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SINGLE INCISION LAPAROSCOPIC GALLBLADDER SURGERY

                    

 

 

                       

 

 

 Single incision laparoscopic cholecystectomy

 

SILS-- (Single Incision Laparoscopic Surgery)

It is the next advancement in laparoscopic surgery.

Let me remind you-----we use the routine lap instruments and normal ports and hence are able to give the cost advantage to the patient unlike others who use fancy and costly SILS port and instruments to conduct this type of surgery thereby substantially increasing the cost of this type of surgery.

Single-incision Laparoscopy Surgery

Traditional laparoscopic surgeries use a telescopic rod attached to a video camera called a laparoscope, which is inserted through a small incision. Apart from this, 3 to 5 additional small cuts are made to insert the other surgical instruments to perform the surgery.

However, single-incision laparoscopy surgery (SILS) is a revolutionary minimally invasive surgical procedure conducted through a single incision. It provides a better cosmetic outcome, as a small incision is made through the patient’s navel or belly button, resulting in an almost scarless outcome.

Indications

Most patients who are good candidates for laparoscopic surgery are eligible for single-port procedures. Some of the surgeries that single incision laparoscopy is indicated for include cholecystectomy (removal of gall bladder), appendectomy (removal of appendix), splenectomy (removal of spleen), hepatectomy (removal of liver) and adrenalectomy (removal of adrenal glands). SILS can also be used for diagnostic purposes.

However, patients who have previously undergone multiple major surgeries to the abdominal region and those who are morbidly obese are not considered for SILS.

Procedure

Single Incision Laparoscopy is usually performed as day surgery either in the hospital or outpatient surgery center under general, regional, or occasionally local anesthesia depending on the type of procedure performed and the surgeon’s preference.

The patient is made to lie down in a tilted position so that the feet are placed higher than the head. The surgeon makes a single incision of about 3/4th of an inch at the belly button and injects a harmless gas to expand the area and obtain a clear view of the operative site. A tube called a trocar or port is placed through the incision, through which the laparoscope (a narrow telescope having a light source and camera) and tiny surgical instruments are inserted. The laparoscope guides your surgeon with images of the abdominal contents that can be viewed on a large screen. Once the diseased organ is excised, your surgeon removes the instruments, releases the gas, and closes the incision with a small bandage.

Recovery

Common post-operative guidelines following Single Incision laparoscopy include the following:

  • You will need someone to drive you home after you are released as the anesthesia may make you feel groggy and tired
  • Do not remove the dressing over the incision for the first two days and keep the area clean and dry.  No showering or bathing during this time.  The incision usually heals in about 5 days
  • Your surgeon may give you activity restrictions such as no heavy lifting. It is very important that you follow your surgeon’s instructions for a successful recovery
  • You may feel soreness around the incision area. Your surgeon may give you a prescription pain medicine or recommend NSAID’s (non-steroidal anti-inflammatory drugs) for the first few days to keep you comfortable
  • If the abdomen was distended with gas, you may experience discomfort in the abdomen, chest, or shoulder area for a couple days while the excess gas is being absorbed

Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incisions, chest pain, shortness of breath, leg pain, and or dizziness.

Risks and Complications

As with all surgical procedures, SILS can be associated with certain risks and complications such as infections, blood loss, nerve damage and allergic reactions to medications, although these are rare.  Contact your doctor immediately if you have a fever, chills, increased pain, bleeding or fluid leakage from the incision, chest pain, shortness of breath, leg pain, and or dizziness.

Benefits

Several benefits account for the increasing popularity of SILS when compared to conventional laparoscopy. These include:

  • Speedy recovery
  • Reduction in post-operative infections and pain
  • Reduction in the duration of hospital stay
  • Smaller or no visible scar 

           IMMEDIATE POST OP …..SILS APPENDIX REMOVAL
             IMMEDIATE POST OP …GALL BLADDER REMOVAL
Instead of traditional four to five small incisions, a single small incision can be used at the entry point. All surgical instruments are placed through this small incision and the incision site is located in the umbilicus which becomes hidden after a few months.
                 CLOSE UP PHOTO OF UMBLICUS AFTER SILS
                          POST OP UMBLICUS AFTER SILS

Providing the benefits of fewer scars, the opportunity of less pain, and shorter recovery periods, SILS is one of the newest laparoscopic techniques and it is regarded as non-invasive. In general, SILS techniques take about the same amount of time to do as traditional laparoscopic surgeries. However, SILS is recognized as to be a more complicated procedure because it involves manipulating three articulating instruments through one access port.


The patient’s hospital stay is shorter . Although SILS offers exciting benefits for any wide variety of patients facing weight-loss challenges, not everyone is an applicant for the procedure. Obesity, severe adhesions, or scarring from previous surgeries are a few of the factors in which it may become difficult to do Single Incision surgery.


Single incision laparoscopic cholecystectomy (SILC) is a revolutionary new way of performing laparoscopic surgery in which only one small (1.5– 2 cm) incision is made to carry out an operation.

 

How is SILC different from traditional laparoscopic surgery?
Over the last decade laparoscopic surgery has replaced open surgery in the treatment of several diseases. In traditional laparoscopic surgery, the abdomen is filled with carbon dioxide gas to create a space for the surgeon to work in. Tubes called ports are then inserted through three to four small cuts, each measuring around – 1 cm. A telescope attached to a camera inserted through one of the ports allows the surgical team to observe a magnified picture of the internal organs on a television screen. The surgeon carries out the surgery with the help of instruments introduced through the ports

 

In SILC, the surgeon makes only one incision of around 1.5 cm – 2 cm (commonly just below the navel) to allow placement of three thin ports side by side. Else, a specially designed port is inserted into the abdomen; this port carries the telescope as well as the laparoscopic instruments. The surgeon then carries out an operation identical to a traditional laparoscopic one 

How is SILC better for the patients?
As there is only one incision the patient experiences much less pain as compared to traditional laparoscopic surgery and recovers even faster. The small scar of healed incision practically fades awsay with time. All patients enjoy these benefits, but SILC is of particularly great cosmetic value to ladies (as most would prefer to have as few scars as possible) and to busy corporate executives who wish to recover rapidly from surgery so as to get back to work.

Can SILC be offered to all patients with gallstones?
The surgeon would assess an individual patient to decide whether or not he / she are a suitable candidate for SILC. SILC may not be applicable to some patients, e.g.

  • Those who have had multiple previous abdominal operations and
  • Patients who are likely to have grossly enlarged or thickened diseased organ e.g. an acutely inflammed gallbladder

 

Of course , all these patients can be operated by normal 4 port laparoscopic surgery.

 

  • Those who are very obese, 

     

    What happens if an operation cannot be completed by SILC? 
    In 5% to 10% patients it may not be possible to complete the operation by SILC due to technical difficulties. The surgeon places one or two additional ports and completes the procedure in the traditional laparoscopic manner.  

     

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  • 2016-05-18T12:03:29

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