BERKELEY, CA (UroToday.com) - The hottest area of minimally invasive surgery is now that of NOTES (natural orifice transluminal endoscopic surgery) and SPA (single port access). However, most of the work has been in the laboratory and very little has seen the light of clinical experience. Herein, using a novel Uni-X Single Port Access Laparoscopic System (Pnavel Systems, Morganville, NJ), the authors report successfully performing renal cryotherapy (4), wedge biopsy of a kidney (1), abdominal sacrocolpopexy (4), and even radical nephrectomy (1). The single access port is placed via a 1.5 cm incision; the port has 3 portals for passage of a 5 mm flexible steerable laparoscopic endoscope and 2, 5 mm articulating instruments. Hence, the endoscope and instruments can be triangulated at broader angles than would be possible with straight instruments or a rigid endoscope passed through the same port.

The single SPA nephrectomy did require an extra 10 mm port which was placed where a 4 cm incision was planned in order to remove the kidney intact. All procedures were successfully accomplished; the average hospital stay was 2.8 days. Unfortunately, no data are provided with regard to use of analgesics, in hospital analog pain scores, or short term convalescence. Likewise, at this point there are no financial data provided with regard to cost of the SPA port or the specialized, apparently disposable, articulating/rotating instrumentation. The next challenge is to answer the aphorism: "All things good were once new, but all things new are not necessarily good.". At this point in time, this new approach could easily be subjected to a prospective randomized study be it for sacrocolpopexy or renal cryotherapy. At the very least, it will need a retrospective controlled analysis in the process of determining its proper place in the less invasive armamentarium. Regardless, the authors need to be congratulated for pushing the envelope forward and providing the Phase I/II information necessary for progression to a definitive Phase III trial.

Kaouk JH, Haber GP, Goel RK, Desai MM, Aron M, Rackley RR, Moore C, Gill IS

Urology. 2008 Jan;71(1):3-6
doi:10.1016/j.urology.2007.11.034

PubMed Abstract
PMID: 18242353

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Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

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