Pioneers share experience with single-port access

Is single-opening surgery better?

One thing the robot has not yet performed, but articulated handheld laparoscopic instruments have, is single port access (SPA) surgery in which three or four trocars are placed within a single opening in the abdomen, usually the umbilicus.

Results of the first 100 cases were reported at the recent annual meeting of the Society of Laparo-endoscopic Surgeons by Paul Curcillo, MD, of Drexel University in Philadelphia. In those cases, Curcillo entered primarily the umbilicus with a 1.5-2 cm incision and placed three trocars within that incision to perform a variety of procedures.

Curcillo found that "operative times, results and outcomes were similar for comparable standard multiport procedures." He cautioned the audience that "long-term follow-up is necessary to ensure that no added complications occur later compared with standard multiple-port techniques." Curcillo suggests at least a two-year follow-up to monitor for hernia formation.

Curcillo also said initially he always used articulating instruments for SPA surgeries but found that for most procedures there is enough "independence of movement" with standard instruments. He now has an articulated instrument ready for each case, but he doesn't open it unless is it needed, which keeps down the costs.

Curcillo said, "All the SPA procedures are the same standard procedures, done in the same way. The only difference is the access. We don't change the game."

Currently, there are 25 surgeons trained to perform SPA surgery, with more signed up to learn from around the world.

Stephanie King, MD, also of Drexel, presented "Single-port access hysterectomy and oophorectomy," which also demonstrated the feasibility of performing surgery through the umbilicus, leaving virtually no scar; unlike laparoscopic surgery where there are three or four stab scars from the various ports used for trocars and cameras.

She compared two patient groups: one that had SPA surgery and the other that underwent standard laparoscopic surgery. She said, "Patient populations and surgical indications were similar in both groups. Operative times were comparable, as was blood loss and length of stay." King concluded that "early results comparing SPA procedures to standard multiport procedures demonstrate comparable results, but allow us to perform the procedures through a single incision concealed within the umbilicus."

Curcillo and King stressed the importance of maintaining the same standard dissection technique and doing the same procedure as always, just reducing the number of abdominal entry points to one. Both surgeons said they think that SPA surgery is a viable, cost-conscious alternative to multiport surgery. SPA surgery allows the surgeon to perform the same procedure, with the same outcome, and at the same cost, but gives the patient only one hidden scar in the bellybutton.