Clinical Application Of Transumbilical Single Port Surgery

Background and objective:Surgical operation is an important component in disease therapy in modern clinical medicine, but exogenous wound is usually inevitable to the human body. In the history of abdomen surgery, as to relieving trauma caused in procedures, hundreds of doctors had made efforts to change their surgical programs and improve surgical skills, however, the results were not satisfactory. Until the late 1980s, laparoscopic surgery was successful in decreasing surgical wounds, which satisfied human desire of minimally invasive operations, after that, the Minimally Invasive Surgery(MIS) came to the world. In 21st century, MIS leads one of the trends of the modern medical field. With the development of MIS techniques and instruments, some scholars suggest"no scar"techniques based on laparoscopic and endoscopic surgery. Among"no scar"techniques are two representatives ,one is the natural orifice transluminal endoscopic surgery (NOTES),the other is the single incision laparoscopic surgery (SILS).As the major branches of SILS, transumbilical laparoendoscopic single-site surgery(U-LESS)has performed fast progress. Operators can make excellent cosmetic results by hiding scars into the umbilicus which seems to be the natural scar of the human body. Compared to NOTES, U-LESS avoids open and closing of the natural orifice, makes the operation easier and lowers the expenses through applying conventional laparoscopic instruments, meanwhile avoids celiac infections and complications such as fistula etc. Therefore, U-LESS receives widespread attention in recent years.This study is to investigate the safety and feasibility of the transumbilical single port laparoscopic surgery, in which providing an objective evidence for its better implementing in clinical medicine. Methods:A retrospective review of 66 patients undergoing laparoscopic cholecystectomy(LC) and laparoscopic appendectomy(LA) between September 2009 and September 2010 in general surgery department of 2th Affiliated Hospital of Shantou University Medical College was performed. Of the 66 patients, 30 patients underwent conventional LC and 12 patients underwent transumbilical single port LC; 10 patients underwent conventional LA, 8 patients underwent transumbilical single port LA. Cosmetic results, length of operating time, intraoperative bleeding, time of postoperative bowel recovery, length of hospital stay, total expenses and postoperative complications were compared .Results:Transumbilical single port(TUSP) procedures got better cosmetic results compared to conventional laparoscopic procedures for their scars hiding well into the umbilicus which was even hard to indentify. TUSP procedures were not significant with conventional laparoscopic procedures in intraoperative bleeding, time of postoperative bowel recovery, length of hospital stay and total expenses, p>0.05. All the patients did not have any intraoperative or postoperative complications occur. The operating time of TUSPLC was longer than that in conventional LC, which was(123.61±30.19min vs. 59.63±12.04min, p<0.01),as the same as above, the operating time of TUSPLA was also longer than that in conventional LA, which was(109.43±17.24min vs. 46.30±9.25min, p<0.01). The operating time of TUSP procedures was decreasing due to the accumulation of cases and experience, which was even closing to the conventional laparoscopic procedures. Conclusion:TUSPLC and TUPLA are safe and feasible, which clinical outcome are as the same as the conventional laparoscopic surgery. Based on making scarless of the abdominal wall, U-LESS brings more obvious cosmetic results than conventional laparoscopic surgery, which attracts young patients. U-LESS will be further popularized by the upgrade of operative skills and the reduction of operating time.