Single Port Laparoscopic Surgery: Concept and Controversies of New Technique

During the last two decades laparoscopic surgery has become the standard care for the management of various emergent and elective surgical pathologies. Well-known advantages of laparoscopy include faster recovery, less postoperative pain, lower perioperative complications, and improved cosmesis. Recent development of laparoscopy was represented with introduction of the concept of scarless surgery using natural orifice transluminal endoscopic surgery (NOTES). Unfortunately , NOTES approach has not yet has been overcome and refused due to need for specialized instruments, learning curve, and prolonged surgery time. Single-port laparoscopic surgery (SPLS) is a rapidly evolving technique in the field of minimally invasive surgery. SPLS was initially described in 1992 for gynecologic surgery and in general surgery seven years later. The most commonly reported advantages of SPLS include improved cosmesis, lower morbidity associated with elimination of peripheral ports, shorter length of hospital stay, and potential for decreased incisional pain. Another advantage of this technique is the ability to convert to an alternate minimally invasive procedure such as multiport laparoscopy and avoid the need for an open procedure, therefore maintaining the patient benefits well associated with minimally invasive surgery. Development of innovative articulated or bent instruments , adjustments in laparoscopes, and developed special multilumen access devices allowed simultaneous multiple instruments insertion facilitated the acceptance of this technique. Increasing application of this modality has been described through case reports and case series proving it is a safe and feasible technique for the surgical treatment of benign and malignant diseases expanded within general, urological, gynecological, and pediatric surgery. Recent publications described using SILS for appendectomy, cholecystectomy, colectomy, adrenalectomy, splenectomy, bariatric surgery, hysterectomy, ovarian cystectomy, and hernias repair. The interest for the technique has gradually progressed toward assessing its efficacy compared with established techniques in minimally invasive surgery. Comparative studies with standard and hand-assisted laparoscopic surgery have shown that SPLS maintains the benefits of minimally invasive surgery. There are number of challenges associated with SPLS: special access ports, instrumentation, and surgical techniques. Many of healthcare manufacturers that designed and developed various access devices as SPLS port (Covi-Germany) have made single site surgery easier and more efficient. While there exists concern about the learning curve of the experimented surgeons who are used to perform a classic laparoscopic approach, current evidence suggests that this technique can safely be mastered in the hands of experienced laparoscopic surgeons. The technical challenges of SILS included limited trian-gulation and retraction due to confinement of the …