single site umbilical laparoscopic surgery (ssuls)
DESCRIPTION
Single Site Umbilical Laparoscopic Surgery (SSULS). George W. Holcomb, III, M.D., MBA Surgeon-in-Chief Children’s Mercy Hospital Kansas City, MO. Open Surgery. Laparoscopic Surgery Less discomfort Reduced hospitalization Faster return to routine activities Cosmesis. SSULS - PowerPoint PPT PresentationTRANSCRIPT
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