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THE CUTTING EDGE: INTRODUCING REDUCED PORT LAPAROSCOPIC SURGERY |
Table 1. Traditional Multiport Thoracoscopic & Laparoscopic Procedures for Companion Animals
Type of Procedure
Specific Surgical Procedure
Thoracoscopic UÊLung lobectomy UÊPericardiectomy UÊPRAA correction UÊPleural biopsy
Laparoscopic
UÊAdrenalectomy UÊCholecystectomy UÊCryptorchidectomy UÊCystotomy UÊGastropexy UÊLiver biopsy
PRAA = persistent right aortic arch
access device are being assessed in both human and veterinary surgery. Efficacy in veterinary patients is currently being clinically evaluated in select canine >n`ÊviliniÊV>ÃiÃÊ>ÌÊ1niÛiÀÃiÌÞÊovÊ*innÃÞlÛ>ni>Ê-VhoolÊ of Veterinary Medicine. As of yet, no data exist within ÌhiÊÛiÌiÀin>ÀÞÊliÌiÀ>ÌÕÀiÊVom«>Àin}Ê/Ài«oÀ̳ÊÌoÊÃÌ>n- dard multiport laparoscopy.
GelPOINT Access System /hiÊ il*" /ÊmÕlÌiÌÀoV>ÀÊ `iÛiViÊ Figure 4) is an ->««ÀoÛi`Ê mÕlÌiÌÀoV>ÀÊ >VViÃÃÊ ÃÞÃÌimÊ ÕÃi`Ê voÀÊ reduced port surgery in humans.
Port Components UÊ/hiÃÊmÕlÌiÌÀoV>ÀÊ«oÀÌÊ VonÃiÃÌÃÊovÊÎÊ Vom«oninÌÃ\Ê Alexis wound retractor, GelSeal cap, and a set of 4 instrument cannulas.
UÊ/hiÊ ÃÕ««lii`ÊÜoÕn`Ê ÀiÌÀ>VÌoÀÊh>ÃÊ >Ê l>À}iÊ`iÃÌ>lÊ ring that can accommodate a range of abdominal inViÃionÃÊvÀomÊ£°xÊÌoÊÇÊVmÊ>ÃÊÜillÊ>ÃÊ>ÊÜi`iÊÀ>n}iÊ of abdominal wall thicknesses. The wound retrac- ÌionÊÃhi>ÌhÊin>LliÃÊÎÈäo
of atraumatic retraction.14
UÊ/hiÊoÕÌiÀÊ«oÀÌionÊovÊÌhiÃÊmÕlÌiÌÀoV>ÀÊ port is composed of flexible GelSeal that acts as a resealable barrier.
UÊ/hiÊ il-i>lÊ >lloÜÃÊ >llÊ V>nnÕl>ÃÊ to be repeatedly introduced and removed during a procedure.
UÊ-«iViminÊ ÀimoÛ>lÊ V>nÊ LiÊ Ã>vilÞÊ repeated during a procedure with- out removing the Alexis portion of the port, which provides a protec- tive barrier for the incision site (Figure 9).14
Port Placement UÊ/hiÊ«oÀÌÊÀiµÕiÀiÃÊ>Êv>ÃVi>lÊinViÃionÊ approximately 2 cm wide; howev- er, this incision can be increased
UÊPulmonary mass resection UÊPyothorax lavage UÊThoracoscopic exploration UÊThymectomy
UÊNephrectomy UÊOmental mass resection UÊOvariectomy UÊOvariohysterectomy UÊPancreatic biopsy UÊPartial liver lobectomy
up to 5 cm, allowing removal of larger tissues, such as a spleen or kidney. UÊ /hiÊ«oÀÌÊ iÃÊ ÌÞ«iV>llÞÊ«l>Vi`Ê midline at the level of the umbi- licus; however, in my experi- ence, the port can be placed in alternate locations off the midline (eg, the flank region), accommodating
such proce-
dures as reduced port nephrec- tomy or splenectomy. UÊ /oÊ«l>ViÊ ÌhiÊ«oÀÌ]Ê ÌhiÊ liÝiÃÊ retractor is inserted through the skin incision. UÊ "nViÊÌhiÊ
liÝiÃÊ«oÀÌionÊ
in>LliÃÊ ÃÕvviViinÌÊ ÎÈäcÊ À>`i>lÊ wound retraction, the GelSeal portion of the port is then latched onto the outer ring of the Alexis.
UÊ/hiÊ«oÀÌÃÊ>ÀiÊ«l>Vi`ÊÌhÀoÕ}hÊÌhiÊ il- Ê«oÀÌionÊ as needed once the desired arrangement of instru- ments is determined for that particular procedure.
Clinical Evaluation /hiÊVliniV>lÊLiniviÌÃÊ>n`ÊlimiÌ>ÌionÃÊovÊÌhiÊ il*" /Ê access system are currently being evaluated in veter- inary surgery. Select canine patients are currently «>ÀÌiVi«>Ìin}Ê inÊ ÌÀi>lÃÊ >ÌÊ1niÛiÀÃiÌÞÊ ovÊ *innÃÞlÛ>ni>Ê School of Veterinary Medicine. To date, no data in the veterinary literature compares this system to standard multiport laparoscopy.
CONCLUSION Current efforts in human laparoscopy are focused on reducing overall surgical morbidity and veterinary l>«>ÀoÃVo«ÞÊ h>ÃÊ VonÌinÕi`Ê ÌoÊ volloÜÊ ÃÕiÌ°Ê
oÜiÛiÀ]Ê
reduced port surgery in veterinary medicine is in its inv>nVÞ°Ê ÕÀÌhiÀÊ ÀiviniminÌÃÊ inÊ inÃÌÀÕminÌ>ÌionÊ>n`Ê operative techniques are required before this method of surgical access can be widely accepted.
Table 2. Reduced Port Surgical Platform: SPA, SILS, LESS, or GelPOINT Procedures for Companion Animals
Type of Procedure
Specific Surgical Procedure
Thoracoscopic UÊPleural biopsy UÊPyothorax lavage UÊThoracoscopic exploration
Laparoscopic
UÊCholecystectomy UÊCryptorchidectomy UÊGastropexy UÊLiver biopsy
UÊNephrectomy UÊOvariectomy UÊOvariohysterectomy UÊSplenectomy
LESS = laparo-endoscopic single-site surgery; SILS = single incision laparoscopic surgery; SPA = single port access
January/February 2012 Today's Veterinary Practice 19