title: Single-incision multiport laparoendoscopic surgery using a newly developed short-type flexible endoscope: a combined procedure of flexible endoscopic and laparoscopic surgery.
abstract: OBJECTIVE
  We hypothesized that using a flexible endoscope as a working scope in laparoscopic surgery through a single incision might provide many benefits. To this end, a short-type flexible endoscope with a working length of 600 mm was newly developed. In this animal experimental study, we aimed to evaluate the technical feasibility of our new approach, single-incision multiport laparoendoscopic (SIMPLE) cholecystectomy, using this endoscope.
  
  
  METHODS
  Eight pigs were subjected to SIMPLE cholecystectomy using the short-type flexible endoscope. The endoscope was inserted through a 12-mm trocar in an SILS Port followed by the insertion of two additional 5-mm trocars in the SILS Port. Encirculation and ligation of the pedicle of the cystic artery and duct were carried out using laparoscopic instruments through the 5-mm trocars, while the dissection of the gallbladder from the intrahepatic fossa was predominantly performed using a cutting device through the endoscope.
  
  
  RESULTS
  A complete gallbladder excision, with complete encirculation and ligation of the pedicle, was completed in all cases. The mean operating time was 58 min (range 34-78 min). The endoscope provided a good view of the operating field, and it allowed some degree of freedom to the working laparoscopic instruments without compromising the field of view. Dissection of the gallbladder using the cutting device through the endoscope was much easier than that using the laparoscopic device, because the articulating instruments together with the endoscope enabled operation with triangulation. Furthermore, the water-jet and suctioning functions and the self-cleaning lens capability of the endoscope served the surgery well.
  
  
  CONCLUSIONS
  SIMPLE cholecystectomy using the newly developed short-type flexible endoscope is a technically feasible procedure. Using this flexible endoscope for various tasks, such as resection, suctioning, and smoke evacuation, can make the surgical procedures easier.
authors.affiliation: Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan. abenbtg@ks.kyorin-u.ac.jp
authors.forename: Nobutsugu
authors.initials: N
authors.lastname: Abe
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Atsuko
authors.initials: A
authors.lastname: Ohki
authors.forename: Hisae
authors.initials: H
authors.lastname: Aoki
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Masaki
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Mori
authors.forename: Masanori
authors.initials: M
authors.lastname: Sugiyama
mesh_terms: D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D019723:Endoscopes; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D013552:Swine