MANHASSET, NY – While thousands of minimally invasive procedures have been performed in recent years at North Shore University Hospital (NSUH), a new advancement that enables surgeons to operate through the umbilicus, or belly button, has led to an unprecedented expansion of the hospital’s laparoscopic surgery capabilities.

The latest type of procedure is called laparoendoscopic single-site surgery, or LESS, with technology developed by Olympus. Tiny ports (also known as trocars), usually three of them (sometimes contained in a single large trocar), are inserted into the belly button through a single-access system, where surgeons insert their tiny instruments and a miniature camera that lets them see what they are doing.

NSUH is already using this new single-site access technology for general, obstetric/gynecologic, urologic and bariatric surgeries – a level of expertise unmatched by any other hospital in New York.

For patients, the benefits of laparoscopy are well known: a shorter hospital stay, less pain and scarring, reduced blood loss and infection risk, and a faster recovery and return to normal activities, according to George DeNoto, MD, chief of laparoscopic surgery at NSUH. “The additional advantage of going in through the umbilicus is that there is a very high degree of cosmesis—in fact, there is virtually no visible scarring—because that area inverts as it heals,” he said.

In May 2008, Dr. DeNoto performed the first laparoendoscopic single-site surgery at NSUH – and one of the first in the metropolitan area. By May 2009 he had handled nearly 100 cases, including gall

bladder removal (known as cholycystectomy), and small bowel and colon resection (removing diseased sections and reattaching the healthy ends) to treat diverticulitis and colitis. He is also training surgeons in LESS within the North Shore-LIJ Health System and all over the world.

In 2006, Dr. DeNoto was the first surgeon in the country to perfect a sigmoid colon resection using the DaVinci surgical robot at NSUH. Now, he performs LESS robotically. The DaVinci system, he said, offers some important advantages: “The visualization is bright, clear and three-dimensional,” he explained. “With a scale of three inches to one inch, a small movement of the doctor’s hand becomes a smaller, more precise movement of the instrument.”

At the North Shore-LIJ Health System’s Arthur Smith Institute for Urology in Lake Success, Louis Kavoussi, MD, chairman of urology, and Lee Richstone, MD, director of laparoscopic and robotic surgery, are among the leading laparoendoscopic surgeons in their field. As members of NSUH’s transplant team, they perform donor nephrectomy, in which a donated kidney is removed through a single incision. “Only Cleveland Clinic is in a league with our health system when it comes to that procedure,” said Dr. Richstone. Dr. Richstone also performs radical nephrectomy (removal of the entire kidney) and partial nephrectomy (removal of part of the kidney) using the LESS approach. 

Dr. Richstone is one of the first surgeons in the world to have performed nerve-sparing radical prostatectomy for prostate cancer using the LESS technique; this involves removing the prostate and seminal vesicles while sparing the nerves that provide for erections.  North Shore-LIJ is also a leader when it comes to LESS pyeloplasty, which corrects a congenital obstruction of the kidney preventing urine from draining into the ureter tube.

“For nearly two decades, the laparoscopic surgeons of the North Shore-LIJ Health System have been the leaders in minimally invasive techniques,” said Michael Nimaroff, MD, chief of gynecology and minimally invasive and robotic surgery at North Shore University Hospital. He was one of the first gynecologic surgeons in New York to perform single-site laparoscopy. “When our general surgical and urological colleagues here at NSUH began performing advanced laparoscopic single-site procedures, we quickly followed along,” he said.

Among the procedures Dr. Nimaroff performs with LESS is prophylactic oophorectomy, or removal of the ovaries to lower the risk of inherited breast and ovarian cancer in women with the gene mutation BRCA1 or BRCA2. He also performs hysterectomies and removal of ovarian cysts and small fibroid tumors and treats precancerous conditions. Dr. Nimaroff performs many gynecologic procedures with the DaVinci robot and expects to offer his patients robotic single-incision surgery in the near future with the advent of smaller robotic instruments.

Dominick Gadaleta, MD, and Lawrence Gellman, MD, are codirectors of bariatric surgery for the control of obesity at NSUH, which is recognized as a Bariatric Surgery Center of Excellence by the US Centers for Medicare and Medicaid Services. Since 2001, when the procedure became available in the United States, they have performed thousands of laparoscopic lap band, or gastric band, procedures, and in the past year they have begun to perform the procedure through the belly button. The adjustable band is placed around the top portion of the stomach to create a smaller gastric pouch. The band limits the amount of food that the stomach will hold at any time. The patient feels full with a much smaller amount of food than he or she is accustomed to eating and continues to feel full for several hours.

Dr. Gadaleta stressed that not every patient is a candidate for totally transumbilical lap band surgery. “There are many factors to consider,” he said, “including fat distribution, body shape, and size of the liver.”

A common thread among patients who have undergone single-site laparoscopies is that they are thrilled with their outcomes. “Our patients have battled obesity for years. Now they are having a procedure that they hope and expect will be transformative physically,” said Dr. Gellman. “They are excited that it won’t leave a visible scar.”

To better document patients’ experience, Dr. DeNoto said NSUH will be one of 10 hospitals around the world participating in a study assessing 200 patients for their satisfaction with single-site versus multi-site laparoscopies. And Dr. Nimaroff and Drs. Gadaleta and Gellman are collecting data for studies to determine the clinical benefits.

As the instruments and the camera become more sophisticated, the doctors say LESS will be used in more procedures, on more patients. Soon, they predict, minimally invasive surgeries will become so common that a likely question will be: What procedure can’t be done laparoscopically?

For more information about LESS, call 516-734-8050.

Media Contact:
Terry Lynam
516-465-2640/2600
tlynam@nshs.edu