Search Results (34)

Background/Objectives: Single-port laparoscopy represents a significant advancement in minimally invasive surgical techniques and is designed to reduce surgical trauma and enhance cosmetic outcomes. However, ongoing debate surrounds its relative benefits and limitations as compared with conventional multi-port laparoscopy. This study systematically reviewed and analyzed comparative outcomes between these two approaches. Methods: We conducted a comprehensive systematic search of major electronic databases from January 2000 to October 2023, following PRISMA guidelines. Only randomized controlled trials comparing single-port laparoscopy with conventional laparoscopy were included. We analyzed operative outcomes, postoperative recovery parameters, complications, and patient-reported measures using random-effects models, with heterogeneity explored through subgroup analyses. Results: Forty-three randomized controlled trials involving 5807 patients were analyzed. Single-port laparoscopy demonstrated longer operative times (weighted mean difference: +10.5 min; 95% CI: 7.83–13.18; p < 0.001), superior cosmetic satisfaction (standardized mean difference: +0.61; 95% CI: 0.39–0.83; p < 0.001), and reduced postoperative pain within 24 h (standardized mean difference: −0.58; 95% CI: −0.95 to −0.21; p = 0.002). The overall complication rates showed no significant differences (risk ratio: 0.94; 95% CI: 0.78–1.14; p = 0.31), though incisional hernia risk increased with single-port laparoscopy (odds ratio: 2.26; 95% CI: 1.23–4.15; p = 0.009). Conclusions: Single-port laparoscopy offers meaningful improvements in cosmetic outcomes and early pain relief, balanced against longer operative times and increased hernia risk. The substantial heterogeneity observed underscores the importance of surgeon experience, appropriate patient selection, and optimal technique selection in determining outcomes. Full article

Background/Objectives: The aim of this case series is to evaluate the outcomes and safety of video-assisted mastectomy, illustrating the harmonious collaboration of oncologic and plastic surgery. This novel minimally invasive technique allows immediate prosthetic reconstruction and represents a cost-effective alternative to robotic breast surgery. Methods: Video-assisted, single-port nipple-sparing mastectomies were performed in patients with small to medium-sized breasts, followed by immediate direct-to-implant reconstruction with either prepectoral or dual plane implant placement. The patients’ electronic medical records were analyzed, including demographic characteristics, operative times and histopathology reports. Results: A total of 18 patients underwent successful video-assisted mastectomy, without conversion to traditional open procedure. Fifteen of the operations were risk-reducing mastectomies. Twelve patients had complementary procedures performed concurrently on the previously operated contralateral breast (delayed reconstruction/expander-to-implant exchange). Moreover, three patients benefited from additional minimally invasive techniques during the same surgery (prophylactic laparoscopic hysterectomy). Immediate breast reconstruction with polyurethane or microtextured breast implants up to 450 cc was performed, with satisfactory aesthetic outcomes and no cancer recurrences at 6 to 12 months postoperative follow-up. Early complications included transient hypercapnia, areolar congestion and cellulitis. No skin necrosis or implant-related complications were reported. The most frequently encountered late issues were contour irregularities. Conclusions: Video-assisted mastectomy facilitates the safe removal of proven pathologic or healthy breast tissue with minimal damage to the breast’s skin envelope, facilitating single-stage breast reconstruction. Full article

Background: Single-port laparoscopic hepatectomy is a minimally invasive modality for the treatment of benign and malignant liver lesions. Due to the method’s technical challenges, it is suitable for experienced hepatobiliary surgeons and selected groups of patients. The aim of this study was to evaluate the results of a single Slovenian center performing single-port laparoscopic hepatectomy with a literature overview. Methods: A single-center retrospective consecutive case series of the twenty-six patients with liver disease operated with the single-port technique from January 2018 to July 2024 at the Department of Abdominal Surgery at the University Medical Centre, Ljubljana, was performed. Lesions were located in easy-to-treat segments. Operative time, conversion rate, length of hospital stay, and surgical complications were recorded and evaluated. Results: We performed twenty-six single-port laparoscopic liver resections (median age 63.5, range 31 to 79 years). The mean operative time was 92 ± 31 min. None of the cases were converted to multi-port laparoscopic or open surgery. Safe resection margins were obtained in cases of malignant disease. The mean hospital stay was 4 days. The post-operative complication rate involving intervention was 7% (2/26). The incisional hernia rate was 11.5% (3/26). No life-threatening surgical complications or morbidity were noted. Conclusions: Single-port laparoscopic hepatectomy is a safe and feasible technique for the resection of benign and malignant liver lesions in the hands of skilled and well-trained hepatobiliary surgeons. Full article

