Original Video Article

Single Port Laparoscopy
Authors: Luiz Caravalho, Rebecca Flyckt, Pedro Escobar, Tommaso Falcone
Cleveland Clinic, Cleveland, Ohio

Capsule: Knowledge of abdominal wall anatomy can facilitate surgical access for a single site or single port laparoscopy

Abstract:
Objective: Single Port Laparoscopic (SPL) surgery has reduced the number of sites required to perform laparoscopic surgery.1-3 However, the incision at the umbilicus is larger than conventional laparoscopic surgery. The objective of this video is to demonstrate the abdominal wall anatomy necessary to perform a single port laparoscopic procedure.  Design: Video presentation of clinical article. The video uses animation and surgical cases to demonstrate the relevant abdominal wall anatomy to establish surgical access for a single site or single port laparoscopy.
Results: This video demonstrates the regional anatomy pertinent to the anterior abdominal wall specifically of the umbilicus. The umbilicus is a focal point of fusion of the anterior abdominal wall muscles that allows entry into the peritoneal cavity. For this procedure there are 2 incisions possible, a small midline intra-umbilical one and am omega incision.  The video demonstrates each technique. Introduction of a port into this single incision is demonstrated with 2 different trocar systems. These trocar systems show how the limitations of using a single site may be reduced.
Conclusion: The abdominal wall anatomy is unique at the umbilicus and allows optimal placement of a single trocar to allow laparoscopic surgery.

References
Escobar PF. Fader AN. Paraiso MF. Kaouk JH. Falcone T. Robotic-assisted laparoendoscopic single-site surgery in gynecology: initial report and technique. Journal of Minimally Invasive Gynecology. 2009:589-91.

Escobar PF. Bedaiwy MA. Fader AN. Falcone T. Laparoendoscopic single-site (LESS) surgery in patients with benign adnexal disease. Fertility & Sterility. 2010; 93:e7-10.

Escobar PF, Kebria M, Falcone T. Evaluation of a novel single-port robotic platform in the cadaver model for the performance of various procedures in gynecologic oncology. Gynecol Oncol. 2011 120:380-38

Conclusion: The abdominal wall anatomy is unique at the umbilicus and allows optimal placement of a single trocar to allow laparoscopic surgery.