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 • Cosmesis, but less risky c/w NOTES • NOTES • Cosmesis, but risks Open Surgery Laparoscopic Surgery
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.
Umbilical Portals (U.S.) Tri - Port (Olympus) SILS Port (Covidien)
Instruments are in-line and parallel to each other What Else Is Different? Ideally, instruments/telescope should be different lengths
What Else Is Different? Assistant/camera holder stands next to or behind the surgeon
What Else Is Different? Harder to operate
Appendectomy Cholecystectomy Splenectomy Ileocecectomy Pyloromyotomy (CH-A) Fundoplication (CH-A) Others What Operations Are Being Done Using This SSULS Approach?
SSULS Appendectomy Please use this link if you experience problems viewing the video above.
SSULS Cholecystectomy Please use this link if you experience problems viewing the video above.
SSULS Splenectomy Please use this link if you experience problems viewing the video above.
SSULS Ileocecectomy • Intracorporeal dissection/mobilization • Extracorporeal resection/anastomosis
CMH Experience 142 SSULS procedures: • Appendectomy (103) • Cholecystectomy (24) • Splenectomy (2) • Cholecystectomy/splenectomy (1) • Ileocecectomy (8) CAPS, 2010
Results CAPS, 2010
SIPESCH - ALABAMA Appendectomy - 130 Pyloromyotomy - 32 Cholecystectomy - 32 Fundoplication - 6 Pull-through - 4 204 Pediatr Surg Int 2010
Conclusion These series show that single site surgery is feasible, and appears to be associated with acceptable operating times
Conclusion Disadvantages • Compromised degrees of freedom and triangulation • Visualization limited by inline field of view and motion of instruments • More difficult for the surgeon
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
Prospective Randomized Trials Power10 Outcome AnalysisVariable SSULS Appendectomy 360 (324) Infection SSULS Cholecystectomy 60 (44) Operative time SSULS Splenectomy 30 ( 5) Operative time
Other Variables Being Collected • Pain • Cost (hospital charges) • Cosmesis (Validated Scar Assessment Tool)