The Small-Port Effect and the Small-Triangle Manipulation in Laparoendoscopic Single-Site Surgery: Concept from a Training Model to the Clinic

Abstract Objectives: A small port could possibly minimize the collision of instruments and increase operability in laparoendoscopic single-site surgery (LESS) through the realization of small-triangle manipulation. In this study, we attempted to verify the small-port effect in an in vitro suture model and in vivo LESS hysterectomy with different-sized ports. Subjects and Methods: Two different-sized homemade glove ports were used and assessed in both in vitro and in vivo studies. The trocar head of port 1 was 36 mm in diameter and that of port 2 was 25 mm. Thirty sutures under LESS were conducted in a laparoscopic training box with each port. In LESS hysterectomy, 40 patients were recruited, of whom 20 underwent surgery under port 1 and the remaining 20 under port 2. One surgeon with experience in LESS conducted all sutures. The suture time of each stitch in the training box and for closing the vaginal cuff was videotaped and compared. Results: In the training model, the mean time for each suture with port 1 and port 2 was 18.6 ± 0.5 and 12.5 ± 0.3 seconds, respectively. In LESS hysterectomy, the mean suture time of the vaginal cuff with port 1 and port 2 was 15.2 ± 3.1 and 12.4 ± 2.6 minutes, respectively. Suture with port 2 was less time consuming than that with port 1 in both in vivo and in vitro studies, and the difference was statistically significant. Conclusions: A small port could save time in the suture process both in a training model and in operating room as a result of decrease in instrument collision and realization of small-triangle manipulation.