Puesta en marcha de un programa de entrenamiento para laparoscopia urológica por puerto único

Two-Port Laparoscopic Reconstructive Surgery of the Urinary Tract with Reusable Umbilical System (Hybrid Less): A Proof of Concept Study

“…It duplicates the principles of standard laparoscopy but offers less surgical scar and potentially less surgical trauma [28]. The hybrid LESS that we propose is advantageous both for small size specimen extraction and for using large caliber haemostatic devices such as Ligasure™ or harmonic scalpel; however, it needs specific training and expertize [27]. Of course, the fact that large surgical experience in multiport laparoscopy is needed before execution of LESS procedures may somehow introduce bias in the results presented in this study favoring hybrid LESS in some operative results.…”

“…On the other hand, the trauma caused by minilaparoscopy material is reduced and can be used for drainage placement [20]. The use of one or several accessory ports (3-3.5-mm) represents the ideal complement to LESS surgery, facilitating the angulation and performance of sutures and helping transition from conventional laparoscopy to LESS [27]. Likewise, the temporary placement of marionette sutures for bladder, colon or uterine retraction causes no scarring and facilitates the procedure [18,21].…”

“…Nevertheless, it is clear that umbilical surgery has several disadvantages that the surgeon must consider. Even surgeons with extensive experience in laparoscopic surgery must undergo specific training [27]. Moreover, acquiring the ideal instrumentation to enable the correct triangulation involves an initial financial outlay to launch a program using this technique.…”

Trans-umbilical single-port radical nephrectomy with concomitant cholecystectomy

“…We believe it is necessary to advance in the use of clinical simulation to have effective training models to perform an initial learning curve. 10 However, not everything is advantageous in this type of surgery, as there is a loss of triangulation, a frequent crash of instruments and difficulties due to the proximity of the hands, which currently cannot be avoided and which generate an increase in the technical difficulty of this surgery. We would like to advise the use of systems which include a 15-mm port because, this way, we can introduce an extraction bag with retractor ring which greatly facilitates the removal of the piece reducing surgical time.…”

Pure transumbilical approach for oncologic surgeries of the male pelvis is now closer to become a reality

“…A significant clushing of intra and extracorporeal instruments with very limited maneuverability, lack of vision, and difficulty for vascular control are easily recognized and constitute the major step backwards for widespread use of umbilical surgery, at least in its present form. Besides, a very significant learning curve needing specific teaching programs is another unfortunate reality ( 15 ). Rapid innovation is needed to effectively face the difficulties inherent to complex surgical techniques, such as radical prostatectomy or radical cystectomy, including reduced visual field in which all the instruments are in parallel.…”