Single incision (laparoscopy) laparoscopic surgery using the Hakko E-Z Access and lap protector

Single-incision laparoscopy (laparoscopic surgery) is challenging. There are many ways of performing this surgery and I have described the different methods in my book “Laparoscopic surgery in Gynaecology and Common diseases in Women”. Recently I performed single incision laparoscopy (Laparoscopic Surgery) using a Japanese product made by Hakko. It is called E-Z Access and lap protector. They come in 2 shapes namely round and elliptical. I performed 3 cases using the elliptical port namely laparoscopic cystectomy and laparoscopic adhesiolysis for endometriosis, total laparoscopic hysterectomy for fibroid and laparoscopic myomectomy for a fibroid.

Lap Protector
E-Z Access

I am pleased with this port for several reasons.

  1. Most ports (SILS, Glove port, triport) do not allow you to operate with the instruments in a parallel position. Crossing of instruments is necessary and this causes confusion during dissection. Also, most of the time when instruments are crossing, the surgeon is suturing using only 1 hand. I prefer ports that allow me to use straight instruments with parallel dissection and suturing. So far only 3 ports allow me to do this namely the Lagis Port, Gel Port and this one the E-Z Access.
  2. Unlike the LAGIS LapBase Port, this port is small. When you use a large port like the Lagis port, the inner ring sits in the abdomen in a wider area. So when you want to place an extra port laterally, the inner ring interferes with the placement of the port and it has to be placed quite far away. E-Z port being small the extra port can easily be placed laterally.
  3. After experimenting with midline and transverse incisions in the umbilicus, I prefer a transverse incision. In this way my instruments are placed side ways and they are far apart .The Elliptical structure of the E-Z port allows me to place the 2 instrument ports even further apart so that using the 2 instruments in a parallel manner is easier.

What are the drawbacks of this port?

  1. It takes some time to learn how to place the lap protector into the abdomen.
  2. The lap protector is soft and can tear easily.

The best part of single incision laparoscopy (laparoscopic surgery) is that removal of specimen is easy. Cysts such as dermoid cyst can be removed through the 2 to 2.5 incisions in the umbilicus easily. Fibroids can be placed in a bag and hand morcellated through the incision.

Please view the video of single incision laparoscopic myomectomy using the E-Z Access port.

Lap Protector in Place
E-Z Access placed with the trocars inserted
Performing single incision laparoscopic myomectomy
E-Z Access
Suturing the incision
Wound at the end of the surgery
Wound after 1 week


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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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