Single Site Umbilical Laparoscopic Surgery

(SSULS)

George W. Holcomb, III, M.D., MBA

Surgeon-in-ChiefChildren’s Mercy Hospital

Kansas City, MO

Open Surgery

Laparoscopic Surgery

1) Less discomfort

2) Reduced hospitalization

3) Faster return to routine activities

4) Cosmesis

SSULS Cosmesis, but less

risky c/w NOTES

Open Surgery Laparoscopic Surgery

NOTES • Cosmesis, but

risks

• SILS (TM) - Single Incision Laparoscopic Surgery

• SPA (TM) - Single Port Access

• SSULS - Single Site Umbilical Laparoscopic Surgery (CMH)

• SIPES – Single Incision Pediatric Endosurgery (CH-A)

All use umbilicus as single site.

Acronyms

Umbilical Portals (U.S.)

SILS Port(Covidien)

Tri - Port(Olympus)

Umbilical Portals (U.S.)

SSULS Appendectomy

What Else Is Different?

Instruments are in-line and parallel to each other

Ideally, instruments/telescope should be different lengths

What Else Is Different?

Assistant/camera holder stands next to or behind the surgeon

What Else Is Different?Harder to operate

What Operations Are Being Done Using This SSULS Approach?

• Appendectomy

• Cholecystectomy

• Splenectomy

• Ileocecectomy

• Pyloromyotomy (CH-A)

• Fundoplication (CH-A)

• Others

SSULS Appendectomy

SSULS Appendectomy

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Postoperative Appearance

SSULS Cholecystectomy

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SSULS Splenectomy

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SSULS Splenectomy

SSULS Ileocecectomy

•Intracorporeal dissection/mobilization•Extracorporeal resection/anastomosis

CMH Experience

142 SSULS procedures:

• Appendectomy (103)

• Cholecystectomy (24)

• Splenectomy (2)

• Cholecystectomy/splenectomy (1)

• Ileocecectomy (8)

CAPS, 2010CAPS, 2010

ResultsResults

Procedure Additional ports Mean Op time (min)

Mean LOS (days) Complications

Appendectomy (103) 10 34+/-16 1 6

Cholecystectomy (24) 2 73+/-28 1.5 0

Splenectomy (2)

0 90+/- 6 1.5 0

Cholecystectomy/splenectomy

(1)0 116 1 0

Ileocecectomy (8) 0 86+/-22 5 0

CAPS, 2010CAPS, 2010

SIPESCH - ALABAMA

Appendectomy - 130

Pyloromyotomy - 32

Cholecystectomy - 32

Fundoplication - 6

Pull-through - 4204

Pediatr Surg Int 2010Pediatr Surg Int 2010

Conclusion

These series show that single site surgery is feasible, and appears to be associated

with acceptable operating times

Conclusion

Disadvantages

• Compromised degrees of freedom and triangulation

• Visualization limited by inline field of view and motion of instruments

• More difficult for the surgeon

Questions

• Do the benefits outweigh the risks?

• What are the benefits?

• Is there improved cosmesis?

• Prospective evidence needed• We are enrolling in 3 SSULS PRT’s

Appendectomy, Cholecystectomy, Splenectomy Validated scar assessment tool

Prospective Randomized Trials

Power 10 Outcome Analysis Variable

SSULS Appendectomy 360 (324) Infection

SSULS Cholecystectomy 60 (44) Operative time

SSULS Splenectomy 30 ( 5) Operative time

Other Variables Being Collected

• Pain

• Cost (hospital charges)

• Cosmesis (Validated Scar Assessment Tool)

www.centerforprospectiveclinicaltrials.com

www.cmhmis.com