Surgeons offer procedures through belly button

September 23, 2012 by Cheryl Powell

There's a novel way to remove a gallbladder: Use a surgical robot to take it out through the navel.

Rather than using just their hands to guide instruments through multiple incisions, some surgeons are performing remote-controlled procedures through the patient's belly button.

The single-port, robotic-assisted gallbladder removal is the latest step in the push to make minimally even less invasive.

After placing robotic arms and a 3-D camera through a 1 1/2-centimeter incision in the belly button, trained surgeons can sit away from the patient at a control panel for the daVinci System and carefully navigate through an inflated with tiny, precise movements.

"We are heading toward minimizing minimally invasive surgery," said Dr. Jihad Kaouk, director of the Center for Robotic and Image Guided Surgery at the Cleveland Clinic.

The first robotic single-port gallbladder removal using new instruments designed for the technique was performed about 1 1/2 years ago at the Cleveland Clinic as part of a trial, according to Kaouk. The surgical system was approved by the U.S. for gallbladder removal about nine months ago.

Akron General and Summa health systems in Akron, Aultman Hospital and Mercy Medical Center in Canton and Wooster Community Hospital are offering the single-incision, robotic to patients who qualify for the procedure, according to the maker of the daVinci Surgical System.

Performing surgery through the belly button can mean less scarring, reduced pain, lower blood loss and faster recovery than with the four incisions typically used for laparoscopic surgery, according to Dr Adrian G. Dan, an advanced at Summa.

And by operating with a robot through the single port, he said, surgeons can get a better view with less clashing of instruments than what occurs when they try to manually move through one opening.

With robotic-assisted single-incision surgery, "the movements are much smoother," agreed Dr. Charu Paranjape, director of acute-care surgery service at Akron General. "It has 3-D vision, so it's much clearer."

Because the robotic approach is newer, the procedures can take longer and cost more, Paranjape said. The single incision also needs to be slightly larger compared to the cuts used for a multiport, minimally invasive approach.

But, he said, "the important part is it's evolving. It's very exciting."

When John Mohney, 46, of Stow, Ohio, had his malfunctioning gallbladder removed at Summa Akron City Hospital last week, he opted for Dan to perform the procedure through one incision in the .

"It seemed like a good choice - one incision instead of four," he said.

Mohney was a good candidate for single-port robotic surgery because he's not overweight and doesn't have scarring from previous abdominal surgery - factors that can be contraindications, Dan said.

Mohney left the hospital several hours after his surgery. Two days later, he was able to go watch his son's middle school football game.

"It's a lot better than I thought it would be," he said. "I'm glad I did it this way."

Not everyone, however, is convinced less is more.

Dr. Raymond P. Onders, director of the adult minimally invasive surgery program at University Hospitals Case Medical Center in Cleveland, said he stopped doing any procedures through a single incision after discovering an increased risk for postsurgical hernias.

The results of a multisite, long-term study presented last year by Onders at an American College of Surgeons meeting showed 8.4 percent of patients suffered postsurgical hernias at the incision site within one year of single-incision laparoscopic . Patients who had gallbladders removed through the four-port laparoscopic procedure had a 1.2 percent postsurgical hernia rate.

"We feel the data did not support single-port gallbladder surgery," he said. "It's not worth having a second surgical procedure."

Instead, Onders said, he opts for minimally invasive surgery with fewer incisions - three instead of four.

Summa's Dan said the risk for hernia can increase whenever larger incisions are used. However, he said, the risk can be minimized if "a very meticulous, good closure" is performed by the surgeon.

Kaouk pointed to another multisite study involving Cleveland Clinic surgeons that showed no increased hernia risk with single-port laparoscopic procedures.

Kaouk said he expects more robotic procedures to be done through a single incision as the technology improves.

"We think that the future of single-port surgery would be in robotics," he said, "and we are just witnessing the early attempts of it."

Explore further: Robotic surgery with one small incision


Related Stories

Robotic surgery with one small incision

December 22, 2011
On Tuesday (Dec. 20), Dr. Santiago Horgan, chief of minimally invasive surgery at UC San Diego Health System, was the first surgeon in the United States to remove a diseased gallbladder through a patient’s belly button ...

Single-incision surgery repertoire expands to treat colorectal conditions

October 27, 2011
(Medical Xpress) -- A minimally invasive “bellybutton” surgery technique already used to remove smaller organs like the gallbladder and appendix has now been adapted to allow URMC surgeons to excise much larger ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.