Abstract
Background:
The adoption of laparoscopic single-site surgery (LESS) is limited by the high cost of commercial platforms. We present a self-designed glove-port for LESS ovarian teratoma resection.
Technique:
A single-port platform was constructed from a surgical glove and rings from a disposable suction tube. A specimen retrieval bag was modified with a silk drawstring and a secondary opening to create a closed system. The teratoma was dissected within the closed bag and all contents were removed via the umbilicus.
Results:
The procedure was successfully performed. The self-assembled port provided stable access, and the modified bag enabled complete specimen containment and extraction without spillage or auxiliary incisions.
Conclusion:
This technique demonstrates a safe, feasible, and low-cost alternative for LESS. Utilizing ubiquitous materials improves the accessibility of minimally invasive, cosmetically favorable surgery in resource-constrained settings.
Keywords: Glove-port, Laparoscopic single-site surgery, Ovarian neoplasms
INTRODUCTION
Laparoscopic single-site surgery offers cosmetic and minimally invasive advantages; however, the high cost of commercial systems restricts its use, especially in low-resource settings.1,2 We describe a novel, low-cost laparoscopic single-site surgery technique for ovarian teratoma resection using a self-designed glove-port and modified retrieval bag, demonstrating its safety and feasibility.
TECHNIQUE DESCRIPTION
A 1.5- to 2-cm umbilical skin incision is made, and a self-designed surgical glove single-port platform is installed. A 5-cm inner ring and 7-cm outer ring are made from a disposable suction tube (Figure 1A) (Video 1). A 1-0 silk suture secures the inner ring for postoperative removal. The glove wrist is inverted over the inner ring and inserted intra-abdominally, leaving the cuff and fingers of the glove outside the cavity. The outer ring is placed over the glove cuff and folded back to encase the outer ring (Figure 1B). A 10-mm reusable trocar is inserted through a fingertip incision in the glove for laparoscope and instruments (Figure 2).
Figure 1.
A homemade single-port system using two suction tube rings and a 7½ surgical glove. (A) A 5-cm inner ring and 7-cm outer ring are made from a disposable suction tube. A 1-0 black silk is tied at the inner ring to help remove the glove port after surgery. (B) Fit the wrist of a sterile glove over the inner ring with the cuff folded back. Insert the inner ring into the abdominal cavity, leaving the glove cuff and fingers outside. Fold the glove cuff over the outer ring and secure it to establish single-port access.
Figure 2.
Instruments and camera positioning during laparoscope single-site surgery. A 10-mm reusable trocar is inserted through the finger of the surgical glove for carbon dioxide insufflation and laparoscope insertion or operative instruments. The other laparoscopic instruments are inserted through the cut edges of the remaining fingertips without trocars.
For specimen retrieval, a standard bag is modified by replacing its drawstring with 7-0 silk at the proximal end (Figure 3A). A 5-cm purse-string opening is created distally. The retrieval bag was inserted into the abdominal cavity through the 10-mm trocar. The affected ovary was placed into the bag via end A (Figure 3B). The needle from a 20-mL syringe threaded with 7-0 silk suture was percutaneously inserted above the pubic symphysis to externalize and tighten end A. The laparoscope camera and two graspers were introduced into the bag via opening B. The teratoma was dissected within the closed bag, with all specimen components contained and removed via the umbilicus (Figure 3B).
Figure 3.
(A) A specimen retrieval bag is modified by replacing its drawstring with a 7-0 silk suture at the proximal end (end A). A 5-cm opening with a purse-string suture is created at end B. (B) Schematic illustration of teratoma removal within a closed retrieval bag. The teratoma is placed into a custom retrieval bag through opening A. Suture tail A is externalized to secure the proximal opening. The camera and two graspers are introduced into the bag via opening B. The retrieval bag is then completely closed, fully encapsulating the teratoma. Resection of the teratoma is performed within the closed bag. Finally, the single-port platform and retrieval bag are extracted together.
DISCUSSION
This glove-port reduces costs by over 95% compared to commercial systems (>USD300), without compromising functionality. Unlike other homemade designs requiring Alexis wound retractors,3–6 our method uses suction tube rings for comparable effect at minimal cost. The modified retrieval bag ensures secure containment, crucial for preventing chemical peritonitis and adhesions, especially in teratomas with osseous elements.7,8 This technique offers a viable, economical alternative for laparoscopic single-site surgery teratoma removal in resource-limited settings.
Footnotes
Conflict of interests: none.
Funding sources: none.
Disclosure: none.
D. Huang, and W. Huang are joint first authors.
Contributor Information
Dayuan Huang, Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Liangping District, Chongqing, China. (Drs. D. Huang and Chen).
Wenchen Huang, Department of Ultrasonography, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China. (Dr. W. Huang).
Haiyan Chen, Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Liangping District, Chongqing, China. (Drs. D. Huang and Chen).
Qiong Yang, Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Army Medical University, Chongqing, China. (Dr. Yang).
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