The Potential of Single-Site Surgery

The development of single-site laparoscopic surgery (SIL) is attributed to the first decade of the current century by the majority of surgeons. However, the idea to gain access to the abdominal cavity through one incision dates back to 1902, when the German surgeon Georg Kelling performed the first one-port laparoscopy in dogs [1]. It was a Swedish gastroenterologist, namely Hans Christian Jacobaeus, who did the first single-port laparoscopy in humans in 1910 [2]. For reasons of technical and general medical limitations, including but not restricted to the lack of sufficient anesthesiology, it took until the final two decades of the last century for minimally invasive surgery to be accepted as a matter of clinical routine. Again, technical limitations mandated the use of multiple incisions, at least for therapeutic indications. The concept of SIL was then adopted by gynecologists for tubal sterilization using a single incision and a specially adapted instrument [3]. Further surgical and technical developments allowed modified adaptation of the SIL concept in more demanding procedures. Again, gynecologists pioneered the field with the first SIL hysterectomy [4] as well as the first SIL appendectomy in 1991 [5]. At that time, the concept did not meet with great enthusiasm on the part of general surgeons, and so our predecessors either developed extraumbilical one-trocar techniques [6] or gradually reduced the number of incisions for appendectomy by applying a transumbilical laparoscopically assisted technique [7]. The first case series of SIL cholecystectomies using a technique that was similar to what we now know as SIL was published by Navarra and colleagues in 1997 [8]. It took another 10 years for surgeons around the globe to become comfortable with this “new” idea, and subsequently the concept gained momentum and a majority of surgeons busied themselves with this technique. The synonyms of the SIL concept are given in Table 30.1. The number of performed procedures and published reports exploded within a few years and peaked in 2012 and 2013 (Fig. 30.1; publications). The technique spread to all surgical subdivisions and new applications were created.