Single-port laparoscopy : an assessment of safety and feasibility

Nowadays laparoscopic surgery is the standard procedure for many abdominal diseases. Compared with open surgery, laparoscopic surgery offers several advantages, such as reduction of postoperative pain, faster postoperative recovery and shorter admission times to the hospital. The continuous drive to further improve the surgical technique resulted in the development of new less invasive techniques like single-port laparoscopy. Single-port laparoscopic procedures are laparoscopic procedures using only one incision, which is usually transumbilical. At the site of this single incision a multiport device is placed, instead of multiple incisions with multiple ports through which the surgical instruments can be introduced. All instruments can be introduced in the abdomen through this multiport device. By using only one incision surgical trauma is further minimized and thereby further reducing postoperative pain and fasten postoperative recovery which is accompanied by a better cosmetic result. The first single-port laparoscopic procedure, an appendectomy, was performed in 1992. Five years later the first single-port laparoscopic cholecystectomy was performed. After several years the technique was introduced in the Netherlands. In 2010 the first single-port laparoscopic procedure was performed in the Jeroen Bosch Hospital. In the first three studies (Chapter II, III and IV) of this thesis the results of single-port laparoscopic procedures during the first years of its use in the Jeroen Bosch Hospital are described. The single-port technique was primarily introduced in less complex procedures. The fourth study presented in this thesis (Chapter V) describes the results of a cost-analysis of single-port laparoscopic procedures in the treatment of malignant colorectal diseases. Not only the single-port technique has been introduced to minimize surgical trauma, also robotics have been introduced. In the last study (Chapter VI) the results of the use of robotics in single-port laparoscopic cholecystectomies are presented. The use of robotics is feasible, but is encountered by technical challenges. Also high rates of incisional herniation were seen. The use of robotics is quite expensive. With the lack of convincing benefits and the high costs, the use of robotics cannot be justified for single-port laparoscopic cholecystectomies. Further research is needed for the use of robotics in more complex procedures. Single-port laparoscopy is becoming more accepted in the treatment of various diseases. The influence of single-port laparoscopy on cosmetic outcome and quality of life should be investigated as well as the cost effectiveness technique. In our strive to minimize surgical trauma single-port laparoscopy is a promising technique