Two or Combined Procedures

With widespread acceptance of laparoscopic surgery, efforts are aimed to minimize further surgical trauma. The last decade has seen a few novel approaches, such as mini-laparoscopy, needlescopic surgery, natural orifice translumenal endoscopic surgery (NOTES), and single-port endo-laparoscopic surgery (SPES). The latter two methods are the most recent surgical innovations that have heralded the trend toward scarless and less invasive surgery. While current clinical application of NOTES requires significant improvement in technique and technology, SPES can be performed with the refinement of existing laparoscopic instruments and is gaining popularity among surgeons and patients. SPES was first performed and reported as early as 1992 by Pelosi, which were single-puncture laparoscopic appendectomy and hysterectomy. Since then, many case reports and case series have emerged in the fields of gastrointestinal, urological, and gynecological surgery using the reduced port technique. In this chapter we will review and discuss the prevailing controversies in SPES for combined surgical procedures. For the purpose of this chapter, we will use the term SPES, even though there are several accepted definitions and no agreement among the surgical community regarding the best term.