04/12/23The Mount Sinai Hospital of Queens 1

Minilaparoscopy as an Alternative to Natural Orifice Surgery

Daniel Tsin, MD Dawar Mahmood, MDPanagiotis Manolas , MDJoan Padouvas, MD

04/12/23The Mount Sinai Hospital of Queens 2

Objective

• Present the use of the suprapubic port as an alternative to the operative Culdolaparoscopy , MANOS and NOTES.

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Advantages

• Smaller nearly invisible scars

• Can be used in male and females

• Can be used in females with narrow vaginas, obliteration of the cul-de-sac or when the surgeon is not credentialed in colpotomy

• Less time to close port sites

• Avoids umbilical hernias(umbilicus is the weakest part of the abdominal wall)

• Less pain

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Trocar Type Fascial Closure

2 mm MiniSite* Introducer NO

5 mm NO10 mm (below the level of the

Umbilicus)YES

10 mm (above the level of the Umbilicus) NO

12 mm YES

15 mm YES

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Relative Contraindications

• Body Habitus Height greater than six feet

• Acute Cholecystitis (not attempted)

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Method and Port Placement for Laparoscopic Appendectomy

• 2.8mm Umbilical port

• 2.8mm Left lower quadrant port

• 12mm Suprapubic port

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Method and Port Placement Laparoscopic Cholecystectomy

• 2.8mm Subxyphoid port

• 2.8mm Umbilical port

• 2.8mm Right upper quadrant port

• 10mm Suprapubic port

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•Placement of the 2,8 mm Umbilical Port

•Placement of the 2,8 mm Umbilical Port

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•Three 2,8 mm ports and a 12 mm suprapubic port

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•Gallbladder extraction via a suparapubic port

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Conclusion

• As an alternative to a vaginal port.

• Could be use in males and females

• Reference: Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P. Operative Culdolaparoscopy : A New Approach Combining Operative Culdoscopy and Minilaparoscopy. JAAGL 2001:8;438-441

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Results

• 4 Appendectomies

• 7 Cholecystectomies (elective)

• Were performed without complications and with operative times comparable to traditional laparoscopic surgeries