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Single Site Umbilical Laparoscopic Surgery (SSULS)

Single Site Umbilical Laparoscopic Surgery (SSULS). George W. Holcomb, III, M.D., MBA Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO. Open Surgery. Laparoscopic Surgery Less discomfort Reduced hospitalization Faster return to routine activities Cosmesis. SSULS

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Single Site Umbilical Laparoscopic Surgery (SSULS)

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  1. Single Site Umbilical Laparoscopic Surgery(SSULS) George W. Holcomb, III, M.D., MBA Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO

  2. Open Surgery • Laparoscopic Surgery • Less discomfort • Reduced hospitalization • Faster return to routine activities • Cosmesis

  3. SSULS • Cosmesis, but less risky c/w NOTES • NOTES • Cosmesis, but risks Open Surgery Laparoscopic Surgery

  4. Acronyms • SILS(TM) - Single Incision Laparoscopic Surgery • SPA (TM) - Single Port Access • SSULS - Single Site Umbilical Laparoscopic Surgery (CMH) • SIPES – Single Incision Pediatric Endosurgery (CH-A) All use umbilicus as single site.

  5. Umbilical Portals (U.S.) Tri - Port (Olympus) SILS Port (Covidien)

  6. Umbilical Portals (U.S.)

  7. SSULS Appendectomy

  8. Instruments are in-line and parallel to each other What Else Is Different? Ideally, instruments/telescope should be different lengths

  9. What Else Is Different? Assistant/camera holder stands next to or behind the surgeon

  10. What Else Is Different? Harder to operate

  11. Appendectomy Cholecystectomy Splenectomy Ileocecectomy Pyloromyotomy (CH-A) Fundoplication (CH-A) Others What Operations Are Being Done Using This SSULS Approach?

  12. SSULS Appendectomy

  13. SSULS Appendectomy Please use this link if you experience problems viewing the video above.

  14. Postoperative Appearance

  15. SSULS Cholecystectomy Please use this link if you experience problems viewing the video above.

  16. SSULS Splenectomy Please use this link if you experience problems viewing the video above.

  17. SSULS Splenectomy

  18. SSULS Ileocecectomy • Intracorporeal dissection/mobilization • Extracorporeal resection/anastomosis

  19. CMH Experience 142 SSULS procedures: • Appendectomy (103) • Cholecystectomy (24) • Splenectomy (2) • Cholecystectomy/splenectomy (1) • Ileocecectomy (8) CAPS, 2010

  20. Results CAPS, 2010

  21. SIPESCH - ALABAMA Appendectomy - 130 Pyloromyotomy - 32 Cholecystectomy - 32 Fundoplication - 6 Pull-through - 4 204 Pediatr Surg Int 2010

  22. Conclusion These series show that single site surgery is feasible, and appears to be associated with acceptable operating times

  23. Conclusion Disadvantages • Compromised degrees of freedom and triangulation • Visualization limited by inline field of view and motion of instruments • More difficult for the surgeon

  24. Questions • Do the benefits outweigh the risks? • What are the benefits? • Is there improved cosmesis? • Prospective evidence needed • We are enrolling in 3 SSULS PRT’s • Appendectomy, Cholecystectomy, Splenectomy • Validated scar assessment tool

  25. Prospective Randomized Trials Power10 Outcome AnalysisVariable SSULS Appendectomy 360 (324) Infection SSULS Cholecystectomy 60 (44) Operative time SSULS Splenectomy 30 ( 5) Operative time

  26. Other Variables Being Collected • Pain • Cost (hospital charges) • Cosmesis (Validated Scar Assessment Tool)

  27. www.centerforprospectiveclinicaltrials.com www.cmhmis.com

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