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Keyhole Surgery: Look, Ma! No Scar!

Date:  January 22nd, 2013

Contact/Phone:  Mary Muhlbradt
(701)857-5116, Fax: (701)857-5683

e-mail:   Mary Muhlbradt

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(MINOT, ND)—The days of proudly showing off one's surgical
scars may be coming to an end.

For many common surgical procedures there has been a remarkable evolution over the last two
decades from open surgeries with a large incision to laparoscopic procedures that use four small incisions or punctures that serve as ports for the laparoscopic instruments.

But now laparoscopic surgery itself has evolved, giving way to a single port method for some procedures “ one that requires just one small incision, and a discreet one at that.

Dr. Lane Lee, a board-certified general and vascular surgeon with Trinity Health, has been performing single incision laparoscopic surgery for the past couple of years. He says it was a natural progression borrowing techniques from basic procedures like tubal ligations and appendectomies, long performed with a single incision, and applying them to more difficult cases like gallbladder surgery and bowel resections. He also completed a laparoscopic fellowship where he was trained in advanced single incision methodology.

“The use of a single incision for more advanced procedures like gallbladders and bowel resections came about because of better lighting, better tools, better instrumentation, and better imaging,” Dr. Lee explained.  “Now we have halogen lights, HD cameras and flexible tools. Everything is much more sophisticated, and that's made it more feasible.”

Key among the improvements in technology is a flexible tipped camera that can twist and turn in any direction. “We see them used in
cop shows to look through keyholes. We use them too. We can go in and move the camera around and look at the structures from different perspectives.”

Dr. Lee says that after years of doing conventional laparoscopies, it became apparent to surgeons that some four-port surgeries
could have been done with three ports or incisions. That led operators to ask “ why keep poking more holes if we don't need to? The obvious answer was to consider using fewer ports.

With the single incision method the surgeon creates a single incision in the navel about 15 millimeters in diameter. The single port has multiple little holes, and all of the instruments are inserted through the same port. There's a learning curve when it comes to manipulating the instruments, holding tissue, dissecting and suturing.

Not every patient is a candidate for single incision laparoscopic surgery, according to Dr.
Lee. The ideal candidate is someone reasonably fit and fairly short-waisted (the latter criterion being related to
the distance between the ribs and the pelvis).

Whether a surgery is single port or multiple port - the differences can be subtle. There are cases particularly suited to single
incision surgery, such as one involving the removal of large gall stones. But perhaps the greatest advantage involves

“Patients generally experience the same outcome, length of stay, and level of comfort,” Dr. Lee states. “Cosmetically, of course, single incision is superior because you have one incision that hides in the navel.”

Depending on your lifestyle, such a difference can be significant. SPACE index.php