In the past 20 years, surgical techniques have moved toward a less invasive approach from open to single-incision minimally invasive surgery. Innovations in minimally invasive surgical technology, such as multichannel ports, articulating instruments, and flexible high-definition endoscopes, have allowed laparoendoscopic surgeons to perform increasingly complex surgeries through smaller incisions.
The laparoendoscopic single-site surgery (LESS) is introduced as an alternative to conventional multiport laparoscopy.
There are several difficulties to perform LESS, such as poor exposition, loss of triangulation, lack of space on patient’s exterior because of crowded instruments, and “sword fighting” among instruments.
In order to overcome the disadvantages of the LESS technique, some surgeons combined it with robotic surgery which led to a new kind of surgery named R-LESS. R-LESS surgery is the new MIS technique.
Robotic surgery has greatly improved surgeon dexterity, surgical precision, visualization, ergonomics, and technical limitations of laparoscopic surgery (instrument crowding and loss of depth of perception with current two-dimensional flexible optics) and may shorten the minimally invasive learning curve for surgeons compared with traditional laparoscopy.
Despite these advantages, the current version of the set still has limitations. First, the instruments are not wristed. Manual suturing and other advanced manipulations are thus more difficult to perform when compared with the wristed robotic instruments. Second, the da Vinci single-site instrumentation has a very limited range of motion within the surgical field.
FDA approval for R-LESS hysterectomy and adnexal surgery was granted in 2013, and preliminary case reports for gynecological procedures suggest favorable surgical outcomes and furthermore, with regard to gynecological oncology procedures.
Food and Drug Administration
Laparoendoscopic single-site surgery
Robotic laparoendoscopic single-site surgery
Single incision laparoscopic surgery
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Single port placement (M4V 5,246,787 bytes)
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