Skip to main content
SpringerLink
Log in

The Potential of Single-Site Surgery

  • Chapter
  • First Online:
Innovative Endoscopic and Surgical Technology in the GI Tract

Abstract

The development of single-site laparoscopic surgery (SIL) is attributed to the first decade of the current century by the majority of surgeons. However, the idea to gain access to the abdominal cavity through one incision dates back to 1902, when the German surgeon Georg Kelling performed the first one-port laparoscopy in dogs [1]. It was a Swedish gastroenterologist, namely Hans Christian Jacobaeus, who did the first single-port laparoscopy in humans in 1910 [2]. For reasons of technical and general medical limitations, including but not restricted to the lack of sufficient anesthesiology, it took until the final two decades of the last century for minimally invasive surgery to be accepted as a matter of clinical routine. Again, technical limitations mandated the use of multiple incisions, at least for therapeutic indications. The concept of SIL was then adopted by gynecologists for tubal sterilization using a single incision and a specially adapted instrument [3]. Further surgical and technical developments allowed modified adaptation of the SIL concept in more demanding procedures. Again, gynecologists pioneered the field with the first SIL hysterectomy [4] as well as the first SIL appendectomy in 1991 [5]. At that time, the concept did not meet with great enthusiasm on the part of general surgeons, and so our predecessors either developed extraumbilical one-trocar techniques [6] or gradually reduced the number of incisions for appendectomy by applying a transumbilical laparoscopically assisted technique [7]. The first case series of SIL cholecystectomies using a technique that was similar to what we now know as SIL was published by Navarra and colleagues in 1997 [8]. It took another 10 years for surgeons around the globe to become comfortable with this “new” idea, and subsequently the concept gained momentum and a majority of surgeons busied themselves with this technique. The synonyms of the SIL concept are given in Table 30.1. The number of performed procedures and published reports exploded within a few years and peaked in 2012 and 2013 (Fig. 30.1; publications). The technique spread to all surgical subdivisions and new applications were created.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

Literature

  1. Schultheiss D, Moll F. Die Geschichte der Urologie in Dresden. Springer Verlag; 2009. p. 90–3.

    Book  Google Scholar 

  2. Jacobäus HC. Über die Möglichkeit die Zystoskopie bei Untersuchungen seröser Höhlen anzuwenden. Munch Med Wochenschr. 1910;57:2090.

    Google Scholar 

  3. Siegler AM. An instrument to aid tubal sterilization by laparoscopy. Fertil Steril. 1972;23(5):367–8.

    Article  CAS  PubMed  Google Scholar 

  4. Pelosi MA, Pelosi MA 3rd. Laparoscopic hysterectomy with bilateral salpingo-oophorectomy using a single umbilical puncture. N J Med. 1991;88(10):721–6.

    CAS  PubMed  Google Scholar 

  5. Wolenski M, Markus E, Pelosi MA. Laparoscopic appendectomy incidental to gynecologic procedures. Todays OR Nurse. 1991;13(12):12–8.

    CAS  PubMed  Google Scholar 

  6. Inoue H, Takeshita K, Endo M. Single-port laparoscopy assisted appendectomy under local pneumoperitoneum condition. Surg Endosc. 1994;8:714–6.

    Article  CAS  PubMed  Google Scholar 

  7. Kala Z, Hanke I, Neumann C. [A modified technic in laparoscopy-assisted appendectomy--a transumbilical approach through a single port] Rozhl Chir. 1996;75:15–8.

    Google Scholar 

  8. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997;84(5):695.

    CAS  PubMed  Google Scholar 

  9. Blinman T. Incisions do not simply sum. Surg Endosc. 2010;24(7):1746–51.

    Article  PubMed  Google Scholar 

  10. Weiss HG, Brunner W, Biebl MO, Schirnhofer J, Pimpl K, Mittermair C, et al. Wound complications in 1145 consecutive transumbilical single-incision laparoscopic procedures. Ann Surg. 2014;259(1):89–95.

    Article  PubMed  Google Scholar 

  11. Morales-Conde S, Barranco A, Socas M, Méndez C, Alarcón I, Cañete J, et al. Improving the advantages of single port in right hemicolectomy: analysis of the results of pure transumbilical approach with intracorporeal anastomosis. Minim Invasive Surg. 2012;2012:874172.

