Opening Ceremony & Welcome Reception - Wednesday, February 1, 2012 Kick off the summit with the Opening Ceremony, followed by an informal reception. Open to all registrants.
Surgical Surprises and Video Session - Thursday, February 2, 2012 In this unusual video format, a multispecialty panel of invited experts will invoke their specialty backgrounds in discussing surgical accidents, mishaps, and surprises with attention given to lessons learned and appropriate action/reaction.
SLS Luau Under the Stars - Thursday, February 2, 2012
Get involved. Join the AsianAmerican MultiSpecialty Summit V–Laparoscopy and Minimally Invasive Surgery Organizing Committee. Organizing Committee members receive a reduced registration fee and are asked to assist in the selection of presentation topics and representative organizations at this multicultural, multispecialty conference. To request participation on the committee, please complete the organizing committee form. Click here to read more about the Summit.
ASIANAMERICAN MULTISPECIALTY SUMMIT: A DIVERSE PROGRAM COVERING INNOVATIVE TECHNIQUES
WILLIAM E. KELLEY, JR., MD
SLS members attending the AsianAmerican MultiSpecialty Summit III in Honolulu were treated to an excellent and diverse program of scientific as well as cultural presentations. We learned about endoscopic breast surgery in India, multiple approaches to laparoscopic colon surgery (including robotic), complex laparoscopic surgery for endometriosis, the varied surgical presentations of tuberculosis, robot-assisted laparoscopic aortoiliac surgery, and complex advanced laparoscopic surgery through a single 18-mm umbilical incision.
Dr. Paul Curcillo and his colleagues from Drexel University presented their multidisciplinary experience with single-port access (SPA) laparoscopic surgery, also known as single-incision laparoscopy (SIL). Laparoscopic gallbladder, foregut, and gynecologic procedures were described in detail. Other current applications include urologic, colorectal, hernia, and spleen surgery.
The multidisciplinary applications of SPA are expanding, and the potential significance of the technique is yet to be recognized. Safety and efficacy studies of SPA are underway in many institutions. The technique has potential incremental advantages over traditional MIS for cosmesis, wound infection, postoperative pain (especially in upper abdominal surgery), and recuperation. Specialized disposable and reusable instruments are being produced to facilitate SPA, but no major capital investments are required. Many advanced laparoscopic procedures are being performed via SPA using traditional laparoscopic instruments, thus keeping costs competitive with costs for traditional MIS. Traditional laparoscopic 2-handed dissection, ablation, and suturing techniques are utilized, so surgeon training in SPA should be much less painful than the transition from open surgery to traditional laparoscopic surgery in the early 1990s was. Most procedures are currently being carried out using a 5-mm camera trocar and two 5-mm working trocars, all introduced through one peri-umbilical incision. A flexible, radially dilating, 3- or 4-channel port could certainly be envisioned for the near future.
Much attention is being paid to totally incision-free, natural orifice translumenal endoscopic surgery (NOTES). This surgery, presently experimental, has the potential for more significant improvement in cosmesis, skin infections, hernias, postoperative pain, and recuperation. NOTES must be distinguished from fully endolumenal, natural orifice surgery (NOS), such as cystoscopic, colonoscopic, transanal, and endoscopic procedures carried out within a hollow structure. NOTES technology, by contrast, is designed to produce an opening in an unrelated organ which must be safely and reliably repaired at the end of the procedure. In NOTES, a highly specialized, sophisticated instrument is passed through an incision in the stomach, vagina, bladder, or colon to access the peritoneal cavity, thus upgrading the potential severity of complications as a result of the entry process. Animal studies are underway in many institutions evaluating the risks of transluminal entry of this kind and attempting to develop the optimal endoscopic closure technique , as well as the ideal endoscopic vehicle and effector instruments. As of July, 2008, seven clinical papers have been published describing experience with 10 peritoneoscopies , 3 appendectomies , 1 cholecystectomy , and 1 repair of a dislodged PEG tube , four cholecystectomies , and two hybrid studies of one cholecystectomy with two 3 mm umbilical trocars , and three cholecystectomies with a 5mm left upper quadrant trocar . It is widely recognized that substantial technological development and years of experience in dedicated centers will be needed to evaluate and perfect NOTES technology.1 As the instrumentation evolves, safety and efficacy studies will be needed followed by extensive outcome studies comparing NOTES results with results for traditional MIS.
In the meantime, SPA has a much stronger potential to be safely learned by experienced laparoscopic surgeons and may offer some advantages over traditional MIS with comparable cost. Practicing surgeons and community hospitals that are so inclined should be able to acquire the skills and instrumentation and offer patients this alternative to NOTES during the early developmental phase of the translumenal procedures. SPA may serve as a bridge, a transition, an adjunctive safety procedure, or ultimately an alternative to NOTES. Comparative outcome studies among all of these techniques will be critically important.
SLS is indeed fortunate to have hosted the first presentation of single-port access surgery at a national meeting, delivered by Dr. Curcillo at the SLS Cyber Café during the San Francisco meeting in 2007. The first scientific paper presentations were performed by Dr. Curcillo and his colleagues at the AsianAmerican MultiSpecialty Summit in February. They have submitted 4 papers for the SLS Meeting and EndoExpo in Chicago this September discussing SPA hysterectomy and oophorectomy, SPA colon resection, their first 100 SPA cholecystectomies, and 1-year follow-up for their early cohort of SPA cholecystectomies. Dr. Dan Geisler will also be presenting Single-Port Laparoscopic Colectomy in Chicago.
William E. Kelley, Jr., MD, President of the Society of Laparoendoscopic Surgeons, is the Director of General Surgery for the Minimally Invasive Surgery Center of Virginia. He is in private practice with The Richmond Surgical Group in Richmond, Virginia, and serves on the clinical faculty at the Medical College of Virginia. Dr. Kelley serves on the editorial board of JSLS. He has contributed over one hundred-fifty papers and presentations in the fields of surgical oncology, minimally invasive surgery, image guided breast surgery, and robot-assisted surgery, and textbook chapters in laparoscopic antireflux, colon and spleen surgery.
Correspondence: William E. Kelley, Jr., MD, 8921 Three Chopt Rd, Ste 300, Richmond, VA 23229, USA. Telephone: 804 285 9416, Fax: 804 285 0840, Email: Bill.Kelley@Earthlink.com
1. Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ. A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery, experimental models, techniques, and applicability to the clinical setting. Ann Surg. 2008;247;583-602.
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.