What is Single Incision Laparoscopic Surgery?
Single Incision Laparoscopic Surgery is the latest significant technical advancement in the field of laparoscopic surgery. As the name suggests, the surgery is performed making a single cut. Usually, this cut is made at the navel or the belly-button.
Why Single Incision Laparoscopic Surgery?
Traditional Laparoscopic surgery is performed by makingmultiple incisions (ranging from 3mm to 12mm) which may result in visible scars. Single Incision Laparoscopic Surgeryhas been able to accomplish the same through a single 20 mm incision through the belly button. Thus, this advancement in laparoscopic surgery has the potential for no visible scar. As an extension, this may minimize the wound pain associated with the multiple incisions for entry used during traditional laparoscopic surgery. The main advantages include:
Extremely short hospital stay
Lastly and most importantly, an almost invisible scar buried within the umbilicus
What are the benefits of this new surgery for the patient?
A single small incision is definitely preferred over multiple cuts. Pain is lesser and patients can get back to work earlier. The incision usually lies in the navel and is hardly visible after healing.
How is this surgery performed? What equipment is used in the process?
As the name suggests, the abdomen is entered through a single incision in the navel. Special ports are now available through which 2 to 3 trocars can be inserted. Also, there are special instruments that can be rotated at the end. These provide surgeons with maneuverability and optimal access to the target tissue through a single access point.
What is the cost of this surgery?
Specialised equipment required to perform surgery include special ports, rotating hand instruments. These equipments make the procedure more expensive. As more companies get involved in the instrumentation, the cost of instruments should come down.
Is it a day care surgery?
Yes. This procedure can be performed as a daycare procedure. This is possible depending on the nature of the illness for which the surgery is performed.
What kind of surgeries can be done?
It is being used for planned elective surgeries. As the surgeon’s skill level and experience increase over time, it may be used even for emergency surgeries.
Which patients can undergo surgery by this technique?
The criteria for patient selection are similar as for traditional laparoscopic surgery. In the initial days, a young medically fit patient is preferred.
What are the risks involved with this technique?
This technique takes longer than usual laparoscopic procedures. It should be done only by an experienced laparoscopic surgeon. Risk is more if a surgeon does not have experience with laparoscopic surgery.
With longer duration of surgery & anasthesia, is there any advantage with this technique?
In the initial days, traditional laparoscopic surgery involved longer hours of surgery. Over a period of time, these timings reduced thereby making laparoscopic surgery truly advantageous over conventional open surgery. Single incision laparoscopic surgery is also in its infancy. Time will provide its true advantages
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.
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.
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.
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.
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
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.