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04/12/23The Mount Sinai Hospital of Queens 1
Minilaparoscopy as an Alternative to Natural Orifice Surgery
Daniel Tsin, MD Dawar Mahmood, MDPanagiotis Manolas , MDJoan Padouvas, MD
04/12/23The Mount Sinai Hospital of Queens 2
Objective
• Present the use of the suprapubic port as an alternative to the operative Culdolaparoscopy , MANOS and NOTES.
04/12/23The Mount Sinai Hospital of Queens 3
Advantages
• Smaller nearly invisible scars
• Can be used in male and females
• Can be used in females with narrow vaginas, obliteration of the cul-de-sac or when the surgeon is not credentialed in colpotomy
• Less time to close port sites
• Avoids umbilical hernias(umbilicus is the weakest part of the abdominal wall)
• Less pain
04/12/23The Mount Sinai Hospital of Queens 4
Trocar Type Fascial Closure
2 mm MiniSite* Introducer NO
5 mm NO10 mm (below the level of the
Umbilicus)YES
10 mm (above the level of the Umbilicus) NO
12 mm YES
15 mm YES
04/12/23The Mount Sinai Hospital of Queens 5
Relative Contraindications
• Body Habitus Height greater than six feet
• Acute Cholecystitis (not attempted)
04/12/23The Mount Sinai Hospital of Queens 6
Method and Port Placement for Laparoscopic Appendectomy
• 2.8mm Umbilical port
• 2.8mm Left lower quadrant port
• 12mm Suprapubic port
04/12/23The Mount Sinai Hospital of Queens 7
04/12/23The Mount Sinai Hospital of Queens 8
Method and Port Placement Laparoscopic Cholecystectomy
• 2.8mm Subxyphoid port
• 2.8mm Umbilical port
• 2.8mm Right upper quadrant port
• 10mm Suprapubic port
04/12/23The Mount Sinai Hospital of Queens 9
04/12/23The Mount Sinai Hospital of Queens 10
04/12/23The Mount Sinai Hospital of Queens 11
•Placement of the 2,8 mm Umbilical Port
•Placement of the 2,8 mm Umbilical Port
04/12/23The Mount Sinai Hospital of Queens 12
•Three 2,8 mm ports and a 12 mm suprapubic port
04/12/23The Mount Sinai Hospital of Queens 13
04/12/23The Mount Sinai Hospital of Queens 14
•Gallbladder extraction via a suparapubic port
04/12/23The Mount Sinai Hospital of Queens 15
Conclusion
• As an alternative to a vaginal port.
• Could be use in males and females
• Reference: Tsin DA, Colombero LT, Mahmood D, Padouvas J, Manolas P. Operative Culdolaparoscopy : A New Approach Combining Operative Culdoscopy and Minilaparoscopy. JAAGL 2001:8;438-441
04/12/23The Mount Sinai Hospital of Queens 16
Results
• 4 Appendectomies
• 7 Cholecystectomies (elective)
• Were performed without complications and with operative times comparable to traditional laparoscopic surgeries