Background and Objectives: Regional anesthesia is a key component of multimodal analgesia following minimally invasive gynecologic surgery. However, single-port laparoscopic adnexal surgery differs anatomically and physiologically from multiport or open approaches, particularly in terms of incision site, tissue handling, and pain characteristics. Despite its increasing use, evidence supporting procedure-specific regional analgesic protocols for this approach remains limited. This study aimed to compare the analgesic efficacy of quadratus lumborum block (QLB) and rectus sheath block (RSB) in this surgical context. Materials and Methods: In this randomized controlled trial, 68 patients undergoing single-port laparoscopic adnexal surgery were randomly assigned to receive either QLB or RSB at the end of surgery. Four patients were excluded due to missing patient-controlled analgesia (PCA) data, resulting in 64 patients analyzed (QLB group: n = 32; RSB group: n = 32). The primary outcome was cumulative opioid consumption over the first 24 postoperative hours. Secondary outcomes included interval-based opioid consumption, time to first PCA bolus, postoperative pain scores, and incidence of postoperative nausea and vomiting (PONV). Results: The RSB group demonstrated significantly lower cumulative opioid consumption at 24 h postoperatively (132.9 [61.3, 338.4] µg vs. 453.0 [253.1, 811.0] µg, p < 0.001). This trend persisted across most postoperative time points up to 48 h. Interval-based opioid consumption was also lower in the RSB group during 0–24 h and 32–48 h intervals (each comparison p < 0.05). The time to first PCA bolus was significantly longer in the RSB group (56.5 [41.0, 340.3] minutes vs. 40.5 [33.3, 68.8] minutes; p = 0.014), and Kaplan–Meier analysis confirmed a delayed first bolus request in the RSB group (log-rank p = 0.007). Pain scores and postoperative nausea and vomiting incidence were comparable between groups. Conclusions: Compared with QLB, RSB provided similar pain relief with significantly lower opioid consumption following single-port laparoscopic adnexal surgery. These findings highlight the potential advantages of RSB in enhancing analgesic efficiency and support the development of procedure-specific regional analgesia protocols tailored to this surgical approach. Full article

Robot-assisted surgery has transformed the landscape of genitourinary cancer treatment, offering enhanced precision, reduced morbidity, and improved recovery compared to open or conventional laparoscopic approaches. As the field matures, a new generation of technological innovations is redefining the boundaries of what robotic systems can achieve. This narrative review explores the integration of artificial intelligence, advanced imaging modalities, augmented reality, and connectivity in robotic urologic oncology. The applications of machine learning in surgical skill evaluation and postoperative outcome predictions are discussed, along with AI-enhanced haptic feedback systems that compensate for the lack of tactile sensation. The role of 3D virtual modeling, intraoperative augmented reality, and fluorescence-guided surgery in improving surgical planning and precision is examined for both kidney and prostate procedures. Emerging tools for real-time tissue recognition, including confocal microscopy and Raman spectroscopy, are evaluated for their potential to optimize margin assessment. This review also addresses the shift toward single-port systems and the rise of telesurgery enabled by 5G connectivity, highlighting global efforts to expand expert surgical care across geographic barriers. Collectively, these innovations represent a paradigm shift in robot-assisted urologic oncology, with the potential to enhance functional outcomes, surgical safety, and access to high-quality care. Full article

