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Flexible versus rigid single-port peritoneoscopy: a randomized controlled trial in a live porcine model followed by initial experience in human cadavers

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Abstract

Introduction

We compared single incision laparoscopic surgery with flexible endoscope (“flexible SILS”) and with rigid optic (“rigid SILS”) for access to 11 elective sites of peritoneal carcinomatosis.

Materials and methods

Back-to-back flexible and rigid SILS peritoneoscopy were performed in ten live pigs. SILS peritoneoscopy was performed using a flexible endoscope or a rigid optic, in random order, together with two rigid 5-mm laparoscopic forceps. Primary endpoint was access success rate to 11 elective sites of peritoneal carcinomatosis. Findings for the most favorable option were then assessed in four human cadavers.

Results

In the porcine model, the overall rate of access to targets was 98% with flexible SILS and 87% with rigid SILS (p < 0.001). Both flexible and rigid SILS allowed a 100% access rate to diaphragmatic domes, paracolic gutters, splenic and hepatic hilum, pelvic floor, and trigonal bladder. The rates of access to other sites by flexible versus rigid SILS, respectively, were: root of the mesentery (90 vs. 50%), origin of the inferior mesenteric vein (90 vs. 50%), inferior vena cava (100 vs. 90%), and cul-de-sac of Douglas (100 vs. 50%). No complications were observed. Procedures were performed in mean time of 26 and 24 min, respectively. These findings were confirmed for flexible SILS in four human cadavers.

Conclusions

Flexible SILS is superior to rigid SILS to evaluate the peritoneal cavity in a timely manner. This suggests a need for flexible instrumentation or other technical solutions to perform thorough minimally invasive surgical evaluation of peritoneal carcinomatosis.

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Abbreviations

NOTES:

Natural orifice translumenal endoscopic surgery

SD:

Standard deviation

SILS:

Single incision laparoscopic surgery

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Acknowledgments

This study was made possible thanks to the support of the EURO-NOTES Foundation and to an Ethicon Endo-Surgery Research Fund grant. Y. L. received a grant from the Association Benoit Malassagne, Paris, France to support her research on minimally invasive surgical and endoscopic techniques. The authors would like to thank Karl Storz Endoscopy (Tübigen, Germany) that provided the endoscopic and laparoscopic equipment free of charge, and Covidien (Elancourt, France) that provided the SILS® port free of charge. This study was presented at the 4th European NOTES Workshop, September 9–11, 2010, Roma, Italy, at the Digestive and Disease Week, May 2–5, 2010, New Orleans, Louisiana, USA, and at the 5th International NOTES W.I.D.E.R., Barcelona, Spain, November 21–22, 2011.

Disclosures

Authors Yamina Ladjici, Marc Pocard, Philippe Marteau, Patrice Valleur, and Xavier Dray have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Digestive Diseases, Tertiary Care Centre for Peritoneal Carcinomatosis, School of Surgery, & Paris Diderot Paris 7 University, Lariboisière Hospital APHP, Paris 7 University, 2, rue Ambroise Paré, 75010, Paris, France

    Y. Ladjici, X. Dray, P. Marteau, P. Valleur & M. Pocard

  2. INSERM U965, Paris, France

    Y. Ladjici, X. Dray & M. Pocard

  3. Laboratoire EA3199, Conservatoire National des Arts et Métiers, Paris, France

    X. Dray & P. Marteau

  4. Division of Gastroenterology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    X. Dray

Authors
  1. Y. Ladjici
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  2. X. Dray
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  3. P. Marteau
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  4. P. Valleur
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  5. M. Pocard
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Corresponding author

Correspondence to X. Dray.

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Ladjici, Y., Dray, X., Marteau, P. et al. Flexible versus rigid single-port peritoneoscopy: a randomized controlled trial in a live porcine model followed by initial experience in human cadavers. Surg Endosc 26, 2651–2657 (2012). https://doi.org/10.1007/s00464-012-2218-3

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  • DOI: https://doi.org/10.1007/s00464-012-2218-3

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