Single port laparoscopy (SPL), also known as single port access surgery (SPA), single port incisionless conventional equipment-utilizing surgery (SPICES), single incision laparoscopic surgery (SILS), Single access endoscopic surgery (SAES), laparo-endoscopic single-site surgery (LESS), natural orifice transumbilical surgery (NOTUS), and one port umbilical surgery (OPUS), is a recently developed technique in laparoscopic surgery

Laparoscopic surgery

Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...

. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel

Navel

The navel is a scar on the abdomen caused when the umbilical cord is removed from a newborn baby...

. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.

Technique and equipment

SPL is accomplished through a single 20 mm incision in the navel (umbilicus or belly button), minimizing the scarring and incisional pain associated with the multiple points of entry used during traditional laparoscopic surgery.

Specialized equipment for SPL surgery falls into two broad categories; access ports and hand instruments. There are a number of different access ports including GelPOINT system from Applied Medical, the SILS device from Covidien, the R-Port and TriPort from Advanced Surgical Concepts and the Uni-X from Pnavel. Hand instruments come in two configurations - standard or articulating. Standard hand instruments are rigid in design and were developed over the last 30 years for use in laparoscopy. Articulation is designed to overcome one of the challenges inherent in SPL, decreased triangulation of instrument. A number of factors influence a surgeon's decision to use standard or articulating hand instruments including which access port they use, their own surgical skills and cost as articulating instruments are significantly more expensive than standard instruments. SPL is enhanced by the use of specialized medical devices such as the SILS Multiple Instrument Access Port manufactured by Covidien

Covidien

Covidien , formerly Tyco Healthcare, is a healthcare device and supply company, incorporated in Dublin, Ireland, although its corporate offices are located in Mansfield, Massachusetts. On June 29, 2007, Covidien became an independent publicly traded company after being spun off from Tyco...

. This device is a flexible port that can be fitted through a small incision in the navel to allow surgeons to use up to three laparoscopic devices simultaneously. Certain articulating instruments can be inserted through such specialized ports, providing surgeons with manueverability and access to the target tissue from a single access point.

Applications

The SPL technique has been used to perform many types of surgery, including adjustable gastric band

Adjustable gastric band

A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity...

ing, appendectomy, cholecystectomy

Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder. It is the most common method for treating symptomatic gallstones. Surgical options include the standard procedure, called laparoscopic cholecystectomy, and an older more invasive procedure, called open cholecystectomy.-Open surgery:A...

, colectomy

Colectomy

Colectomy consists of the surgical resection of any extent of the large intestine .-History:Sir William Arbuthnot-Lane was one of the early proponents of the usefulness of total colectomies, although his overuse of the procedure called the wisdom of the surgery into question.-Indications:Some of...

, hernia repair, hysterectomy

Hysterectomy

A hysterectomy is the surgical removal of the uterus, usually performed by a gynecologist. Hysterectomy may be total or partial...

, sleeve gastrectomy

Sleeve gastrectomy

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach, following the major curve. The open edges are then attached together to form a sleeve or tube with a banana shape. The...

, nephrectomy

Nephrectomy

Nephrectomy is the surgical removal of a kidney.-History:The first successful nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869 in Heidelberg. Simon practiced the operation beforehand in animal experiments...

, and sacrocolpopexy. SPL has been employed by surgeons at Cleveland Clinic

Cleveland Clinic

The Cleveland Clinic is a multispecialty academic medical center located in Cleveland, Ohio, United States. The Cleveland Clinic is currently regarded as one of the top 4 hospitals in the United States as rated by U.S. News & World Report...

for clinical trials and in the Geneva University Hospital in Switzerland. Although a number of single incision techniques use specialized instrumentation, most SPL operations in the United States and Europe have used standard instrumentation.

Risks and benefits

When compared with traditional multi-port laparoscopic techniques, benefits of SPL techniques include less postoperative pain, less blood loss, faster recovery time, and better cosmetic results. Despite the potential advantages of SPL techniques, there may also be complications. Potential complications include significant postoperative pain, injury to organs, bleeding, infection, incisional hernia, intestinal adhesions and scarring.

History

The first documented procedures of significance occurred in the late 1990s. This approach has recently seen more publicity and excitement as surgeons continue to develop techniques to evolve surgery to less invasive approaches. The first described SPL procedure was a gallbladder removal in 1997. Since that time, thousands of SPL procedures have been successfully performed in the United States, from general surgery to urologic, gynecologic and bariatric surgery applications.