Background: CT image guidance and navigation, although routinely used in complex endovascular procedures, is an unexplored territory in evolving vascular robotic procedures. In robotic surgery, it promises the better localization of vasculature, the optimization of port placement, less inadvertent tissue damage, and increased patient safety during the dissection of retroperitoneal structures. However, unknown tissue displacement resulting from induced pneumoperitoneum and positional changes compared to the preoperative CT scan can pose significant limitations to the reliability of image guidance. We aimed to study the displacement of retroperitoneal organs and vasculature due to factors such as increased intra-abdominal pressure (IAP) due to CO₂ insufflation and patient positioning (PP) using intraoperative CT imaging in a cadaveric model. Methods: A thawed, fresh-frozen human cadaveric model was positioned according to simulated procedural workflows. Intra-arterial, contrast-enhanced CT scans were performed after the insertion of four laparoscopic ports in the abdomen. CT scans were performed with 0–5–15–25 mmHg IAPs in supine, left lateral decubitus, right lateral decubitus, Trendelenburg, and reverse Trendelenburg positions. Euclidean distances between fixed anatomical bony and retroperitoneal vascular landmarks were measured and compared across different CT scans. Results: Comparing the effects of various IAPs to the baseline (zero IAP) in the same PP, an average displacement for retroperitoneal vascular landmarks ranged from 0.6 to 3.0 mm (SD 1.0–2.8 mm). When changing the PPs while maintaining the same IAP, the average displacement of the retroperitoneal vasculature ranged from 2.0 to 15.0 mm (SD 1.7–7.2 mm). Conclusions: Our preliminary imaging findings from a single cadaveric model suggest minimal (~3 mm maximum) target vasculature displacement in the retroperitoneum due to elevated IAP in supine position and higher displacement due to changes in patient positioning. Similar imaging studies are needed to quantify procedural workflow-specific and anatomy-specific deformation, which would be invaluable in developing and validating advanced tissue deformation models, facilitating the routine applicability and usefulness of CT image guidance for target delineation during robotic vascular procedures. Full article

Background/Objectives: Laparoscopic surgery plays a central role in the management of abdominal trauma, particularly in patients with hemodynamic stability. Recently, single-port laparoscopic surgery (SPLS) has emerged as a technique that further reduces access-related trauma while preserving the benefits of conventional laparoscopy. Thus, this review aimed to examine the current landscape of SPLS in trauma care, summarizing available clinical data and highlighting practical considerations for its use. Despite the limited experience, early evidence suggests that SPLS can achieve diagnostic and therapeutic outcomes comparable to those achieved by multi-port approaches in selected cases. Particular attention is given to a hybrid method that combines intracorporeal assessment with extracorporeal small bowel examination and repair through a single umbilical incision. This technique offers a pragmatic balance between thorough exploration and minimal invasiveness. Methods: We searched PubMed, Scopus, Web of Science, and Google Scholar through December 2023 using the terms “single-port laparoscopy”, “single-incision laparoscopic surgery”, “trauma laparoscopy”, and related phrases. Case reports, case series, comparative studies, and reviews describing single-incision laparoscopic surgery in trauma were included in this narrative analysis. Results: SPLS may offer advantages in terms of postoperative pain, wound complications, and cosmetic outcomes, especially in younger patients. As familiarity with the approach increases and dedicated instrumentation becomes more accessible, its role in trauma protocols may expand. Conclusions: Further prospective research is needed to define long-term outcomes, refine patient selection, and integrate SPLS more systematically into trauma care protocols. Full article

