title: Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study.
abstract: BACKGROUND
  The umbilicus can be considered as the embryological opening for single-access laparoscopic procedures. We report on single-access transumbilical laparoscopic appendectomy (SATLA) and cholecystectomy (SATLC), performed using new curved reusable instruments.
  
  
  METHODS
  A retrospective review of a prospectively maintained database of 30 patients who underwent SATLA and 20 patients who underwent SATLC between May and November 2009 was undertaken. All procedures were performed with an 11-mm nondisposable trocar for the scope, and curved reusable instruments (Karl Storz-Endoskope, Tuttlingen, Germany) placed transumbilically without trocars. Outcome measures were conversion to standard laparoscopy, operative time, scar length, complications, hospital stay, and use of pain medication.
  
  
  RESULTS
  All SATLA patients had acute appendicitis, and SATLC patients had symptomatic gallstones (15), chronic cholecystitis (3), and acute cholecystitis (2). No extraumbilical trocars were necessary. Mean total operative times were 57.3 ± 15.9 min (SATLA) and 73.9 ± 20.1 min (SATLC). Mean laparoscopic times were 39 ± 13.1 min (SATLA) and 57.5 ± 18.9 min (SATLC). Mean scar lengths were 14.8 ± 2.2 mm (SATLA) and 15.8 ± 2.3 mm (SATLC). Five SATLA patients and one SATLC patient developed postoperative complications. Mean hospital stay was 2.9 ± 1.3 days for SATLA patients and 1.8 ± 0.8 days for SATLC patients. Pain medication used was minimal. At the minimum follow-up of 3 months no late complications were registered.
  
  
  CONCLUSIONS
  SATLA and SATLC can be performed safely using curved reusable instruments, which helps avoid the conflict between the surgeon's hands or between the instruments' tips and allows the surgeon to operate in an ergonomic position. The reusable instruments kept the cost similar to that of classic laparoscopy.
authors.affiliation: Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322, Rue Haute, 1000 Brussels, Belgium. giovanni@dapri.net
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Casali
authors.forename: Hélène
authors.initials: H
authors.lastname: Dumont
authors.forename: Laurens
authors.initials: L
authors.lastname: Van der Goot
authors.forename: Leila
authors.initials: L
authors.lastname: Herrandou
authors.forename: Els
authors.initials: E
authors.lastname: Pastijn
authors.forename: Maurice
authors.initials: M
authors.lastname: Sosnowski
authors.forename: Jacques
authors.initials: J
authors.lastname: Himpens
authors.forename: Guy-Bernard
authors.initials: GB
authors.lastname: Cadière
mesh_terms: D000328:Adult; D001062:Appendectomy / Q000295:instrumentation* / Q000379:methods; D001064:Appendicitis / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D002764:Cholecystitis / Q000601:surgery; D002769:Cholelithiasis / Q000601:surgery; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013525:Surgical Instruments; D014472:Umbilicus; D055815:Young Adult
references.citation: J Pediatr Surg. 2007 Jun;42(6):1071-4
references.pmid: 17560223
references.citation: Surg Endosc. 2010 Jan;24(1):220
references.pmid: 19533241
references.citation: World J Surg. 2009 May;33(5):1015-9
references.pmid: 19116734
references.citation: J Gastrointest Surg. 2009 Feb;13(2):188-92
references.pmid: 19031097
references.citation: Indian J Gastroenterol. 2007 Jul-Aug;26(4):192
references.pmid: 17986755
references.citation: Surg Endosc. 2010 Mar;24(3):686-91
references.pmid: 19690912
references.citation: Surg Endosc. 2010 Aug;24(8):1842-8
references.pmid: 20174950
references.citation: Surg Endosc. 1998 Jul;12(7):997-1000
references.pmid: 9632879
references.citation: Surg Endosc. 2009 Aug;23(8):1825-30
references.pmid: 19169749
references.citation: Ann Surg. 1998 Apr;227(4):481-4
references.pmid: 9563533
references.citation: Eur J Surg. 1999 Jan;165(1):29-34
references.pmid: 10069631
references.citation: Cir Pediatr. 2007 Jan;20(1):10-4
references.pmid: 17489486
references.citation: Surg Endosc. 2010 Aug;24(8):1854-60
references.pmid: 20135180
references.citation: Surg Endosc. 2010 Jun;24(6):1374-9
references.pmid: 20039073
references.citation: HPB (Oxford). 2008;10(5):336-40
references.pmid: 18982149
references.citation: Eur J Pediatr Surg. 2002 Feb;12(1):24-7
references.pmid: 11967755
references.citation: Surg Endosc. 2010 Aug;24(8):1958-61
references.pmid: 20112110
references.citation: Surg Endosc. 2009 Apr;23(4):896-9
references.pmid: 18815836
references.citation: J Reprod Med. 1992 Jul;37(7):588-94
references.pmid: 1387906
references.citation: Surg Endosc. 2009 May;23(5):969-72
references.pmid: 19118419
references.citation: Surg Endosc. 2008 May;22(5):1211-3
references.pmid: 17943370
references.citation: Surg Endosc. 2009 Jun;23(6):1409-14
references.pmid: 19288157
references.citation: Rozhl Chir. 1996 Jan;75(1):15-8
references.pmid: 8768951
references.citation: Zentralbl Chir. 2004 Oct;129(5):391-5
references.pmid: 15486791
references.citation: Surg Endosc. 2002 May;16(5):833-5
references.pmid: 11997832
references.citation: Surg Endosc. 2009 Jul;23(7):1660-6
references.pmid: 19415381
references.citation: Surg Endosc. 2009 Apr;23(4):813-7
references.pmid: 18649097
references.citation: J Endourol. 2009 May;23(5):781-6
references.pmid: 19397426
references.citation: Surg Endosc. 2010 Jun;24(6):1403-12
references.pmid: 20035355
references.citation: Br J Surg. 1997 May;84(5):695
references.pmid: 9171771
references.citation: Surg Endosc. 2010 Aug;24(8):1861-5
references.pmid: 20108149
references.citation: Surg Innov. 2009 Sep;16(3):211-7
references.pmid: 19723692
references.citation: J Laparoendosc Adv Surg Tech A. 2009 Feb;19(1):75-8
references.pmid: 19196084
references.citation: Surg Endosc. 2009 Jul;23(7):1419-27
references.pmid: 19347400
references.citation: Surg Endosc. 2009 Jun;23(6):1393-7
references.pmid: 19118436
references.citation: J Laparoendosc Adv Surg Tech A. 1999 Aug;9(4):361-4
references.pmid: 10488834