This demonstration of the technical feasibility of using robotics opens the door for further advances. However, considerable additional technological advances are necessary to increase the widespread usage of robotics in single-port laparoscopy.
Cleveland, OH (PRWEB) June 16, 2008
Doctors at the Cleveland Clinic Glickman Urological and Kidney Institute shared news of their success performing several surgical "firsts" at last month's American Urological Association (AUA) annual meeting in Orlando, Fla. Cleveland Clinic's minimally invasive urology team recently performed a series of world "firsts" in the emerging field of single-port laparoscopy, in which surgeries are performed entirely through a single, tiny incision. The team has even mastered virtually scar-free single-port laparoscopic surgery by concealing the incision within the belly button (umbilicus).
Single-port surgeries and trans-umbilical surgeries are major advances over traditional laparoscopic procedures that entail making three to six small "key-hole" incisions in the abdomen to perform major operations.
Inderbir S. Gill, M.D., Professor & Chairman, Department of Urology and Director of the Laparoscopic and Robotic Surgery Center, kidney donors for kidney transplantation. In this new approach, all aspects of kidney harvesting are completed through the navel, including removal. Instead of a visible six-inch external scar and a four to six week recovery period, this minimally invasive procedure offers patients a two-week recovery period and a scar that is almost completely hidden in the belly button.
"Performing scar-free kidney removal in a healthy donor is a significant step forward by decreasing the pain and scarring associated with major kidney surgery," said Dr. Gill, who recently performed the first single-port laparoscopic partial nephrectomies in the world in five kidney cancer patients as well.
Jihad Kaouk, M.D., Director of Robotic Urology, recently performed the first two robotic single-port surgeries for renal pelvis reconstruction/revision (pyeloplasty) and surgical removal of all or part of the prostate gland (radical prostatectomy), showing promise that surgeons looking to learn and apply these highly technical procedures can now be assisted by robots.
"For single-port surgery to advance to the next level, use of robotics is going to be necessary," said Dr. Kaouk. "This demonstration of the technical feasibility of using robotics opens the door for further advances. However, considerable additional technological advances are necessary to increase the widespread usage of robotics in single-port laparoscopy." Dr. Kaouk has also performed several other world-first single-port trans-umbilical surgeries including radical prostatectomy, radical cystectomy (removal of the bladder), renal tumor cryoablation (using cold energy to kill tumor tissue in the kidney), vaginal prolapse surgery (repair of the vaginal canal), and varicoclectomy (surgical correction of enlarged veins in the scrotum) in children.
Mihir Desai, M.D., Director of Endourology and Stone Disease, recently performed the first single-port transvesical simple prostatectomy for symptomatic large-volume benign prostate hypertrophy (BPH) in three patients. For the large-volume BPH, transurethral surgery removes approximately 30 percent of the gland. This new single-port approach removes approximately 70 percent of the obstructive BPH tissue, mirroring open surgery, but only requires a single, small incision directly into the bladder. Because of the intra-vesical nature of this novel procedure, recovery is quicker, leading to the possibility of it being performed as an outpatient procedure in the future.
"This truly represents development of a novel technique for patients with significant symptoms from prostate enlargement," said Dr. Desai. "Perhaps more importantly, we have introduced the concept of single-port intraluminal surgery within a hollow organ, which is likely to have a robust application in other fields of surgery as well." Dr. Desai has also performed several other world-first single-port trans-umbilical surgeries, including bilateral pyeloplasty (uretero-pelvic junction repair), ureteroneocystostromy, and ileal ureter replacement (for ureteral obstruction).
Other members of the surgical team on these innovations included Drs. Khaled Fareed, Rene Sotelo, Monish Aron, David Canes, Courtenay Moore, Jim Ulchaker, Raymond Rackley, Jeffrey Palmer and Georges-Pascal Haber.
The members of the institute plan to share its future findings in conferences and continuing medical education forums.
About the Glickman Urological and Kidney Institute
The Glickman Urological and Kidney Institute is one of 26 institutes at Cleveland Clinic that group multiple specialties together to provide collaborative, patient-centered care. The institute is a world leader in treating complex urologic and kidney conditions in adults and children, and U.S. News & World Report has ranked the urology program among the top two in the nation for eight consecutive years.
About Cleveland Clinic
Cleveland Clinic, located in Cleveland, Ohio, is a not-for-profit multispecialty academic medical center that integrates clinical and hospital care with research and education. Cleveland Clinic was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. U.S. News & World Report consistently names Cleveland Clinic as one of the nation's best hospitals in its annual "America's Best Hospitals" survey. Visit Cleveland Clinic's Web site.