Erica R. Podolsky

Single Port Access (SPA™) Cholecystectomy: A Completely Transumbilical Approach

We have seen substantial changes in minimally invasive surgery since its development in the early 1900s. Over the past 10 years, the addition of natural orifice transluminal endoscopic surgery and robotics has turned our attention to improved cosmesis and advancements in instrumentation. We have developed a new technique-single port access (SPA) surgery-and have applied it to the cholecystectomy. In this paper, we present and review the application of this access technique to the first 5 consecutive patients that underwent an SPA cholecystectomy. All 5 patients were female, with an average age of 45 years and an average weight of 172 pounds. Indications included biliary dyskinesia and symptomatic cholelithiasis. Average operative time was 121 minutes in these initial 5 cases. All but 1 patient was discharged in 24 hours. At 6 months, no umbilical hernias were observed. This new technique allows for a complete cholecystectomy to be performed entirely through the umbilicus without the need for additional retraction sites or transabdominal sutures. This procedure utilizes the same basic technique of the laparoscopic cholecystectomy already employed by general surgeons. Therefore, the SPA cholecystectomy can be readily learned and performed by many surgeons without the need for expensive or experimental equipment. Using a single portal of entry to the abdominal cavity, the umbilicus, cosmesis, and scar reduction is achieved.

Single Port Access (SPA) Surgery—a 24-Month Experience

IntroductionIn April 2007, we performed our first single port access (SPA) surgical procedure. Beginning with simple procedures, we progressed to more complex procedures employing modifications of the initial technique.MethodsMaintaining our abdominal entry technique through a single incision, typically umbilical, we have now successfully performed cholecystectomies, colon resections, small bowel procedures, liver biopsy, splenectomy, adrenalectomy, and surgery of the gastroesophageal junction.ResultsTwo procedures have required additional port sites, none has employed transabdominal sutures, and <5% of all procedures have required articulation. Immediate follow-up demonstrates safe completion of multiple procedures with acceptable outcomes of blood loss and hospital stay. Although initial operative times are extended, a decrease is seen following a learning curve. At 2-year follow-up, two hernias developed at the extended incision for colon extraction.Discussion and ConclusionWith initial procedures performed in April 2007, we now report 24-month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that SPA surgery is an alternative to multiport procedures with proposed initial benefits of decreased number of incisions and improved cosmesis for the patient. Long-term prospective randomized large case series will be necessary to assess pain, recovery, and hernia formation proving advantages, if any, over multiport laparoscopy.

The road to reduced port surgery: from single big incisions to single small incisions, and beyond.

Single-port surgery has seen almost as rapid an application as multiport laparoscopy during the early 1990s. Hopefully, we will learn from our predecessors to apply the dictums of safety and science as we move forward with this new technique to ensure adequate adoption and successful outcomes with limited errors and concerns along the way.

Single Port Access (SPA) gastrostomy tube in patients unable to receive percutaneous endoscopic gastrostomy placement.

BackgroundAccess procedures for alimentation have been performed both endoscopically and surgically. In those patients in whom endoscopic tubes cannot be placed, the minimally invasive approach is a viable alternative. To minimize incisions and their sequelae, we have developed a single port access (SPA) technique in which minimal access surgery can be done through one portal of entry, often the umbilicus.MethodsWe have used the SPA technique to place gastric feeding tubes in patients who are not candidates for PEG tubes due to supraglottic stenosis. We reviewed our experience in the first five procedures we performed.ResultsIn all five patients a gastrostomy tube was placed laparoscopically via an umbilical incision and a left-upper-quadrant tube insertion point. Mean operative time was 44 min. All patients began tube feeds on postoperative day 1.ConclusionWe present the first series of five SPA gastric tube placements, offering a viable alternative to PEG or open placement.

Optimizing single port surgery: a case report and review of technique in colon resection.

Minimally invasive colon surgery was first described in the early 1990s, decreasing the morbidity compared with open procedures. Recently, single port laparoscopy has emerged, with reports of applications to colon surgery. Although feasible, many new technical challenges exist.

Robotic Resection of Pheochromocytoma in the Second Trimester of Pregnancy

In this study, a Da Vinci robotic system was successfully used to perform resection of pheochromocytoma during the second trimester of pregnancy.

Single Port Access (SPA) Splenectomy

A single port access technique is described to accomplish laparoscopic splenectomy.

Initial surgeon training for single port access surgery: our first year experience.

This study suggests that single port access techniques can be easily learned in an animate laboratory setting.

Single Port Access (SPA™) technique: video summary

The Single Port Access (SPA) technique offers a novel approach to minimally invasive abdominal surgery [1–2]. Using standard instrumentation, laparoscopic procedures can be performed entirely through the umbilicus in a similar fashion to standard multiport procedures. Utilizing subcutaneous flaps, very low-profile trocars, and standard instruments, we have demonstrated a platform that allows ‘‘independence of motion’’ for each of three instruments and a camera in a wide array or laparoscopic procedures, including cholecystectomy, colon resection, GE jxn procedures, hysterectomy, splenectomy, and adrenalectomy [3–6]. This technique allows the entire incision to be hidden within the umbilicus. In addition, based on standard instrumentation, the technique can be learned in a stepwise progression from multiport to Single Port Access surgery [1, 3–6]. This video demonstrates the technique as it applies to cholecystectomy.

[Reduced port surgery : Developing a safe pathway to single port access surgery].

ZusammenfassungDie „narbenlose“ Chirurgie ist ein wünschenswertes Ziel in der Welt der Laparoskopie und interventionellen Endoskopie. Eine Möglichkeit, dieses Ziel zu erreichen, ist der abdominelle Zugang durch eine natürliche Körperöffnung („natural orifice translumenal endoscopic surgery”, NOTES); diesem Verfahren fehlt jedoch noch eine geeignete Plattform und die Anwendung ist bisher limitiert. Weitere Möglichkeiten sind Reduced-Port-Techniken oder die „single port access surgery“, die nur minimale fasziale Defekte hinterlassen. Die Entwicklungs- und Wachstumsmöglichkeiten auf diesem Gebiet umfassen eine weites Spektrum. Allerdings muss vor einer breiten Anwendung der Verfahren gewährleistet sein, dass diese Techniken auf sichere Art und Weise sowie wirtschaftlich und ökologisch sinnvoll umgesetzt werden können. Der Beitrag gibt einen Überblick über die Verfahrensentwicklung, die Erlernbarkeit und den Einsatz der neuen Verfahren.Abstract“Scarfree” surgery is a desired goal in the world of laparoscopy and interventional endoscopy. One possibility to achieve this goal is abdominal access via a natural orifice (natural orifice transluminal endoscopic surgery, NOTES); however, this procedure and its applications lack an appropriate platform. Further possibilities are reduced port techniques or single port access surgery, which result in minimal scarring. Development and continued growth in this area cover a broad spectrum. Although acceptance has been demonstrated, the technique must be adopted in a safe and effective manner and must be economically and ecologically safe. This article gives an overview of the development of the technique, the learning curve, and new applications for this new technique. An English full-text version of this article is available at SpringerLink as supplemental.