Single-port laparoscopy: Has the future arrived?

October 1, 2008

Stephen Y. Nakada, MD, interviews Jihad Kaouk, MD, about the nuances of single-port surgery technique, patient selection, the learning curve, technical modifications, and outcomes.

Q What is single-port laparoscopy, and how is it different from conventional laparoscopy?

A It is a new approach in which we're trying to minimize the incisions we need to do during laparoscopy. In conventional laparoscopy, you need three to five incisions to operate. With a single-port approach, we make one incision that's about an inch in size, sometimes totally hidden in the umbilicus, to perform the procedure. Through the umbilical incision, we insert one special port with three channels: one through which we put a scope and the other two for the working instruments.

Q What are the current indications for the single-port laparoscopic technique?

Q. If someone were to embark on single-port laparoscopy, what would be the ideal first case?

A Our focus is obviously on urology. Unfortunately, in urology, we don't have a straightforward procedure such as gallbladder removal to gain initial experience. If I could choose an easy case in urology to start as my initial experience, it would be cryoablation of the kidney. You can make one incision and all you need is good exposure, getting the fat out of the way, and freezing the mass.

Q What are the advantages of single-port laparoscopy?

Q What is NOTES, and how does it differ from single-port laparoscopy?

A NOTES stands for natural orifice translumenal endoscopic surgery. The philosophy behind it is going for a scarless surgery by using natural orifices: through the stomach, the colon, or the vagina.

Q Have there been any reports of NOTES in urology to date?

A There are none in urology so far, to my knowledge, but there are a few anecdotal papers in general surgery.