[Multi-instruments cannula: a new concept of laparoscopy].

Objectives: Five or six perforations of the abdominal wall increase the possibilities of organ injury, infection, or hernia. Laparoscopy originally offered great advantages and significant progress. Multiple abdominal ports are now considered superfluous, excessively traumatic and, today, hardly merit the term 'minimally-invasive-surgery'. All that led us to design a device to help surgeons meet new standards that can have several uses.
Methods: The instrument is a 4 cm diameter, 5 cm long cannula. The superior extremity or lid has five 5 mm sealed openings, one for the telescope and four for instruments. Below the lid and its notched retaining screw is the tap to insufflate the operating field. The peripheral flange limits insertion depth and seals the skin wound. Lids with more or less openings are available. The device has been proven first in a simulator, and then five pigs between 20 and 30 kg have been operated. In the first two cases the cannula was introduced through the umbilicus and a cystostomy with suture was carried out. In the other three cases nephrectomy was performed inserting the cannula through the flank. RESULT The experimental series has allowed us to get adapted to the cannula; we have verified that diameter and length of the device are optimal, and vision is excellent. Also the device is hermetic, since there is no loss of gas and the instruments are not trapped inside, what has allowed us to work and to suture without special difficulty.
Discussion: A single port through the abdomen or even transvaginally represent a real challenge to laparoscopy because in the 21st century to make 5 or 6 perforations in the abdominal wall appear untenable. Finally, with this system there are enormous possibilities for robotization with only one arm that includes the telescope and instruments, that sooner that we might imagine is going to revolutionize surgical practice.