FROM THE ASIANAMERICAN MULTISPECIALTY SUMMIT III, FEBRUARY 6–9, 2008
STEPHANIE A. KING, MD, ATA ATOGHO, MD, ERICA PODOLSKY MD, PAUL G. CURCILLO II, MD
Laparoscopic techniques have been widely accepted in gynecologic surgery since the 1960's facilitating easier dissection and visualization in the confines of the pelvis. A variety of procedures have become the standard of care making sometimes difficult open procedures safer and quicker. In the 1970's, the single arm operative scope was employed for tubal ligations. This scope required a single abdominal port of entry and allowed one rigid functional instrument to be inserted alongside the scope. Its use was limited in other procedures by the rigidity of the instruments. A single port access (SPA) surgical technique has been developed at our institution. Using one umbilical incision with articulating instrumentation, this technique reduces surgical scarring while broadening the variety of procedures to be performed through a single incision.
Five SPA bilateral salpingoophorectomies were performed at our institution. A transverse umbilical incision following the medial fold was used as the portal of entry for all five procedures. A 5 mm trocar was inserted at the midline for a 5 mm scope. Skin flaps were raised laterally allowing for two 5 mm accessory trocars to be inserted inferior and lateral to the initial trocar. Using the accessory trocars the round ligament and infundibulopelvic ligaments were transected. The suspensory ligament, fallopian tube, and mesosalpinx were then dissected. The ovary was removed through the umbilicus. The same procedure was repeated on the opposite side. The fascia was closed using 0 Vicryl and the skin with a running 4 Vicryl subcuticular stitch.
All five women tolerated the procedure well. Operative time and length of stay were comparable to the traditional multiple port procedures. Postoperative recovery was uneventful. No complications were encountered. Cosmetic results were excellent with scars being hidden in the umbilicus.
Gynecologic surgery was among the first surgical specialties to adopt minimally invasive surgery. Improved visualization allows for easier dissection of the tight pelvic anatomy. Laparoscopy also allows for reduction of surgical scarring.
In the 1970's the single arm operative scope further reduced operative scarring by utilizing a single incision at the umbilicus. This technique was limited because only one instrument could be inserted alongside the scope. A single eyepiece was used for visualization restricting this procedure to single operator.
Single port access (SPA) surgery uses the umbilicus for a single portal of entry into the abdominal cavity. In more difficult dissection, articulating instruments allowed us to maintain the procedure as a single port technique. The technique of dissection is the same as being done in standard pelvic minimally invasive surgeries. Although the articulating instruments were not necessary for all procedures their availability facilitated difficult dissections.