J Korean Surg Soc.  2013 Jun;84(6):360-366. 10.4174/jkss.2013.84.6.360.

Transumbilical scarless surgery with thoracic trocar: easy and low-cost

Affiliations
  • 1Department of Pediatric Surgery and Pediatric Urology, Dicle University Faculty of Medicine, Diyarbakir, Turkey. iuygun@hotmail.com

Abstract

PURPOSE
Single-site laparoscopic surgery has become increasingly common. We herein report an easy and low-cost thoracic trocar technique (TTT) for these types of procedures and recommend the simpler name "transumbilical scarless surgery" (TUSS) to minimize confusion in nomenclature.
METHODS
We retrospectively reviewed patients who underwent TUSS by TTT using a thoracic trocar and surgical glove in our hospital between November 2011 and November 2012. Operating time, postoperative stay, and complications were detailed.
RESULTS
A total of 101 TUSS by TTT were successfully performed, comprising appendectomy (n = 63), ovarian cyst excision (n = 7), splenectomy (n = 5), nephroureterectomy (n = 5), orchidopexy (n = 4), pyeloplasty (n = 3), nephrolithotomy (n = 2), orchiectomy (n = 2), varicocelectomy (n = 2), lymphangioma excision (n = 2), ureterectomy (n = 1), Morgagni diaphragmatic hernia repair (n = 1), ovarian detorsion (n = 1), antegrade continence enema (n = 1), intestinal resection anastomosis (n = 1), and intestinal duplication excision (n = 1). Kirschner wires were used for some organ traction. Nine patients required an additional port, but no major complications occurred. The postoperative stay (mean +/- standard deviation) was 3.2 +/- 1.4 days, and operating time was 58.9 +/- 38.3 minutes.
CONCLUSION
We recommend the simpler name of TUSS to minimize confusion in nomenclature for all transumbilical single-incision laparoendoscopic surgeries. TTT is an easy and low-cost TUSS technique.

Keyword

Minimally invasive surgical procedures; Laparoscopy; Appendectomy

MeSH Terms

Appendectomy
Bone Wires
Enema
Female
Gloves, Surgical
Hernia, Diaphragmatic
Humans
Laparoscopy
Lymphangioma
Orchiectomy
Orchiopexy
Ovarian Cysts
Retrospective Studies
Splenectomy
Surgical Instruments
Surgical Procedures, Minimally Invasive
Traction

Figure

  • Fig. 1 Transumbilical scarless surgery for appendectomy by the thoracic trocar technique constructed with the standard 10.5-mm threaded thoracic trocar (A), surgical glove, and conventional instruments (B).

  • Fig. 2 (A) Thoracic trocars (10.5- and 15-mm) and reusable laparoscopic trocars. (B) Thoracic trocar technique for transumbilical scarless surgery requires three instruments constructed with the standard 15-mm threaded thoracic trocar.

  • Fig. 3 Transumbilical scarless surgery for nephrolithotomy. (A) Four kidney stones on a plain X-ray. (B) Extraction of the larger stone using a second imaging system with a cystoscope and basket catheter (LK, left kidney). (C) After 2 days, the scar is nearly gone (arrow, second 5-mm port entry).

  • Fig. 4 Transumbilical scarless surgery for nephroureterectomy. (A) Traction of the ureter by a Kirschner wire (arrow). (B) Fixation of the wire onto the abdominal wall (arrow). (C) After 1 month, there is no scar.


