Single Port Access (SPA) Surgery-a 24-Month Experience

In April 2007, we performed our first single port access (SPA) surgical procedure. Beginning with simple procedures, we progressed to more complex procedures employing modifications of the initial technique. Maintaining our abdominal entry technique through a single incision, typically umbilical, we have now successfully performed cholecystectomies, colon resections, small bowel procedures, liver biopsy, splenectomy, adrenalectomy, and surgery of the gastroesophageal junction. Two procedures have required additional port sites, none has employed transabdominal sutures, and < 5% of all procedures have required articulation. Immediate follow-up demonstrates safe completion of multiple procedures with acceptable outcomes of blood loss and hospital stay. Although initial operative times are extended, a decrease is seen following a learning curve. At 2-year follow-up, two hernias developed at the extended incision for colon extraction. With initial procedures performed in April 2007, we now report 24-month follow-up of a novel laparoscopic approach utilizing standard instrumentation. We demonstrate that SPA surgery is an alternative to multiport procedures with proposed initial benefits of decreased number of incisions and improved cosmesis for the patient. Long-term prospective randomized large case series will be necessary to assess pain, recovery, and hernia formation proving advantages, if any, over multiport laparoscopy.