Laparoscopic Surgery Performed Through a Single Incision: A Systematic Review of the Current Literature

Abstract

Minimally invasive surgery has evolved over the last 3 decades, and this continues today. For example, modifications of the standard 4-port laparoscopic cholecystectomy (LC) are common in the literature, and have focused primarily on decreasing the number and size of access ports. Three-port, 2-port, and needlescopic techniques have been reported by numerous authors. ¹ Leggett P.L. Bissell C.D. Churchman-Winn R. Ahn C. Three-port microlaparoscopic cholecystectomy in 159 patients. Surg Endosc. 2001; 15 : 293-296 Crossref PubMed Scopus (40) Google Scholar ^{,  2} Poon C.M. Chan K.W. Ko C.W. et al. Two-port laparoscopic cholecystectomy: initial results of a modified technique. J Laparoendosc Adv Surg Tech A. 2002; 12 : 259-262 Crossref PubMed Scopus (18) Google Scholar ^{,  3} Franklin Jr, M.E. Jaramillo E.J. Glass J.L. et al. Needlescopic cholecystectomy: lessons learned in 10 years of experience. JSLS. 2006; 10 : 43-46 PubMed Google Scholar ^{,  4} Hosono S. Osaka H. Minilaparoscopic versus conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Laparoendosc Adv Surg Tech A. 2007; 17 : 191-199 Crossref PubMed Scopus (29) Google Scholar More recently, natural orifice translumenal endoscopic surgery (NOTES) techniques have been described and are being assessed for applicability to clinical practice. ⁵ Gumbs A.A. Fowler D. Milone L. et al. Transvaginal natural orifice translumenal endoscopic surgery cholecystectomy: early evolution of the technique. Ann Surg. 2009; 249 : 908-912 Crossref PubMed Scopus (84) Google Scholar ^{,  6} Sodergren M.H. Clark J. Athanasiou T. et al. Natural orifice translumenal endoscopic surgery: critical appraisal of applications in clinical practice. Surg Endosc. 2009; 23 : 680-687 Crossref PubMed Scopus (67) Google Scholar ^{,  7} Zorron R. Maggioni L.C. Pombo L. et al. NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc. 2008; 22 : 542-547 Crossref PubMed Scopus (209) Google Scholar Some speculate that routine use of NOTES will be unlikely due to its inherent complexity, high cost, and absence of high quality data showing a significant patient benefit. ⁸ Pearl J.P. Ponsky J.L. Natural orifice translumenal endoscopic surgery: a critical review. J Gastrointest Surg. 2008; 12 : 1293-1300 Crossref PubMed Scopus (128) Google Scholar ^{,  9} Smith C.D. A critical assessment of NOTES: a pessimistic view from an optimist. J Laparoendosc Adv Surg Tech A. 2008; 18 : 665-667 Crossref PubMed Scopus (2) Google Scholar