Reference

1. Pelosi MA, Pelosi MA 3rd. Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med. 1992. 37:588–594.
2. Esposito C. One-trocar appendectomy in pediatric surgery. Surg Endosc. 1998. 12:177–178.
3. Garey CL, Laituri CA, Ostlie DJ, St Peter SD. A review of single site minimally invasive surgery in infants and children. Pediatr Surg Int. 2010. 26:451–456.
4. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008. 54:1020–1029.
5. Akgur FM, Olguner M, Hakguder G, Ates O. Appendectomy conducted with Single Port Incisionless-Intracorporeal Conventional Equipment-Endoscopic Surgery. J Pediatr Surg. 2010. 45:1061–1063.
6. de Armas IA, Garcia I, Pimpalwar A. Laparoscopic single port surgery in children using Triport: our early experience. Pediatr Surg Int. 2011. 27:985–989.
7. Muensterer OJ, Keijzer R. Single-incision pediatric endo-surgery-assisted ileocecectomy for resection of a NEC stricture. Pediatr Surg Int. 2011. 27:1351–1353.
8. Alkhoury F, Burnweit C, Malvezzi L, Knight C, Diana J, Pasaron R, et al. A prospective study of safety and satisfaction with same-day discharge after laparoscopic appendectomy for acute appendicitis. J Pediatr Surg. 2012. 47:313–316.
9. Stylianos S, Nichols L, Ventura N, Malvezzi L, Knight C, Burnweit C. The "all-in-one" appendectomy: quick, scarless, and less costly. J Pediatr Surg. 2011. 46:2336–2341.
10. Park J, Kwak H, Kim SG, Lee S. Single-port laparoscopic appendectomy: comparison with conventional laparoscopic appendectomy. J Laparoendosc Adv Surg Tech A. 2012. 22:142–145.
11. Bi Y, Lu L, Ruan S. Using conventional 3- and 5-mm straight instruments in laparoendoscopic single-site pyeloplasty in children. J Laparoendosc Adv Surg Tech A. 2011. 21:969–972.
12. Jung GO, Park DE, Chae KM. Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution. J Korean Surg Soc. 2012. 83:374–380.
13. Koo EJ, Youn SH, Baek YH, Roh YH, Choi HJ, Kim YH, et al. Review of 100 cases of single port laparoscopic cholecystectomy. J Korean Surg Soc. 2012. 82:179–184.
14. Kim HO, Yoo CH, Lee SR, Son BH, Park YL, Shin JH, et al. Pain after laparoscopic appendectomy: a comparison of transumbilical single-port and conventional laparoscopic surgery. J Korean Surg Soc. 2012. 82:172–178.
15. Lee JS, Choi YI, Lim SH, Hong TH. Transumbilical single port laparoscopic appendectomy using basic equipment: a comparison with the three ports method. J Korean Surg Soc. 2012. 83:212–217.
16. Hong TH, You YK, Lee KH. Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc. 2009. 23:1393–1397.
17. Khiangte E, Newme I, Phukan P, Medhi S. Improvised transumbilical glove port: a cost effective method for single port laparoscopic surgery. Indian J Surg. 2011. 73:142–145.
18. Day W, Lau P. Novel "glove" access port for single port surgery in right hemicolectomy: a pilot study. Surg Laparosc Endosc Percutan Tech. 2011. 21:e145–e147.
19. Won Lee J, Arkoncel FR, Rha KH, Choi KH, Yu HS, Chae Y, et al. Urologic robot-assisted laparoendoscopic single-site surgery using a homemade single-port device: a single-center experience of 68 cases. J Endourol. 2011. 25:1481–1485.
20. Martinez-Ferro M, Duarte S, Laje P. Single-port thoracoscopy for the treatment of pleural empyema in children. J Pediatr Surg. 2004. 39:1194–1196.
21. Cuesta MA, Berends F, Veenhof AA. The "invisible cholecystectomy": a transumbilical laparoscopic operation without a scar. Surg Endosc. 2008. 22:1211–1213.
22. Bayazit Y, Aridogan IA, Abat D, Satar N, Doran S. Pediatric transumbilical laparoendoscopic single-site nephroureterectomy: initial report. Urology. 2009. 74:1116–1119.
23. Agrawal V, Bajaj J, Acharya H, Chanchalani R, Raina VK, Sharma D. Laparoscopic management of pediatric renal and ureteric stones. J Pediatr Urol. 2013. 9:230–233.
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