Access for laparoendoscopic single site surgery

Abstract

Laparoscopic surgery is the standard of care for many abdominal and pelvic operations and is widely applied today. LESS (Laparo-Endoscopic Single Site) surgery, originally attempted in the 1990s, is an advanced minimally invasive approach that allows laparoscopic operations to be undertaken through a small (<15 mm) incision in the umbilicus, a preexisting scar. The presence of a preexisting scar allows LESS surgery to be essentially scarless, which is the key benefit to LESS operations. Herein, we review our experience with over 500 LESS operations and discuss the key techniques to establishing access to the peritoneal cavity. We review the options for obtaining access, available instrumentation, common challenges and solutions for access. We conclude that LESS surgery is safe and provides outcomes with superior cosmesis relative to conventional laparoscopy. LESS surgery should be embraced, as patient demand is rapidly increasing.

Figure 1

LESS TriPort.

Figure 2

SILS port.

Figure 3

Two 5 mm trocars in place at the umbilicus.

Figure 4

Instruments in two 5 mm trocars. Competition for space can be a problem, practically with a 5 mm scope that has a light source entering at 90 degrees, as shown.

Figure 5

Obtaining access into the peritoneal cavity by direct cutdown inside the umbilical ring.

Figure 6

The Postoperative Scarless Umbilicus.