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J Gastrointest Surg (2009) 13:159162 DOI 10.1007/s11605-008-0737-y
Transumbilical Gelport Access Technique for Performing Single Incision Laparoscopic Surgery (SILS)
Aziz M. Merchant & Michael W. Cook & Brent C. White &
S. Scott Davis & John F. Sweeney & Edward Lin
Received: 1 September 2008 /Accepted: 14 October 2008 /Published online: 30 October 2008 # 2008 The Society for Surgery of the Alimentary Tract
AbstractIntroduction Single incision laparoscopic surgery (SILS) is an area of active research within general surgery.
Discussion A number of procedures, including cholecystectomy, appendectomy, urologic procedures, adrenalectomy, and bariatric procedures, are currently being performed with this methodology. There is, as yet, no standard published technique for single-port access to the peritoneal cavity for SILS. We describe, herein, an access technique utilizing existing instrumentation including a Gelport and wound retractor that is reliable and easy. This technique has been used successfully at our institution for a number of single incision laparoscopic procedures.
Keywords Single incision laparoscopic surgery. Gelport .
Single-port access
Introduction
Single incision laparoscopic surgery (SILS), also known as laparoendoscopic single-site surgery or single-port access surgery, is an area of active investigation for abdominal surgery. A number of advantages have been proposed including cosmesis (scarless abdominal surgery performed through an umbilical incision), less incisional pain, and the ability to convert to standard multiport laparoscopic surgery if needed. Single incision cholecystectomy1 has been described by Piskun et al., as early as 1999 with the insertion of two trocars through the umbilical incision and additional stay sutures to stabilize the gallbladder. In addition, a number of recent reports of single-incision
donor nephrectomies2,3 and other urologic applications4,5 have been described, as well as single incision sleeve gastrectomies for morbid obesity.6
The primary disadvantages of SILS are the restricted degrees of freedom of movement, the number of ports that that can be used, and the proximity of the instruments to each other during the operationall of which increase the complexity and technical challenges of the operation. Many of these difficulties can be related to the technique of port placement and utilization during single incision laparoscopic surgery. A number of methods have been described for port access to perform SILS, including multiple fascial punctures through one skin incision, the use of additional transabdominal sutures to stabilize the...