What is LESS Surgery?
LESS (Laparo-Endoscopic Single-Site) surgery, also known by other names including Single Port Access and Single Incision Laparoscopic Surgery, is an advanced minimally invasive surgical procedure in which doctors operate through a single incision in a patient’s navel. A laparoscope is an optical instrument through which doctors can visually examine tissues and organs inside the abdomen and pelvis. In traditional laparoscopic surgery, the surgeon makes three to six incisions in multiple sites, inserts devices into each incision and performs the surgery. Because LESS surgery only uses one incision, the procedure is less invasive than other types of surgery and has the potential to reduce complications that may occur after traditional open and even laparoscopic abdominal surgery.
How is LESS Surgery Performed?
An intra-abdominal portal called the TriPort™ Access System, manufactured by Advanced Surgical Concepts, is placed into a single umbilical incision allowing single-site access for up to three surgical and imaging instruments used to perform the procedure. After the procedure the surgeon removes the port, allowing the natural contours of the bellybutton to hide the surgical incision.
Olympus’ unique 5mm deflectable laparoscope called EndoEYE® is often used in LESS surgery, enabling surgeons to see high-quality images and fine details during surgical procedures. The deflectable tip on the EndoEYE provides surgeons with the flexibility to view the surgical field from multiple angles during the procedure, and helps minimize potential collisions between the instruments, which are common when operating in narrow spaces.
What types of procedures can be performed with LESS surgery?
LESS surgery is most frequently used for gallbladder removal but is also now being used for several other types of procedures, including hernia repair, appendectomy, hysterectomy, gastric banding, gastric bypass, kidney removal and many additional types of urological and gynecological procedures. Not all patients will be candidates for single incision (single port) surgery. For some patients additional incisions or open surgery may be required.
What are the advantages of LESS surgery?
While traditional laparoscopic surgery offers benefits like less pain, faster recovery time, and improved cosmesis over open surgery, LESS surgery has the potential to extend these benefits even further because it offers surgeons the ability to perform procedures through only one small incision in the belly button (approximately 12-25mm).
Who is a candidate for LESS surgery?
For certain procedures, patients considered for laparoscopic surgery also may be candidates for a single-site procedure. Patients may not be eligible if they have had multiple major abdominal surgeries or are morbidly obese, as both conditions limit visibility and movement inside the abdomen.1
How long does it take to recover from LESS surgery?
Though recovery time varies according to procedure, following is a comparison of LESS surgery recovery time vs. standard laparoscopic recovery time in kidney donation surgery.1
· Average number of days on oral pain pills: Standard Laparoscopy = 26; LESS = 3.7
· Average number of days to return to work: Standard Laparoscopy = 51; LESS = 17
· Average number of days to 100% physical recovery: Standard Laparoscopy = 97; LESS = 25
What is the growth potential for LESS surgery?
Through 2013, demand for the advantages of minimally invasive surgery is expected to continue to rise, with techniques such as LESS surgery supporting this trend. The laparoscopic device market is expected to grow in the US by more than 49% over the next four years, from around $2.8 billion in 2009 to $4.2 billion in 2013. 2
When and where did LESS surgery originate?
Although the way LESS surgery is performed today would not have been possible without current technology, the idea of conducting surgery through a single site is more than a decade old. An Italian surgeon is generally credited with the first LESS-type procedure in 1997, performing a cholecystectomy (a procedure to remove the gallbladder) through the umbilicus, although he placed needles and sutures through the abdominal wall.3 The first true LESS procedure in the world was documented for the treatment of appendicitis in 2005 at the Department of Pediatric Surgery, Dokuz Eylul Medical School in Izmir,Turkey.4
Surgeons in the United States started conducting LESS surgery in early 2007. LESS surgery is now gaining momentum and a few dozen physicians across the U.S. are performing an average of a hundred LESS surgeries each in a year’s time.1
In July 2007, Dr. Kate O'Hanlan, a gynecologic oncologist with a medical practice in the San Francisco area, performed the country's first single-site total laparoscopic hysterectomy.5
In September 2007, Dr. Jihad Kaouk, the director of robotic urologic surgery at the Cleveland Clinic, became the first surgeon to use the technique for a radical prostatectomy and radical urinary cystectomy.1
In March 2009, Dr. Sharona Ross, Dr. Alexander Rosemurgy and Dr. Stuart Hart at Tampa General Hospital were the first to perform a double LESS surgery removing both the uterus and gallbladder in the same patient. In June 2009, they completed the first triple LESS surgery by combining an anti-reflux operation, a gallbladder removal, and intra-operative cholangiogram on the same patient. They also did the first successful LESS pancreatic tumor resection to date.6 In July 2009, Dr. Rosemurgy and Dr. Ross performed the first LESS surgery gallbladder removal without the use of general anesthesia.7
Where can I get more information on LESS surgery?
More information on LESS surgery can be found at http://www.olympusamerica.com/less
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9/2009
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References:
1 National Kidney Foundation. Press Release. Cleveland Clinic First to Perform Successful Live Kidney Donation Through Single Belly Button Incision. July, 2008. http://www.kidney.org/news/newsroom/newsitem.cfm?id=85.
2 iDATA Research Inc., U.S. Market for Laparoscopic Devices. May 2009.
3 G. Navarra, E. Pozza, S. Occhionorelli, P. Carcoforo, I. Donini, One-wound laparoscopic cholecystectomy. British Journal of Surgery. 1997; 84:695.
4Department of Pediatric Surgery, Dokuz Eylul Medical School in Izmir,Turkey http://www.tccd.org.tr/egitim/kongre/bilver.php?yil=2006&git=SB-14
5Angela Townsend, New surgery means quicker recovery after hysterectomy. The Plain Dealer. July 2008, courtesy of Cleveland Clinic.
6Tampa General Hospital (data on file)
7 Tampa General Hospital (data on file)