    PubMed  PubMed Central  Google Scholar 

  12. Asakuma M, Komeda K, Yamamoto M, Shimizu T, Iida R, Taniguchi K, et al. A concealed “natural orifice”: umbilicus anatomy for minimally invasive surgery. Surg Innov. 2019;26(1):46–9.

    Article  PubMed  Google Scholar 

  13. Ahmed I, Ciancio F, Ferrara V, Jorgensen LN, Mann O, Morales-Conde S, et al. Current status of single-incision laparoscopic surgery: European experts’ views. Surg Laparosc Endosc Percutan Tech. 2012;22(3):194–9.

    Article  PubMed  Google Scholar 

  14. Deng L, Xiong J, Xia Q. Single-incision versus conventional three-incision laparoscopic appendectomy: a meta-analysis of randomized controlled trials. J Evid Based Med. 2017;10(3):196–206.

    Article  Google Scholar 

  15. Aly OE, Black DH, Rehman H, Ahmed I. Single incision laparoscopic appendicectomy versus conventional three-port laparoscopic appendicectomy: a systematic review and meta-analysis. Int J Surg. 2016;35:120–8.

    Article  Google Scholar 

  16. Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, et al. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc. 2019;33(4):996–1019.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Franz MG. The biology of hernia formation. Surg Clin North Am. 2008;88(1):1–15, vii.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Filipovic-Cugura J, Kirac I, Kulis T, Jankovic J, Bekavac-Beslin M. Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc. 2009;23(4):920–1.

    Article  PubMed  Google Scholar 

  19. Lo CW, Yang SS, Tsai YC, Hsieh CH, Chang SJ. Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis. Hernia. 2016;20(1):21–32.

    Article  PubMed  Google Scholar 

  20. Cardinali L, Mazzetti CH, Cadenas Febres A, Repullo D, Bruyns J, et al. Prospective randomized study comparing single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal (TEP) inguinal hernia repair at 2 years. Surg Endosc. 2018;32(7):3262–72.

    Article  PubMed  Google Scholar 

  21. Barnes H, Spencer R, Uppal S, Rice L, Al-Niaimi A. The adoption of single-port laparoscopic full staging for endometrial cancer: safety, learning curve and surgical outcome. J Minim Invasive Gynecol. 2015;22(6S):S49–50.

    Article  CAS  PubMed  Google Scholar 

  22. Dapri G. 10-year experience with 1700 single-incision laparoscopies. Surg Technol Int. 2019;10(35):71–83.

    Google Scholar 

  23. Suzuki Y, Tei M, Wakasugi M, Masuzawa T, Ohtsuka M, Mikamori M, et al. Role of single-incision laparoscopic surgery in the management of small bowel obstruction. Surg Endosc. 2021;35(6):2558–65.

    Article  PubMed  Google Scholar 

  24. Germane Huscher C, Marzullo E, Albertucci M. Single-access transhiatal esophagectomy for cancer: are we on the right way? Surg Innov. 2011;18(1):91–3.

    Article  PubMed  Google Scholar 

  25. Hu W, Yuan Y, Chen L. Single-port thoracoscopic minimally invasive esophagectomy for esophageal cancer. World J Surg. 2019;43(2):567–70.

    Article  PubMed  Google Scholar 

  26. Hamzaoglu I, Karahasanoglu T, Aytac E, Karatas A, Baca B. Transumbilical totally laparoscopic single-port Nissen fundoplication: a new method of liver retraction: the Istanbul technique. J Gastrointest Surg. 2010;14(6):1035–9.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Sukharamwala P, Teta A, Ross S, Co F, Alvarez-Calderon G, Luberice K, et al. Over 250 laparoendoscopic single site (LESS) fundoplications: lessons learned. Am Surg. 2015;81(9):870–5.

    Article  PubMed  Google Scholar 

  28. Omori T, Fujiwara Y, Moon J, Sugimura K, Miyata H, Masuzawa T, et al. Comparison of single-incision and conventional multi-port laparoscopic distal gastrectomy with D2 lymph node dissection for gastric cancer: a propensity score-matched analysis. Ann Surg Oncol. 2016;23(Suppl 5):817–24.

