Ergonomics of and technologies for single-port laparoscopic surgery

Background: There are a number of major constraints in ergonomics of and technologies for single port laparoscopic surgery. Material and methods: The review is based on a complete literature search through PubMed, Medline. Single port laparoscopic surgery (SPLS), single incision laparoscopic surgery (SILS), laparoscopic single-site surgery (LESS), ergonomics, technologies, robotic SPLS, SPLS or SILS operations were the keywords used for the literature search. Results and discussion: The SPLS approach imposes several restrictions: Maintenance of sufficient exposure, sustained pneumoperitoneum, adequate retraction, collision between instruments (internal and external), collision between instruments and optics, and limited instrument manipulation and triangulation. Compensatory techniques such as using percutaneous sutures for retraction and employing coaxial, flexible, and articulating instruments have been used to improve triangulation. Conclusions: The ergonomics imposed by this approach are different from those of multi-port laparoscopic surgery. Considerable progress in port and instruments for SPLS has been achieved in the last five years in order to overcome the constraints and problems facing the operating surgeon when using the SPLS approach. Further more advanced instrumentation such as hand-held manipulators with seven degrees of freedom (DOF) and robotic devices for SPLS is needed to realize the full potential of the SPLS approach.