May 16, 2007

In a first-of-its-kind procedure, a surgeon at Drexel University College of Medicine successfully removed a woman's gallbladder through a single incision in the patient's belly button. The single port access (SPA) surgery was performed by Paul G. Curcillo II, MD, FACS, associate professor and vice chair of the Department of Surgery at Drexel University College of Medicine and director of Robotic and Minimally Invasive Surgery. Dr. Curcillo performed the surgery at Hahnemann University Hospital. The entire procedure was done with only one incision and left the patient with a hidden scar. It is believed to be the world's first single port laparoscopic gallbladder removal procedure.

"Using recently developed high-dexterity instrumentation, we are now able to decrease the number of incisions required in routine laparoscopy, as well as do more advanced procedures through the laparoscope," said Dr. Curcillo. "Fewer incisions are ultimately better for the patient in terms of the amount of discomfort and recovery time, not to mention the benefit of a hidden scar. Most important, this technique can be easily learned by surgeons and gynecologists currently doing laparoscopy."

The patient, a 28-year-old woman, experienced minimal discomfort and has a barely visible scar compared to traditional laparoscopic gallbladder removal requiring three to four incisions - one in the belly button, the others routinely made through the abdomen and lower chest, leaving obvious scarring. In the past, these incisions have been necessary because current laparoscopic instrumentation requires several port placements.

Dr. Curcillo was able to perform the single port access (SPA) surgery with a newly developed set of high dexterity instruments known as RealHand. RealHand laparoscopic instruments are engineered by Novare Surgical Systems, Inc. of Cupertino, California. According to the company, RealHand instruments are the first full-range-of-motion, hand-held laparoscopic instruments designed to mirror the surgeon's hand direction with the added benefit of tactile feedback. As such, when the surgeon's hand moves in one direction, the tip of the instrument follows exactly.

Using the RealHand high dexterity instrumentation, Dr. Curcillo was able to combine all of the standard laparoscopic entry points into one port of entry - the belly button. The incision was then closed with surgical glue.

Dr. Curcillo's SPA surgery follows recent announcements of other types of "natural orifice" (NOTES) procedures, in which surgeons enter through the mouth, rectum, or vagina in an attempt to minimize scarring and port access through the abdomen. Most of these procedures require extensive training and introduce the possibility of added complications.

"The SPA technique we've developed now allows us to do the same procedure we've been doing for the past 15 years, but through fewer incisions and with no added or new complications,"said Curcillo.

Dr. Curcillo, who believes this technique can be easily taught, foresees holding training seminars at Drexel University College of Medicine to allow other surgeons to offer the procedure to their patients. Dr. Curcillo has already used the SPA technique to remove abdominal masses and the appendix, and to place stomach tubes. He has also used it partially in more complex procedures such as colon surgery. He believes the technique can easily be applied to most other laparoscopic procedures, including the removal of ovaries, bowel surgeries, and performing stomach wraps for reflux disease.

"The benefit of this technique and the new high dexterity instrumentation is that it can be easily applied by all general laparoscopic surgeons with minimal additional training. I believe it will truly revolutionize the way laparoscopic surgery is performed."