Single Port Access: An Advance in Laparoscopic Surgery

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The development of laparoscopic surgery was a landmark advance. In laparoscopic surgery, sometimes simply called laparoscopy,the surgeon introduces medical instruments into the abdomen through small incisions. (Similar small-incision surgery on the thoracic cavity is called thoracoscopic surgery.)

Laparoscopic surgery is also called minimally invasive surgery (MIS) because the patient’s body is opened as little as possible. It goes by several nicknames, including “keyhole surgery” and “bandaid surgery” (the latter term implying that surgical incisions need only a bandaid). Compared to traditional open surgery, laparoscopy results in greater post-surgical comfort, including reduced pain; shorter hospital stays; a cosmetically less troublesome scar; and lessened risk of infection and other wound complications, with patients returning to their daily activities sooner (Katkhouda 2006).

Single Port Access (SPA) Laparoscopic Surgery

Laparoscopic surgery ordinarily involves multiple incisions in the abdominal wall, through which hollow devices called trocars are inserted. Surgical instruments are passed through the trocars into the abdominal cavity to perform the surgery.

A new development in laparoscopy called Single Port Access (SPA) requires only a single incision. This incision is made in the patient’s bellybutton, leaving a hidden, nearly invisible scar.

The first SPA surgery was performed in May 2007 when Dr. Paul Curcillo performed a cholecystectomy (gall bladder removal) using the technique. In July 2007, Dr. Stephanie King reached another SPA milestone by using the technique to perform a bilateral oopherectomy (double ovary removal) (Drexel University n.d.). Altogether, over 100 SPA surgeries had been performed as of December 2007 (Novare Surgical 2008).

An issue in laparoscopic surgery is the triangulation of the instruments inside the patient’s body. Ordinarily, this is done via multiple trocars in more than one incision. In SPA, all the instruments pass through the same point of entry, so special equipment is necessary to make it possible to triangulate the instruments. One large trocar or several small ones may be used (Novare Surgical 2008).

Types of Surgery Using SPA

A range of surgical procedures are appropriate for SPA (Novare Surgical 2008). These include Lap Band (a form of weight loss surgery), hernia repair, appendectomy, gastric tube placement, kidney removal (nephrectomy), and prostate removal (prostatectomy). Many gynecological surgeries also can be performed using SPA, including the removal of cysts and fibroids and even total hysterectomies (Novare 2008). Large organs are removed after being cut into small pieces, a procedure called morcellation.