Single-Port Laparoscopic Surgery

Laparoscopic surgery is associated with decreased blood loss, more rapid postoperative recovery, less pain, shorter hospital stays, and improved oncologic outcomes when compared to the open surgery approach [1]. Until recently, multi-port laparoscopic surgery (MPL) was the mainstay of minimally invasive surgery [2]. Single-port laparoscopic surgery (SPL) has emerged as an innovative surgical technique that minimizes the number of skin incisions and ports required for surgery [3]. 

The fundamental idea of SPL is to have all of the laparoscopic working ports entering the abdominal wall through the same incision, generally the patient’s navel [5]. In contrast, MPL involves multiple incisions, usually following the principle of triangulation [1]. SPL has been frequently used for appendectomy, sleeve gastrectomy, splenectomy, and colectomy [2]. Several studies have shown SPL to be superior to MPL, mainly in regard to postoperative pain and cosmetic result [4]. A 2017 meta-analysis examined 37 randomized control trials comparing MPL to SPL in adult patients with benign gallbladder disease [6]. The researchers reviewed 3,051 patients to determine variables including body image, cosmesis scores, and postoperative pain scores [6]. The data suggested that SPL was associated with better outcomes in terms of cosmesis, body image, and postoperative pain when compared to MPL [6]. 

SPL has been shown to be safe and effective in the treatment of many other conditions. It is associated with better short-term results than MPL in terms of less severe pain in the treatment of gastric cancer [1]. SPL is also used in colectomies, in which it is associated with decreased blood loss and shorter length of hospital stay [2]. SPL has also shown subtle benefits compared to MPL in appendectomies [7]. Both SPL and MPL appear to be feasible and effective techniques for the removal of an appendix due to acute appendicitis, but SPL is more likely to produce ideal cosmetic results [7]. 

Some disadvantages to SPL are that it requires a learning curve, adequate technology, and longer operating time [2]. Other reported difficulties include the propensity for instrument collisions and lack of triangulation [1,2]. One of the major principles of standard MPL is correct port placement and triangulation [7]. This principle allowed for ideal ergonomics during surgery [7]. Triangulation is not possible during SPL, creating a technical obstacle for surgeons trained in using the standard MPL technique [7]. For these reasons, MPL remains more common worldwide [1]. 

The concept of performing laparoscopic surgery via a single incision is rapidly gaining support among patients and surgeons [3]. Several studies have indicated that SPL is a safe procedure for the treatment of various diseases, with postoperative outcomes similar to that of standard MPL [1-3]. Although SPL presents many benefits, including less incisional pain and postoperative scarring, it does have some disadvantages [5]. When deciding between SPL and MPL, it is important for surgeons to carefully weigh the benefits and challenges of each procedure to ensure the best postoperative outcome.  

References 

  1. Omori, T., Yamamoto, K., Hara, H. et al. (2020). A randomized controlled trial of single-port versus multi-port laparoscopic distal gastrectomy for gastric cancer. Surgical Endoscopy. doi:10.1007/s00464-020-07955-0 
  1. Luján, J., Soriano, M., Abrisqueta, J. et al. (2015). Single-Port Colectomy vs Multi-Port Laparoscopic Colectomy. Systematic Review and Meta-Analysis of More Than 2800 Procedures. Cirugía Española (English Edition), 93(5), 307-319. doi:10.1016/j.cireng.2014.11.007 
  1. Romanelli, J., & Earle, D. (2009). Single-port laparoscopic surgery: an overview. Surgical Endoscopy, 23(7), 1419-1427. doi:10.1007/s00464-009-0463-x 
  1. Raakow, J., Klein, D., Barutcu, A. et al. (2020). Single-port versus multiport laparoscopic surgery comparing long-term patient satisfaction and cosmetic outcome. Surgical Endoscopy, 34(12), 5533-5539. doi:10.1007/s00464-019-07351-3 
  1. Saeed, S., & Miraj, S. (2016). Single-incision laparoscopy surgery: a systematic review. Electronic Physician, 8(10), 3088-3095. doi:10.19082/3088 
  1. Haueter, R., Schütz, T., Raptis, D. et al. (2017). Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. British Journal of Surgery, 104(9), 1141-1159. doi: 10.1002/bjs.10574 
  1. Pisanu, A., Porceddu, G., Reccia, I. et al. (2013). Meta-analysis of studies comparing single-incision laparoscopic appendectomy and conventional multiport laparoscopic appendectomy. Journal of Surgical Research, 183(2), e49-e59. doi:10.1016/j.jss.2013.03.038