Introduction: The Da Vinci Single-Port (DV-SP) system emerged in 2018 but there is limited evidence on its use and perioperative outcomes for robot-assisted adrenalectomy (RAA). Methods: A systematic search was performed through PubMed, Scopus, Ovid, and WoS in December 2024. A PICO framework was used. Population: adult patients with adrenal masses; Intervention: DV-SP RAA; Outcomes: feasibility, reproducibility and safety of DV-SP RAA. A total of five retrospective studies involving 342 patients were included. The quantitative analysis was conducted using a random-effect model or a fixed-effect model as appropriate. A risk of bias assessment for non-randomized comparative studies and case series was performed. Results: The pooled mean operative time was 92.5 min (95% confidence interval [CI] 71.2, 113.9, p I² = 0%, four studies), and the mean estimated blood loss (EBL) was 26.5 mL (95%CI −8.1, 61.2, I² = 98.2%, three studies). Most of the procedures were completed with a single incision, though some required additional port placement, with a proportion of 9% (95%CI 0, 29, I² = 71.7%, five studies). Perioperative complications were rare (0%, 95% CI 0, 4, I² = 0%, five studies). Two studies comparing DV-SP and DV multi-port (MP) found no significant differences in complications. One study compared DV-SP RAA to DV Si or Xi single-access procedures. DV-SP showed improved operative techniques and better cosmetic outcomes. Limitations of this study are small sample size and potential selection bias due to smaller masses in the DV-SP RAA group. Conclusions: DV-SP RAA is a promising approach, offering reduced operative time, low EBL, and excellent cosmetic results. This study shows that DV-SP RAA seems reproducible, feasible, and safe. Limitation of the included studies are small sample size and selection bias, which limits the generalizability of the results. Randomized comparative studies between DV-SP and MP RAA are needed to further validate these findings. Full article

Background: Total mesorectal excision (TME) remains the gold standard for the resection of rectal cancer regardless of the modality: open, laparoscopic, or robotic. The transanal TME (TaTME) approach has been utilized to overcome the difficulties encountered with the dissection of tumors in the distal pelvis. Recently, a single-port robotic approach (rSPa) was introduced, where three arms and a camera emanate from a 2.5 cm diameter port. This report presents the first experience in the United States combining those two approaches (rSPa TaTME) in rectal cancer, evaluating its safety and oncologic outcomes. Methods: This is a retrospective review of our prospectively maintained rectal cancer database. Patient demographics, tumor characteristics, neoadjuvant treatment, and oncologic and surgical outcomes were recorded. Results: Between May 2022 and August 2024, ten patients (six females, four males) with a median age at surgery of 53 years (range: 38–85) and a mean BMI of 26 (±5) kg/m² were included for analysis. The median distance of tumors from the anorectal junction was 3.2 cm (range: 2–5.3 cm). All patients had negative margins, with eight complete TME specimens, one near complete, and one incomplete. The mean number of lymph nodes harvested was 24 (±11). The average operative time was 351 (243–411) min. The average length of stay was four days. The ileostomy was reversed in nine out of ten patients. Six patients experienced complications within 30 days of surgery. There were no local or distal recurrences, with a mean follow-up of 20 months (range: 4–30). Conclusions: rSPa TaTME is a unique and innovative method of combining two minimally advanced approaches for the resection of distal rectal cancers, with acceptable surgical and oncologic outcomes. Full article

Background and Objectives: Quadratus lumborum block (QLB) is a regional anesthesia technique widely utilized in multimodal analgesia strategies for abdominal surgeries. While a few studies have investigated its efficacy in multiport total laparoscopic hysterectomy (TLH), its effectiveness in single-port TLH remains uncertain. This study aimed to evaluate whether QLB reduces opioid consumption and postoperative pain in patients undergoing single-port TLH. Materials and Methods: This randomized, controlled, observer-blinded trial included 64 patients undergoing elective single-port TLH. Participants were randomly allocated to either the QLB group (n = 27) or the control group (n = 29). QLB was performed bilaterally under ultrasound guidance after surgery. The primary outcome was cumulative fentanyl consumption within 24 h postoperatively. Secondary outcomes included pain scores at predefined intervals, time to first opioid demand, the incidence of postoperative nausea and vomiting (PONV), and other complications. Results: The 24 h cumulative fentanyl consumption, which was the primary outcome, did not differ significantly between the QLB group, 342.8 [220, 651] mcg, and the control group, 470 [191.6, 648.1] mcg (p = 0.714). Similarly, cumulative fentanyl consumption at other time points, including 2 h, 4 h, 8 h, 12 h, 32 h, and 48 h, as well as in the PACU, also showed no significant differences between the two groups. Pain scores measured at these time points, along with the time to first bolus on demand, were comparable between groups. However, PONV occurred more frequently in the QLB group than in the control group (25.9% vs. 3.4%, p = 0.023). Conclusions: QLB did not significantly reduce opioid consumption, time to first opioid demand, or postoperative pain scores in single-port TLH. However, PONV occurred more frequently in the QLB group. These findings suggest that QLB may have limited analgesic benefits in single-port TLH. Full article