    Article  PubMed  Google Scholar 

  29. Ahn SH, Son SY, Jung DH, Park YS, Shin DJ, Park DJ, et al. Solo intracorporeal esophagojejunostomy reconstruction using a laparoscopic scope holder in single-port laparoscopic total gastrectomy for early gastric cancer. J Gastric Cancer. 2015;15(2):132–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. DE Vogelaere K, VAN DE Winkel N, Simoens C, Delvaux G. Intragastric SILS for GIST, a new challenge in oncologic surgery: first experiences. Anticancer Res. 2013;33(8):3359–63.

    Google Scholar 

  31. Estupinam O, Oliveira ALA, Antunes F, Galvão M, Phillips H, Scheffer JP, et al. Technical innovation: intragastric single port sleeve gastrectomy (IGSG). A feasibility survival study on porcine model. Acta Cir Bras. 2018;33(1):95–101.

    Article  PubMed  Google Scholar 

  32. Nguyen NT, Hinojosa MW, Smith BR, Reavis KM. Single laparoscopic incision transabdominal (SLIT) surgery-adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg. 2008;18(12):1628–31.

    Article  PubMed  Google Scholar 

  33. Saber AA, Elgamal MH, Itawi EA, Rao AJ. Single incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg. 2008;18(10):1338–42.

    Article  PubMed  Google Scholar 

  34. English WJ, DeMaria EJ, Hutter MM, Kothari SN, Mattar SG, Brethauer SA, et al. American Society for Metabolic and Bariatric Surgery 2018 estimate of metabolic and bariatric procedures performed in the United States. Surg Obes Relat Dis. 2020;16(4):457–63.

    Article  PubMed  Google Scholar 

  35. Lainas P, Derienne J, Dammaro C, Schoucair N, Devaquet N, Dagher I. Single-port laparoscopic surgery for the treatment of severe obesity: review and perspectives. Obes Surg. 2020l;30(7):2781–90.

    Article  PubMed  Google Scholar 

  36. Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Weiss H. Single incision laparoscopic sigmoid colon resections without visible scar: a novel technique. Color Dis. 2010;12(1):66–70.

    Article  CAS  Google Scholar 

  37. Bucher P, Pugin F, Morel P. Transumbilical single incision laparoscopic sigmoidectomy for benign disease. Color Dis. 2010;12(1):61–5.

    Article  CAS  Google Scholar 

  38. Lee YS, Kim JH, Kim HJ, Lee SC, Kang BM, Kim CW, et al. Short-term outcomes of single-port versus multiport laparoscopic surgery for colon cancer: the SIMPLE multicenter randomized clinical trial. Ann Surg. 2021;273(2):217–23.

    Article  PubMed  Google Scholar 

  39. Poon JT, Cheung CW, Fan JK, Lo OS, Law WL. Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc. 2012;26(10):2729–34.

    Article  PubMed  Google Scholar 

  40. Huscher CG, Mingoli A, Sgarzini G, Mereu A, Binda B, Brachini G, et al. Standard laparoscopic versus single-incision laparoscopic colectomy for cancer: early results of a randomized prospective study. Am J Surg. 2012;204(1):115–20.

    Article  PubMed  Google Scholar 

  41. Hebbar M, Riaz W, Sains P, Baig MK, Sajid MS. Meta-analysis of randomized controlled trials only exploring the role of single incision laparoscopic surgery versus conventional multiport laparoscopic surgery for colorectal resections. Trans Gastroenterol Hepatol. 2018;3:30.

    Article  Google Scholar 

  42. Tacchino R, Greco F, Matera D. Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc. 2009;23(4):896–9.

    Article  CAS  PubMed  Google Scholar 

  43. Antoniou SA, García-Alamino JM, Hajibandeh S, Hajibandeh S, Weitzendorfer M, Muysoms FE, et al. Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc. 2018;32(1):14–23.

    Article  PubMed  Google Scholar 

  44. Haueter R, Schütz T, Raptis DA, Clavien P-A, Zuber M. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg. 2017;104(9):1141–59.

    Article  CAS  PubMed  Google Scholar 

  45. Klein D, Barutcu AG, Kröll D, Kilian M, Pratschke J, Raakow R, et al. Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up. Langenbeck's Arch Surg. 2020;405(5):551–61.

    Article  Google Scholar 

  46. Arezzo A, Passera R, Forcignanò E, Rapetti L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc. 2018;32(9):3739–53.

