Optimal instrument length for transumbilical laparoendoscopic single site (U-LESS) surgery

Area of Science:

• Surgical Innovation
• Medical Imaging
• Anatomy

Background:

• Transumbilical laparoendoscopic single-site (U-LESS) surgery requires precise knowledge of instrument reach.
• Accurate measurement of distances from the umbilicus to intra-abdominal organs is crucial for U-LESS procedure planning.
• Existing methods may not adequately address the specific needs of U-LESS surgery.

Purpose of the Study:

• To propose a novel method for measuring distances from the umbilicus to intra-abdominal organs.
• To determine an appropriate instrument working length for U-LESS surgeries.
• To enhance surgical planning and instrument selection for U-LESS procedures.

Main Methods:

• Utilized CT scans from 100 adult patients (50 male, 50 female).
• Calculated umbilical distances to 11 intra-abdominal points using perpendicular triangles and the Pythagorean theorem.
• Measured distances with and without insufflation to simulate surgical conditions.

Main Results:

• A novel geometric method was established for measuring umbilical-to-organ distances.
• A working length of 43 cm was found sufficient for U-LESS access to all measured intra-abdominal points.
• The described technique provides a reliable approach for pre-operative planning in U-LESS surgery.

Conclusions:

• The proposed measurement technique is effective for determining intra-abdominal distances from the umbilicus.
• A 43 cm instrument length is recommended to facilitate U-LESS surgery across diverse patient anatomy.
• This method aids surgeons in selecting appropriate instruments, optimizing safety and efficiency in U-LESS procedures.