic University of Korea, Incheon St. Mary’s Hospital, Republic of Korea Study Objective: Single port transumbilical myomectomy and ovarian cystectomy had been hardly performed due to technical difficulties. The author has successfully performed single port myomectomy and ovarian cystectomy since 2008. One laparoscope and 2 instruments were inserted into 3 cannulas of the port that was created by a wound retractor and a surgical glove. During the operation, only conventional laparoscopic instruments (straight and rigid) were used. The author was able to remove the myomas through the umbilical port by cutting the myomas into smaller pieces with a knife. All procedures were completed without any complications. There were no postoperative complications or visible scars. The author reports cases of single port transumbilical myomectomy and ovarian cystectomy.
264
Video Session 9dSingle Port Incision Laparoscopy & NOTES (3:59 PM d 4:06 PM)
Laparoendoscopic Single-Site (LESS) Combined Cholecystectomy and Hysterectomy Hart S,1 Ross SB,2 McFarlin K,2 Rosemurgy AB.2 1Department of Obstetrics and Gynecology, University of South Florida, Tampa, FL; 2 Department of General Surgery, University of South Florida, Tampa, FL Study Objective: To present a video of a combined Laparoendoscopic SingleSite (LESS) cholecystectomy and hysterectomy Materials and Methods: A 37 year old G2P2 presented with combined complaints of a symptomatic fibroid uterus and symptomatic cholelithiasis. Evaluation demonstrated a 12 week size uterus which was globular in appearance consistent with adenomyosis and a non-mobile hyperechoic focus in the neck of the gallbladder consistent with cholelithiasis. The patient underwent a combined Laparoendoscopic Single-Site (LESS) cholecystectomy and hysterectomy procedure. The procedure utilized a combination of articulating instruments including a thermal ligation device and an articulating digital 5 mm camera. The procedure was completed without complications in approximately three hours. Post-operatively, the patient had a rapid recovery and return of normal activity. Conclusion: A combined single site surgical procedure can safely and effectively be performed.
265
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:07 PM d 4:15 PM)
Single-Site Access Surgical Endoscopy (SSASE) Scheib SA, Anderson TL. Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN Study Objective: Single-site access surgical endoscopy (SSASE) is an advanced laparoscopic technique in which the camera and all instrumentation is introduced through a single skin incision. This approach creates unique challenges for the surgeon, including limitations
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:16 PM d 4:21 PM)
SPA with NOTES for the Excision of a Dermoid Cyst Della Badia C. OB/GYN, Drexel University College of Medicine, Philadelphia, PA Study Objective: This is a 5 minute 20 second video that demonstrates the technique of Single Port Access (SPA) to excise a dermoid cyst and it also demonstrates the technique of Natural Orifice Transluminal Endoscopy (NOTES) using the vagina to remove large amounts of tissue with having to expand the abdominal port sites. Traditional laparoscopy would utilize three ports in the abdomen and one of the ports would have to be enlarged to remove the 9 cm dermoid. This technique shows how the three incisions are hidden in the umbilicus and the dermoid cyst is removed through the posterior cul-de-sac.
267
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:22 PM d 4:30 PM)
Laparo Endoscopic Single Site Surgery (L.E.S.S.) in the Management of Ovarian Benign Disease Fagotti A,1 Fanfani F,1 Rossitto C,1 Marocco F,1 Ercoli A,2 Gagliardi ML,1 Gallotta V,1 Scambia G.1 1Gynecologic Oncology, Policlinc Gemelli-Catholic University of the Sacred Heart, Rome, Italy; 2Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Campobasso, Italy Study Objective: A video is planned to show ovarian cystectomy and bilateral adnexectomy performed by a transumbilical single access utilizing a multi-port trocar. The largest diameter of the trocar is 2 cm, and it is composed by 1 port for CO2 insufflation, and 3 operative accesses (2 of 5 mm and 1 of 12 mm). To introduce the trocar, the distal ring is passed into the abdominal cavity utilizing the introducer, by classic laparoscopic open access technique with a cutaneous and fascial 2 cm - incision. Once achieved (12 mmHg) pneumoperitoneum, intra-abdominal visualization is obtained thanks to 5mm 30 high-definition telescope. Working instruments are inserted into the remaining 2 ports, choosing among graspers, cold scissors, suction/ irrigation and bipolar coagulator. All the specimens are removed by an endobag. The purpose of the video was to demonstrate how adnexal benign disease can be managed through this new approach.
268
Video Session 9dSingle Port Incision Laparoscopy & NOTES (4:31 PM d 4:38 PM)
Single-Port Transumbilical Total Laparoscopic Hysterectomy: Kim’s PA (Posterior-to-Anterior) Round Method Kim Y-W. Department of Obstetrics and Gynecology, The Catholic University of Korea, Incheon St. Mary’s Hospital, Republic of Korea Study Objective: Total hysterectomy is the most common operation in gynecology. However, single-port total laparoscopic hysterectomy (TLH) had been hardly performed due to technical difficulties. In 2008, the author successfully performed the first single-port transumbilical TLH in Korea. One laparoscope and 2 instruments were inserted into 3 cannulas of the port created by a wound retractor and a surgical glove. Laparoscopic suturing