    Article  CAS  PubMed  Google Scholar 

  47. Lee W, Roh YH, Kang SH, Kim CY, Choi Y, Han HS, et al. The chronological change of indications and outcomes for single-incision laparoscopic cholecystectomy: a Korean multicenter study. Surg Endosc. 2021;35(6):3025–32.

    Article  PubMed  Google Scholar 

  48. Lima DL, Lima RNCL, Dos Santos DC, Shadduck PP, Carvalho GL, Malcher F. Which cholecystectomy technique would surgeons prefer on themselves? Surg Laparosc Endosc Percutan Tech. 2021;30(6):495–9.

    Article  Google Scholar 

  49. Barbaros U, Sümer A, Demirel T, Karakullukçu N, Batman B, Içscan Y, et al. Single incision laparoscopic pancreas resection for pancreatic metastasis of renal cell carcinoma. JSLS. 2010;14(4):566–70.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kim EY, You YK, Kim DG, Hong TH. Dual-incision laparoscopic spleen-preserving distal pancreatectomy: merits compared to the conventional method. JGastrointest Surg. 2019;23(7):1384–91.

    Article  Google Scholar 

  51. Machado MA, Surjan RC, Makdissi FF. Laparoscopic distal pancreatectomy using single-port platform: technique, safety, and feasibility in a clinical case series. J Laparoendosc Adv Surg Tech A. 2015;25(7):581–5.

    Article  PubMed  Google Scholar 

  52. Kashiwagi H, Kumagai K, Nozue M. Single incision laparoscopic surgery for a life-threatening, cyst of liver. Tokai J Exp Clin Med. 2011;36(1):13–6.

    PubMed  Google Scholar 

  53. Dapri G, Casali L, Bruyns J, Himpens J, Cadiere GB. Single-access laparoscopic surgery using new curved reusable instruments: initial hundred patients. Surg Technol Int. 2010;20:21–35.

    PubMed  Google Scholar 

  54. Brunner W, Schirnhofer J, Waldstein-Wartenberg N, Frass R, Pimpl K, Weiss H. New: single-incision transumbilical laparoscopic surgery. Eur Surg. 2009;3:98–103.

    Article  Google Scholar 

  55. Struecker B, Haber P, Öllinger R, Bahra M, Pascher A, Pratschke J, et al. Comparison of single-port versus standard multiport left lateral liver Sectionectomy. Surg Innov. 2018;25(2):136–41.

    Article  PubMed  Google Scholar 

  56. Saad MR, Choi Y, Han HS, Yoon YS, Cho JY, Lee JS, et al. Solo single-incision laparoscopic liver resection: a cohort series. ANZ J Surg. 2020;90(6):1108–11.

    Article  PubMed  Google Scholar 

  57. Weiss M, Mittermair C, Brunner E, Schirnhofer J, Obrist C, Pimpl K, et al. Inline radiofrequency pre-coagulation simplifies single-incision laparoscopic minor liver resection. J Hepatobiliary Pancreat Sci. 2015;22(12):831–6.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the clinical support by Jan Schirnhofer, Eberhard Brunner, Thomas Schäfer, Cristian Obrist, Katharina Fischer, Michael DeCillia, Vanessa Kemmetinger, Hannes Hoi, Viktoria Mosshammer, and Martin Grünbart.

Author information

Authors and Affiliations

  1. Department of Surgery, Krankenhaus Barmherzige Brüder Salzburg, Salzburg, Austria

    Christof Mittermair & Helmut Weiss

Authors
  1. Christof Mittermair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helmut Weiss
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Helmut Weiss .

Editor information

Editors and Affiliations

  1. Division of Minimally Invasive Surgery, Center for Fluorescence-Guided Surgery, Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Santiago Horgan

  2. Center for the Future of Surgery, University of California San Diego, La Jolla, CA, USA

    Karl-Hermann Fuchs

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mittermair, C., Weiss, H. (2021). The Potential of Single-Site Surgery. In: Horgan, S., Fuchs, KH. (eds) Innovative Endoscopic and Surgical Technology in the GI Tract . Springer, Cham. https://doi.org/10.1007/978-3-030-78217-7_30

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-78217-7_30

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-78216-0

  • Online ISBN: 978-3-030-78217-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation