Cleveland Clinic Urologists Use Virtually Scarless Technique for Many Procedures
By entering a single small incision through the navel, Cleveland Clinic surgeons are taking minimally invasive surgery to a new level.
What is Single-Port Surgery?
Single-port surgery is surgery that is literally performed through a single port – or incision – in a patient’s navel (belly button). Cleveland Clinic urological surgeons Inderbir Gill, MD, Jihad Kaouk, MD, and Mihir Desai, MD, are among only a handful of surgeons across the nation now performing these procedures.
Single-port surgery is a form of minimally invasive – laparoscopic – surgery. In traditional laparoscopic surgery a telescopic rod connected to a video camera, or laparoscope, is inserted through a small incision in the abdomen. Three to five additional small incisions are made and used as “ports” in which to insert instruments to remove a kidney, for example, or to repair the urinary tract. Because laparoscopic surgery usually results in fewer complications and a more rapid recovery, patients often can return home the same day.
What are the Advantages and Disadvantages of Single-Port Surgery?
Because it uses only one port, single-port surgery leaves little to no scarring and may reduce complications that commonly occur after traditional open and even traditional laparoscopic abdominal surgery. Patients are reporting less discomfort and faster recovery compared with those undergoing traditional laparoscopy.
Umbilical incision 3 weeks
after single-port nephrectomy (kidney removal)
leaves little to no scarring.
For surgeons, the single-port approach is more challenging than traditional laparoscopy because the surgeon has less freedom of movement with all instruments using the same entry point. Specially designed flexible instruments help to overcome that limitation.
What Procedures can be Done Using the Single-Port Approach?
- donor nephrectomy (living kidney donation)
- nephrectomy (removal of a kidney)
- cystectomy (removal of the bladder)
- prostatectomy (removal of the prostate)
- cryoablation (freezing of cancerous tissue)
- sacrocolpopexy (treatment for pelvic organ prolapse in women)
- treatment of varicocele (an enlargement of the veins within the scrotum)
- reconstruction of the urinary tract
Who is a Candidate for Single-Port Surgery?
For certain procedures, patients considered for laparoscopic surgery also may be candidates for a single-port procedure. Patients may not be eligible if they have had multiple major abdominal surgeries or are morbidly obese, as both conditions limit visibility and movement inside the abdomen. If you are interested in making an appointment with a surgeon who performs single-port procedures, please call 800.223.2273, ext. 45600.
Who Performs Single-Port Surgery at Cleveland Clinic?
Inderbir S. Gill, MD, Chairman of Urology at Cleveland Clinic, recently performed the first single-port transumbilical live-donor nephrectomies in nine consecutive 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, and we anticipate that this approach will raise the bar significantly for this procedure,” said Dr. Gill. “Our ability to deliver a high degree of surgical finesse and technical precision to perform this delicate operation through the single-port approach is testimony to the validity of this emerging field.” Dr. Gill has pioneered single-port laparoscopic partial nephrectomies as well, having performed five to treat patients with kidney cancer.
Who Performs Single-Port Surgery at Cleveland Clinic?
Jihad Kaouk, MD, Director of Robotic Urology at Cleveland Clinic, recently performed the first robotic single-port surgeries for renal pelvis reconstruction/revision (pyeloplasty), and surgical removal of the prostate gland (radical prostatectomy), showing promise that surgeons desiring 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 also has performed several other single-port transumbilical 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 varicocelectomy (surgical correction of enlarged veins in the scrotum) in children.
Who Performs Single-Port Surgery at Cleveland Clinic?
Mihir Desai, MD, Director of Endourology and Stone Disease at Cleveland Clinic, recently performed the first single-port transvesical simple prostatectomy for symptomatic large-volume benign prostate hypertrophy (BPH) in three patients. For large-volume BPH, transurethral surgery removes approximately 30 percent of the gland, while open surgery removes upwards of 70 percent of the gland. This new approach mirrors open surgery by removing 70 percent of the obstructive BPH tissue but only requires a single small incision through the bladder. Because of the intravesical 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 also has lead teams through single-port transumbilical surgeries, including bilateral pyeloplasty (uretero-pelvic junction repair), ureteroneocystostromy, and ileal ureter replacement (for ureteral obstruction).
Related Content:
Cleveland Clinic surgeon Dr. Inderbir S. Gill, MD, performs the first successful live kidney donation through single belly button incision. Watch Story.
