Single Port Access (SPA™) Cholecystectomy: A Completely Transumbilical Approach

Abstract

We have seen substantial changes in minimally invasive surgery since its development in the early 1900s. Over the past 10 years, the addition of natural orifice transluminal endoscopic surgery and robotics has turned our attention to improved cosmesis and advancements in instrumentation. We have developed a new technique-single port access (SPA) surgery-and have applied it to the cholecystectomy. In this paper, we present and review the application of this access technique to the first 5 consecutive patients that underwent an SPA cholecystectomy. All 5 patients were female, with an average age of 45 years and an average weight of 172 pounds. Indications included biliary dyskinesia and symptomatic cholelithiasis. Average operative time was 121 minutes in these initial 5 cases. All but 1 patient was discharged in 24 hours. At 6 months, no umbilical hernias were observed. This new technique allows for a complete cholecystectomy to be performed entirely through the umbilicus without the need for additional retraction sites or transabdominal sutures. This procedure utilizes the same basic technique of the laparoscopic cholecystectomy already employed by general surgeons. Therefore, the SPA cholecystectomy can be readily learned and performed by many surgeons without the need for expensive or experimental equipment. Using a single portal of entry to the abdominal cavity, the umbilicus, cosmesis, and scar reduction is achieved.

Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases

“…Our initial concerns in the early development of SPA cholecystectomy were the increased difficulty, costs, and concerns of safety [8]. We then enhanced the technique to address each of these concerns [17].…”

“…In April 2007, using a novel approach, laparoscopic cholecystectomy was performed successfully through a single portal of entry [8]. Since its inception, single-portaccess (SPA) surgery has been applied to a number of minimal access surgical procedures using the umbilicus as the only portal of entry [9].…”

Single Port Versus Multiple Port Laparoscopic Cholecystectomy—A Comparative Study

“…This was further described by Piskun and Rajpal [3]. This was further refined and popularized by Castellucci et al [4] and Podolsky et al [5] and published subsequently with their original technique of entry. In their techniques, a skin incision was made at the umbilicus, allowing a flap at the umbilicus to be raised.…”

Transumbilical single-port laparoscopic cholecystectomy using traditional laparoscopic instruments: a report of thirty-six cases

“…Three methods could be adopted to solve the problem: (1) Hanging the cholecystic bottom to the right subcostal abdominal wall by one to three percutaneous sutures could provide adequate working room and the assistant trocar can be moved from the transumbilical incision (Philipp et al, 2009); (2) Using a Triport trocar or self-made apparatus, such as sterile gloves (Romanelli et al, 2008); (3) Using articulating instruments (Podolsky et al, 2009), such as flexible-tip laparoscope (Elazary et al, 2009) and articulating grasper. This reduces operative difficulty, but increases operation fees.…”