These ideas and innovations are improving the efficiency and safety of the most minimally invasive laparoscopy.
David Bernard, Senior Associate Editor
A single incision at the umbilicus can provide access to the entire abdomen with minimally invasive techniques. While single-site surgery advocates admit it's more challenging than traditional multi-site laparoscopy, they also note it's in a state of evolution. "Advances make it a whole different story," says Jeffrey L. Ponsky, MD, who chairs the department of surgery at University Hospitals Case Medical Center in Cleveland. As experience and technology increase efficiency and safety, "single incision may be the way we do it in the future."
See your way clear
Operating through a single incision requires the mastery of a significant learning curve. One fundamental skill involves lining up the tools in use to prevent crowding and clashing at the surgical site inside, says Sharona B. Ross, MD, director of minimally invasive surgery and surgical endoscopy at Florida Hospital's Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive and Robotic Surgery in Tampa. This can prove particularly challenging at the intersection of instrumentation and visualization.
"We use 5mm deflectable tip laparoscopes," she says, which can be laid flat, yet still view another angle on demand. "Can you do single-incision with a rigid scope? Yes, you can, but then you can't move the other instruments out of the way."
What could be better than a scope that circumvents traffic at the site? Well, three-dimensional imaging would be, and the past year has seen the introduction of a 3D laparoscope with a deflectable tip, but it's a 10mm scope, which is too wide of an instrument for single-incision operations. "If you need that and a stapler, there's not enough room in the port," says Dr. Ross.