Single-port (SP) robotic posterior retroperitoneoscopic adrenalectomy (SP-PRA) represents a State-of-the-Art innovation in endocrine surgery, offering a minimally invasive approach for adrenal gland resection with significant improvements in surgical precision, cosmetic outcomes, and patient quality of life. The SP robotic system facilitates surgery through a single incision in the back, avoiding the transperitoneal cavity and enabling direct retroperitoneal access to the adrenal gland. This review explores the evolution, techniques, and clinical outcomes of SP-PRA, emphasizing its advantages over traditional multi-port and laparoscopic methods. Enhanced visualization and precise articulation of the SP robotic system minimize trauma to surrounding tissues, leading to fewer complications and faster recovery times. Initial studies suggest superior patient satisfaction due to hidden incisions and excellent postoperative outcomes. However, challenges such as a steep learning curve, high costs, and limited long-term data remain. This review highlights the need for continued research and innovation to optimize the adoption of SP-PRA and expand its indications. Full article

Objectives: To explore the feasibility and surgical outcomes of robot-assisted vaginal natural orifice transluminal endoscopic surgery (RA-vNOTES) for women suffering from gynecologic disease. Methods: We performed an observational study reporting and analyzing the perioperative outcomes of 298 patients with gynecologic disease who underwent RA-vNOTES in a single institution from June 2019 to August 2024. Results: A total of 298 patients with a median age of 41 years and median body mass index of 29 kg/m² underwent RA-vNOTES. The primary indications for surgery were endometriosis (43.62%), chronic pelvic pain (11.07%), abnormal uterine bleeding (20.81%), and uterine leiomyomata (14.77%). A total of 286 of 298 (95.97%) patients had a hysterectomy. The median total operating time was 138 min, with a port placement time of 5 min, dock time of 3 min, and robot console time of 63 min. The median estimated blood loss was 50 milliliters. Endometriosis resection of all stages was performed in 192 of 298 (64.43%) patients. Three cases (1.01%) were converted to laparoscopic surgery. One case was converted to robot-assisted single incision plus one port laparoscopic surgery (SILS plus one) and two cases were converted to robot-assisted multi-port surgery. The total complication rate was 17.45% (52 cases), of which 2.1% (6 cases) were intraoperative complications and 15.44% (46 cases) were postoperative complications. Conclusions: Our findings indicate that RA-vNOTES is a feasible and less invasive option for various gynecologic procedures, including complex endometriosis excision and sacrocolpopexy. Full article

This study aimed to evaluate the feasibility of single-port laparoscopic pancreatic exploration, laparoscopic ultrasonography, and pancreatic biopsy in dogs. Six clinically healthy Beagles (median age: 13 months; range: 12–30 months; median weight: 8.81 kg; range: 7.82–10.64 kg) with normal findings upon physical examination and no history of systemic disease underwent a single-port laparoscopic procedure via a paramedian incision. In all cases, pancreatic exploration was performed visually through laparoscopy but was limited to the right lobe and body of the pancreas due to anatomical constraints; the left lobe remained inaccessible. The median exploration time was 239 s for the right lobe and 370 s for the pancreatic body. After exploration, a laparoscopic ultrasound was performed on the parenchyma of the explored regions, successfully identifying major anatomical structures, including the cranial pancreaticoduodenal artery, vein, and major duodenal papilla. The median laparoscopic ultrasound evaluation time was 838 s (range: 729–878 s). A pancreatic biopsy was performed on the distal portion of the right lobe, yielding tissue samples of approximately 10 × 10 mm in size. No intra- or postoperative complications were observed. However, this study was conducted in healthy dogs; further validation is necessary to confirm its diagnostic utility. These findings demonstrate the feasibility of single-port laparoscopic exploration and laparoscopic ultrasonography-guided anatomical assessment. Full article

