Journal of Minimal Access Surgery Medknow Publications ISSN: 0972-9941 EISSN: 1998-3921 Vol. 7, Num. 1, 2011, pp. 109-111

Journal of Minimal Access Surgery, Vol. 7, No. 1, January-March, 2011, pp. 109-111

Instrumentation and Equipment

Our ideas for introduction of single-port surgery

Yutaka Kojima, Yuichi Tomiki, Kazuhiro Sakamoto

Department of Coloproctological Surgery, Juntendo University, Tokyo, Japan

Correspondence Address:Yutaka Kojima, Department of Coloproctological Surgery, Juntendo University, Faculty of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113 8421, Japan, yutachan10101970@yahoo.co.jp

Date of Submission: 26-Dec-2009
Date of Acceptance: 23-Jun-2010

Code Number: ma11022

DOI: 10.4103/0972-9941.72400

Abstract

Keywords: Single-incision access surgery, single port surgery

Design of our Device

Three ports, BLUNT PORT PLUS^™ (Covidien, Mansfield, MA, USA), SEPARATOR 5 Χ 100 mm (Applied Medical, Rancho Santa Margarita, CA, USA) and SEPARATOR^™ 5 Χ 55 mm (Applied Medical, Rancho Santa Margarita, CA, USA), and ALEXIS^™ wound retractor S size (Applied Medical, Rancho Santa Margarita, CA, USA), were used. The long and short types of a 5-mm port were used to avoid interference with the port head. These ports were arranged in an inverted triangle, as described in [Figure - 1]. Wet absorbent gauze was then placed between the ports to maintain an airtight seal between them and to alleviate the interference with the ports, and the fulcrum was fixed with rubber [Figure - 2]. The fixed ports were inserted into the middle finger of a glove, which was removed with scissors, and the fulcrum was further fixed with rubber [Figure - 3]a and b. We used a surgical glove that was used in operation usually and size of the glove was 6 or 6.5. The glove with the ports was wrapped around a wound retractor, as described in [Figure - 4]a and b. We adjusted amount of gauze among the ports to part of fulcrum of the ports into wound size. So the glove and ports were fixed around the wound. An approximately 2.5 cm incision [Figure - 5] was made in the stoma for sigmoid cancer and rectal cancer with significant infiltration to the surrounding tissues, and the wound retractor was placed into the incision [Figure - 6]. The glove with the port was wrapped around the wound retractor [Figure - 7] and used at the site to observe the peritoneal cavity and to ablate. There were no problems with the forceps procedure [Figure - 8]a and b.

Discussion

Various devices are used in single-port surgery, including SILS port™ (Covidien), Uni-X™, ^[1] and R-port™, ^[2] but they are only allowed for use in limited facilities. Also, the instrumentation may translate into increased costs. We performed single port surgery using the existing surgical devices. The 5-mm long type and short type ports decreased the interference with the port head. Furthermore, the airtight seal was maintained by placing wet absorbent gauze between the ports. The fixation of the glove with the port into the wound retractor maintained the airtight seal and afforded excellent mobility. There is a possibility that we have difficulty of operability which has been described as a real disadvantage of single port surgery. At that time, we should not hesitate to convert to procedure of standard multiport laparoscopic or open surgery. Merchant et al. ^[3] also reported their cases of cholecystectomy, hemicolectomy, gastrectomy, and oesophagectomy using Gelport. Similar to laparoscopic surgery, which has been widely used as a standard procedure, it is expected that single port surgery will be used worldwide. The procedure that we introduced here using existing surgical devices may be readily available, cost-effective, and useful.

References

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