Tonglu Wanhe Medical Instrument Co., Ltd.
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FAQ
Since the beginning of the 21st century, single-port laparoscopic surgery (LESS) has gradually become one of the important advances in the field of minimally invasive surgery. This technology concentrates the traditional multi-port channels into one channel and inserts multiple operating instruments to complete the endoscopic surgery, which has the advantages of less trauma, better aesthetic effect, less damage, and faster postoperative recovery.
In the field of gynecology, single-port laparoscopic technology has been continuously optimized and developed from transumbilical single-port to transvaginal single-port, and then to artificial single-port and da Vinci robot single-port. For example, the gynecology team of Guangdong Provincial People's Hospital has successfully performed nearly 150 transumbilical single-port laparoscopic surgeries based on the experience of Korean experts and achieved good prognosis. In addition, Wuhan University Zhongnan Hospital has also widely used transumbilical single-port laparoscopic surgery (TU-LESS) and transvaginal single-port laparoscopic surgery (VNOTES) in the field of gynecology, further promoting the development of this technology.
In the field of urology, single-port laparoscopic technology has developed rapidly since it was introduced to China in 2008. Through innovation in surgical approaches and process optimization, the risk of intraoperative massive bleeding is greatly reduced and surgical efficiency is improved. For example, the use of the "tunnel method" single-port laparoscopic splenectomy significantly improves the safety and effectiveness of the operation by optimizing the surgical path and process.
However, single-port laparoscopic surgery also faces some challenges, such as instrument crowding and collision, ergonomic difficulties, lack of triangulation instruments, and the requirement for the operator to have advanced laparoscopic surgical techniques. In order to overcome these difficulties, domestic and foreign physicians continue to expand the application of LESS in various fields, and improve the feasibility and safety of surgery through the development and optimization of new surgical instruments.
In short, single-port laparoscopic surgery technology is constantly developing. Through technological innovation and optimized design, it has gradually overcome the limitations of traditional multi-port laparoscopic surgery and demonstrated greater minimally invasive advantages and cosmetic effects. In the future, with the accumulation of surgical skills and the application of new surgical instruments, single-port laparoscopic surgery will be widely used in more clinical fields.
The latest progress of single-port laparoscopic surgery technology in the field of gynecology is mainly reflected in the following aspects:
Single-arm single-port laparoscopic surgical robot: Professor Jiang Hua's team from the Obstetrics and Gynecology Hospital Affiliated to Fudan University used a single-arm single-port laparoscopic surgical robot to perform a total hysterectomy on a patient with multiple uterine fibroids. This is the first time that this technology has been used clinically.
Transvaginal single-port laparoscopic surgery (V-NOTES): In recent years, transvaginal single-port laparoscopic surgery has developed rapidly in the field of gynecology. It has the advantages of no scars, less trauma, and fast recovery. It has been widely used in adnexal surgery, hysterectomy, myomectomy, pelvic organ prolapse surgery, and gynecological malignant tumor surgery.
Transumbilical single-port laparoscopic surgery (LESS): Professor Chen Jiming proposed the concept of micro-incision single-port laparoscopic gynecological surgery and widely used the 5mm micro-incision LESS surgery. This surgical method is not only less traumatic, but also can achieve a "scarless" effect.
Suspended pneumoperitoneum transumbilical single-port laparoscopic surgery: This surgical method combines the advantages of suspended pneumoperitoneum transumbilical single-port laparoscopic surgery and further improves the safety and effectiveness of the surgery.
There are several ways to overcome the problems of instrument crowding and collision in single-port laparoscopic surgery:
Use grasping forceps and separation forceps with curved front ends: By changing the angle of the instrument during operation, the triangular arrangement can be restored, thereby reducing mutual collision.
Use surgical instruments with multiple active degrees of freedom: This design can complete the surgical operation during the movement of the patient's abdominal cavity, and the external positioning arm remains stationary during the teleoperation process, avoiding the risk of mutual collision during the operation.
Alternate entry of instruments: Each operating instrument is basically in a parallel state, and alternately enters the abdominal cavity to form a "chopstick effect", which can reduce collisions between instruments.
