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LESS : Rationale And Evolution
 

LESS : Rationale And Evolution

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LESS : Rationale And Evolution

LESS : Rationale And Evolution

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LESS : Rationale And Evolution LESS : Rationale And Evolution Presentation Transcript

  • LESS : Rationale And Evolution
  • Lord Moynihan of Leeds
    • ‘ Big surgeons make big incisions’
  • Progression of MIS
    • ‘ Open’ surgery with smaller incisions
    • ‘ Mini’ lap
    • Hand assisted laparoscopy
    • Multiport laparoscopy (inc robotics)
    • LESS
    • NOTES
  • Surgical Revolution
    • All specialties – minimally invasive revolution
    • Laparoscopy = significant patient benefits:
    • Pain
    • Hospitalization
    • Recovery
    • Complications
    • Scars
    • Cost
  • Publications
    • Peer reviewed literature
      • Single Incision Laparoscopic Surgery (SILS)
      • Single Port Access (SPA)
      • One Port Umbilical Surgery (OPUS) 1
      • Natural Orifice Trans Umbilical Surgery (NOTUS) 2
      • Trans Umbilical Endoscopic Surgery (TUES) 3
      • Trans Umbilical Laparoscopic Assisted (TULAA) 4
      • Embryonic orifice - NOTES (e-NOTES) 5
    • 1. Rane et al Single-Port-Access Nephrectomy and Other Laparoscopic Urologic Procedures Using a Novel Laparoscopic Port Urology. 2008 Aug;72(2):260-
    • Cuesta MA et al The "invisible cholecystectomy": A transumbilical laparoscopic operation without a scar. Surg Endosc 2007
    • Zhu JF. Scarless endoscopic surgery: NOTES or TUES. Surg Endosc 2007; 21:1898-1899.
    • 4. Pappalepore et al Transumbilical laparoscopic-assisted appendectomy (TULAA): a safe and useful alternative for uncomplicated appendicitis. Eur J Pediatr Surg 2002; 12:383-386
    • 5. Gill I et al Single Port Transumbilical (E-NOTES) Donor Nephrectomy, J Urol 2008, Vol. 180, 637
  • Terms used to date
    • Single Incision Laparoscopic Surgery (SILS™)
    • Single Site Laparoscopy (SSL™)
    • Single Portal Laparoscopy (S-PORTAL™)
    • Single Port Access (SPA™)
    • Single Port Laparoscopy (SPL)
    • Single Site Access (SSA)
    • One Port Umbilical Surgery (OPUS)
    • Visibly Scarless Urologic Surgery ( VSUS)
    • SLiPP (Single Laparoscopic Port Procedure)
    • Natural Orifice Trans Umbilical Surgery (NOTUS)
    • Trans Umbilical Endoscopic Surgery (TUES)
    • Trans Umbilical Laparoscopic Assisted (TULA)
    • Embryonic Natural Orifice Transluminal Endoscopic Surgery (E-NOTES)
    • Single Laparoscopic Incision Transabdominal (SLIT)
    • (Laparo-Endoscopic Single Site Surgery) LESS
  • Keyword queries from MEDLINE and www.pubmed.gov (accessed 20 Nov, 2008)
    • Keyword Number of citations Urological citations
    • Single port access 131 16
    • Single port access surgery 96 11
    • Combined single port access 11 1
    • Robot assisted single port surgery 8 6
    • Single incision laparoscopic surgery 181 43
    • Single port laparoscopy 162 32
    • Single port laparoscopic surgery 181 39
    • Single incision laparoscopy 142 28
    • One port umbilical surgery 103 14
    • Visibly scarless surgery 8 0
    • Single keyhole umbilical surgery 1 1
    • Single trocar laparoscopic surgery 230 42
    • Single trocar transumbilical surgery 7 5
    • Scarless single port transumbilical surgery 2 1
    • Single access site laparoscopic surgery 18 5
  • Is this LESS?
  • Or is this LESS?
  • 9 July 2008, Cleveland Clinic
    • Multi-disciplinary consortium of experts: general surgeons, gynaecologists, urologists
    • Brainstorming to determine a universally acceptable name for single incision surgery
  • LESS
    • Laparo-Endoscopic Single-site Surgery’ (LESS) was both scientifically accurate and colloquially appropriate
    • LESSCAR: Laparo-Endoscopic Single-site Surgery Consortium for Assessment and Research
    • Term ratified by NOTES working group of the Endourological Society
    • Will be adapted as future standard for reference: multispecialty
    • Transumbilical access: U-LESS
  • LESS
  • Pioneers in Urological LESS
  • PubMed, accessed 10 May, 2009
    • LESS: 24397 hits
    • Laparo Endoscopic Single Site Surgery:
      • 15 citations
      • 13 urology
      • 2 general surgery
  • PubMed, accessed 23 January 2010
    • LESS: 975262 hits
    • Laparo Endoscopic Single Site Surgery:
      • 52 citations (5 review)
      • 32 urology
    • SAGES 2010: 55% of world literature is urological
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  • 5 May 2007: 1 st LESS nephrectomy
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  • Barret et al, J Endourol ,2009
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  • 100 patient series
  • Thank you, gracias, obrigado, 谢谢
    • Acknowledgements:
    • Lee Richstone, Lee Ponsky
    • Rene Sotelo
    • Jeff Cadeddu
    • Jihad Kaouk
    • Mahesh Desai
    • Pradeep and Prashanth Rao
    • Indy Gill, Monish Aron and Mihir Desai