Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.
| THE CUTTING EDGE: INTRODUCING REDUCED PORT LAPAROSCOPIC SURGERY
Figure 2. Single incision laparoscopic surgery (SILS) access system
Figure 3. Triport+ access system for laparo-endoscopic single- site surgery (LESS)
Nomenclature Since the first description of SPA cholecystectomy,Ç
Figure 4. GelPOINT access system
a
wide array of commercially available multitrocar ports have become available. This has led to two platforms available for reduced port surgery. These platforms come with their own acronyms as well; hence, the commercial entities who have developed these ports have adopted their own trademark nomenclature for the laparoscopic techniques used through their mul- titrocar ports. Currently, the two platforms are the: UÊ-in}liÊ«oÀÌÊ>VViÃÃÊ-* ®ÊÌiVhniµÕiÊ«l>ÌvoÀm UÊ-in}liÊ«oÀÌÊ`iÛiViÊ«l>ÌvoÀmðÊÊ The SPA technique maintains use of standard instru-
ments and multiple trocars inserted through a single skin incision (ie, port of entry) with multiple fascial incisions within the abdominal wall. The single port device platforms utilize novel multitrocared ports that can be placed through a larger fascial incision. iÃVÀi«ÌionÃÊ voÀÊ ÌhiÊÕÃiÊovÊ VommiÀVi>llÞÊ >Û>il>LliÊ
multitrocar ports are present throughout the human laparoscopic literature and include but are not limited to:
UÊ- -TMÊ«oÀÌÊ-in}liÊ nViÃionÊ >«>ÀoÃVo«iVÊ-ÕÀ}iÀÞ®ÆÊ covidien.com (Figure 2)
UÊ/Ài*oÀ̳TM access system for laparo-endoscopic
Ãin}li-ÃiÌiÊ ÃÕÀ}iÀÞÊ --®ÆÊ olÞm«ÕÃ>miÀiV>°VomÊ (Figure 3)
UÊÊ il*" /TM access system; appliedmedical.com (Figure 4).
At present, all techniques (SPA and single port device
platforms) have been demonstrated to be equally as effective in humans with respect to operative times, outcomes, and complications compared to multiport laparoscopy. There has not been a strong demonstration showing any benefit in terms of pain, recovery, or return to activity compared to multiport laparoscopy.
16 Today's Veterinary Practice January/February 2012
SINGLE PORT ACCESS TECHNIQUE PLATFORM nÊÓääÇ]Ê-* ÊinÌÀo`ÕVi`Ê>ÊnoÛilÊ>««Ào>VhÊÌoÊ>L`omi-
nal entry for human laparoscopic procedures. A sin- gle, often concealed, skin incision through the umbil- licus5
wide variety of human surgical procedures have been successfully performed, and oophorectomy.9
School of Veterinary Medicine reported on the suc- cessful use of the SPA technique in canine patients.6 SPA maintains standard instrumentation and tech- niques and cost control, while preserving safe dissec- tion techniques defined by multiport laparoscopy.£ä]££ With the SPA technique, the large triangle of trocar positioning seen in multiport laparoscopy is simply moved—the trocars are arranged in a smaller triangle completely within a single incision.
SWITCHING TO THE SPA SURGICAL TECHNIQUE The SPA surgical technique introduces an innovative approach to abdominal entry and trocar placement through a single skin incision. This technique is based on standard exposure and dissection of multiport laparoscopy. It requires the surgeon to learn only one new method of access and then become comfortable performing the familiar dissection and surgical techniques with a new arrangement of standard, familiar instruments in close proximity.5,7,10
(generally < 18 mm in length) was used and a including cholecystectomyÇÊ
Veterinary Patients nÊ Óä£ä]Ê oÕÀÊ }ÀoÕ«Ê >ÌÊ 1niÛiÀÃiÌÞÊ ovÊ *innÃÞlÛ>ni>Ê