Dr. Kaouk
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Cleveland—Surgeons at the Cleveland Clinic's Glickman Urological & Kidney Institute have taken laparoscopic surgery to the next level
by performing a series of surgeries requiring only a single abdominal incision. Using a device newly listed by the FDA, Jihad
H. Kaouk, MD, and colleagues say the single-port procedures leave little to no scarring and reduce postoperative complications.
"This is the first-ever single-port surgery with three channels that can admit a scope and two instruments," Dr. Kaouk explained.
"It minimizes further abdominal trauma and uses an obliterated natural orifice that is scar already; ie, the umbilicus. No
muscle splitting is needed since there is no muscle under the umbilicus."
To date, Dr. Kaouk's team has used the single-port technique to perform renal cryoablation, sacrocolpopexy, simple nephrectomy,
wedge renal biopsy, and pediatric varicocelectomy.
"In addition, we have recently done the first-ever radical prostatectomy and radical cystectomy through the single port in
the navel without any shortcuts or the addition of other instruments," Dr. Kaouk told Urology Times at press time. "These cases highlight the boundaries of what can be done with this technology." 
A single-port cannula with three working channels allows simultaneous passage of 5-mm instruments and a scope. (Photo courtesy
of Jihad H. Kaouk, MD)
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The surgery is performed through a 1.5-cm semicircular incision in the inner curve of the umbilicus, and the rectus fascia
is incised. The recently introduced single port with multiple channels (Uni-X Single-Port Laparoscopic System, Pnavel Systems,
Inc., Cleveland) is inserted and fixed with sutures to the skin. After achieving pneumoperitoneum at 15 mm Hg, a 5-mm scope
with a flexible tip (EndoEYE, Olympus Surgical, Orangeburg, NY) is inserted, and special curved in-struments as well as flexible
instruments are used. Procedures are performed duplicating traditional laparoscopic steps, Dr. Kaouk said.
"As we improve flexible instruments, the procedure becomes less challenging," he said. "Ablative procedures are straightforward.
Reconstructive procedures such as sacrocolpopexy that require suturing are more challenging and require experience in standard
laparoscopy. Obviously, we are selecting easier cases at this time, such as patients with no previous abdominal surgery."
With more than 25 cases completed as of this writing, Dr. Kaouk said there had been no complications, no conversion to standard
laparoscopy, and no addition of ports. The initial experience with the technique will be presented by Dr. Kaouk and colleagues
at the AUA annual meeting in May.
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