Abstract: Background/Objectives: Single-port access (SPA) laparoscopic surgery has gained popularity due to its cosmetic benefits and reduced postoperative pain. However, concerns persist regarding the increased risk of adhesions due to the larger umbilical incision. This study aims to contribute to personalized medicine by evaluating the effectiveness of applying an anti-adhesive agent (Guardix SG^®, HanmiPharmaceutical Co., Ltd., Seoul, Korea) at the umbilical incision and identifying patient-specific risk factors for adhesion formation in SPA laparoscopic surgeries. Methods: In this randomized prospective study, 55 female patients with benign gynecological conditions were enrolled. Participants were randomly assigned to either an intervention group, which received the anti-adhesive agent at both the surgical and umbilical sites, or a control group, which received it only at the surgical site. Participants returned for outpatient visits 1–3 months post-surgery to assess incision site complications, including adhesions. Results: The overall adhesion rate was 10.9%, with 13.3% in the control group and 8% in the intervention group, though the difference was not statistically significant (p = 0.678). Infection rates were 6.7% in the control group and 4% in the intervention group; however, there was no significant difference in complications. Logistic regression identified pre-existing adhesions as a significant risk factor (p = 0.0379; OR = 6.909). Conclusions: Although the adhesion barrier showed a trend toward reducing umbilical adhesions, the difference was not statistically significant. The application of the adhesion barrier did not influence incision site complications, confirming its safety. Our findings highlight the need for personalized approaches to adhesion prevention, considering individual patient characteristics and risk factors. Further larger studies are necessary to explore adhesion prevention in a more personalized manner for individual patients in this context. Full article

Background/Objectives: To compare the outcomes of single-port access laparoscopic surgery (SPALS) and single-site robotic surgery (SSRS) for benign gynecological diseases, we retrospectively analyzed clinical data from 367 patients who underwent gynecologic surgery at Sejong Chungnam National University Hospital from October 2020 to December 2023. Methods: Of these 367 patients, 197 underwent SPALS, whereas 170 underwent SSRS. The SPALS group comprised 87 patients who underwent hysterectomy; 107, adnexal surgery (cystectomy: 44, adnexectomy: 63); and 1 myomectomy. The SSRS group included 68 patients who underwent myomectomy; 61, adnexal surgery (cystectomy: 52, adnexectomy: 9); 35, hysterectomy, and 4, sacrocolpopexy. Results: Both surgical techniques were successful, with no patients requiring open surgery. No significant differences were observed in the baseline characteristics between the two groups. Compared with the SPALS group, the SSRS group had a younger age (39.8 ± 9.5 vs. 44.5 ± 12.3 years, p = 0.001). Severe intra-abdominal adhesions were more frequently observed in the SSRS group (p = 0.004). Operation time (118.1 ± 65.9 vs. 57.1 ± 27.3 min, p = 0.001), gas passing time (39.4 ± 15.37 vs. 30.4 ± 13.5 h, p = 0.001), and hospital length of stay (4.26 ± 1.02 vs. 4.02 ± 0.8 days, p = 0.012) were significantly longer in the SSRS group. However, no significant differences were found between the two groups in terms of intraoperative blood loss, intraoperative complications, or readmission rates. Conclusions: SSRS offers a feasible and promising approach for treating gynecological benign diseases. Younger and lower-parity patients tend to undergo SSRS rather than SPALS, with SSRS primarily performed for myomectomy and complex adnexal surgery. However, operation time and gas passing time were significantly longer in the SSRS group. Full article