Single-port laparoscopy: Issues and complications

The goal of decreasing the invasiveness of surgical procedures has spawned the growth of single-port laparoscopy (SPL) whereby entire operative procedures are completed via a single abdominal wall incision. Early single-institution studies have highlighted that in appropriately selected surgical candidates, SPL maintains the efficacy of conventional laparoscopy while decreasing surgical morbidity and improving cosmesis. Nonetheless, as with many innovative techniques, unique issues and complications may arise that can compromise the safe completion of SPL cases. Central to SPL is appropriate patient and lesion selection, which is predicated both on pathology but also on surgeon experience. Familiarity with much of the newer instrumentation, particularly the robotic platforms, reduces the potential for preventable instrument-related error causing iatrogenic injury. Despite optimal preparation, complications inevitably occur as surgical volume expands. While many of these are similar to complications observed with standard laparoscopy, SPL does present distinct ergonomic challenges that require consideration. In that regard, reviewing the experience of other surgeons provides a stepwise framework for management.