Application of single-ring devices and other technical improvements: For example, the use of single-ring devices and abdominal wall suspension technology to solve the problem of occlusion, etc., these technologies can improve the operating space to a certain extent and reduce instrument crowding and collision.
The new surgical instruments currently used to optimize single-port laparoscopic surgery mainly include the following:
Minilap grasping forceps: This new mini grasping forceps is added in transumbilical single-port laparoscopic cholecystectomy. 20 operations have been completed with satisfactory clinical results.
Jingfeng® Single-port Laparoscopic Surgical Robot SP1000: This robot system only requires one surface surgical incision, which can reduce intraoperative bleeding, relieve pain, and shorten recovery time and hospitalization time. It is especially suitable for young patients with high aesthetic requirements. In addition, the robot also performs well in cervical cancer and endometrial cancer surgery in the field of gynecology.
Surui Single-port Laparoscopic Surgical Robot: This robot has been used in complex surgeries such as urology, gynecology, and thoracic surgery, showing good results.
Single-port multi-channel surgical instrument: This new single-port puncture multi-channel unidirectional operating system breaks through the cross-operation bottleneck of traditional single-port laparoscopes and is suitable for surgical instrument channels for laparoscopic endoscopes. The left and right channels are occupied by operating surgical forceps, and the upper and lower channels can be implanted with endoscopes and auxiliary instruments (such as suction devices or grasping forceps).
The application cases of single-port laparoscopic surgery in the field of urology include the following:
Kidney and adrenal diseases: 33 single-port retroperitoneoscopic surgeries were completed using a homemade single-port multi-channel device and conventional laparoscopic instruments, including adrenal tumor resection and radical nephrectomy for renal cancer.
Radical prostatectomy: Radical prostatectomy was completed using the da Vinci SP surgical system assisted laparoscopy.
3D single-port laparoscopic surgery: In the Department of Urology of Changhai Hospital, 20 3D single-port laparoscopic surgeries were completed, and the feasibility and safety of the surgery were discussed.
Radical renal pelvic cancer surgery: Right renal pelvic cancer radical resection was completed with the assistance of the Jingfeng® single-port robot.
Transumbilical single-port wireless laparoscopic surgery: The Department of Urology of Wenzhou People's Hospital successfully performed a high-position ligation of the hernia sac of the right indirect hernia under a transumbilical single-port wireless laparoscopic approach for a child.
Radical prostatectomy: Radical prostatectomy was performed using suprapubic extraperitoneal robot-assisted single-site laparoscopic technique.
Ureterotomy: Ureterotomy was successfully performed using LESS (laparoendoscopic single-site surgery) technique with a single-port multi-channel cannula.
Ergonomic design in single-port laparoscopic surgery has made significant progress in recent years. Here are some of the latest research and applications:
Robotic-assisted system: Through remote control, three-dimensional imaging, bionics and ergonomics, robotic surgical systems partially make up for the obstacles in traditional single-port laparoscopic operations. This system allows surgeons to use the laparoscope in a comfortable sitting position, thereby fully controlling the third robotic arm.
Improved instrument design: In order to comply with ergonomic principles, single-incision laparoscopic instruments and multi-channel punctures have been developed to reduce operation time and puncture rate. In addition, the design of dedicated bipolar forceps and small surgical laparoscopes also takes ergonomics into consideration, making the surgical process more efficient and comfortable.
Expert consensus and standardized operation: The Chinese expert team released the "Chinese Expert Consensus on Standardized Operation of Single-port Laparoscopic Inguinal Hernia Repair (2023 Edition)", which discusses in detail the importance of ergonomics in surgery and related challenges.
Digital and automated technology: The breakthrough innovation of digital laparoscopic surgery allows surgeons to control the surgical perspective without manual operation, further improving the safety and comfort of the operation.
Learning curve and teaching methods: Studies have shown that by emphasizing key ergonomic methods, the "chopstick effect" in gynecological single-site laparoscopic surgery can be effectively overcome and help surgeons master surgical skills faster.
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