Single Port Surgery

RealHand HD instruments uniquely enable the surgeon to reduce the number of trocars for surgery. RealHand facilitates single port laparoscopy by allowing triangulation of instruments even after they are introduced in the same point of entry. Many single port/single incision procedures are currently being performed entirely through the umbilicus, leaving no visible scar for the patient.

Single port surgery has evolved rather quickly. In May of 2007, Novare announced the first-ever Single Port Access (SPA) Lap Chole by Dr. Paul Curcillo of Drexel University School of Medicine. Adoption of the approach is occurring at a remarkably fast pace and an announcement was again made in December 07’, citing the 100th single port surgery performed with RealHand HD instruments. These ‘hidden scar’ procedures require a single skin incision, and are performed entirely through the patient’s belly button, either with a single larger trocar or several smaller ones. The goal is to reduce post operative pain, speed recovery and improve cosmetic results for the patient.

single_port

Since May 2007, a number of general surgeons, gynecologists and urologists have performed a succession of ‘first-ever’ single port procedures using RealHand HD instruments. To date, there have been a total of 15 different types of single port/single incision procedures performed. Such single port procedures include:

General Surgery
Single Port

Lap Chole	Lap Nissen
Lap Band	Lap Colectomy
Lap Splenectomy	Lap Appendectomy
Lap Heller Myotomy	Lap Hernia
Lap gastric tube placement

GYN Surgery
Single Port

Total Lap Hysterectomy (TLH)

Lap Oopherectomy

Lap Cyst excision

Urology
Single Port

Lap Nephrectomy

Lap Prostatectomy

Lap Pyeloplasty

The approach

Single port/single incision laparoscopic procedures have been performed utilizing several techniques. The single umbilical incision approach employing 3 small trocars making 3 fasciotomies was developed by Dr. Paul Curcillo and has been the most widely utilized. There are a variety of developing approaches as well which incorporate the use of flexible GI scopes/instruments in conjunction with RealHand. Further still has been the advent of a single trocar that allows for the insertion of the instruments and camera through a single incision. Whether the approach is through a single incision with multiple fasciotomies or if a single trocar is employed, one thing is clear: it is necessary to operate with instruments that offer dynamic movement. RealHand HD instruments provide the 7 degrees of freedom of movement to enable these procedures.

Why a single port/ single incision approach?

Potential advantages for the patient:

1) less post-op pain: fewer painful abdominal sticks
2) quicker recovery: less pain and fewer incisions
3) better cosmetic results: scar is hidden in the umbilicus

Potential advantages for the surgeon:

1) Enhanced approach

a) Reduce chance of port-site infection
b) Reduce incidence of ventral hernia
c) Reduce incidence of trocar-related injury

2) A more comfortable and ergonomic approach

a) Less arm movements
b) Operate from the same plane

3) Grow the surgical practice

a) Hidden scar surgery is attractive to patients

Potential advantages for the hospital:

1) Cost savings