Single Incision Laparoscopic Surgery

Rather than the 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 also the incision site is located in the left abdomen or umbilicus.

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.

Although originally designed to concentrate on weight-loss issues, SILS is really a rapidly evolving technique that’s also being put on other areas of healthcare. Some surgeons are successfully using this procedure for urological, gynaecological, kidney, and colon surgeries.

Key Benefits of Single Incision Laparoscopic Surgery

Fewer incisions – Typically, this surgery requires only one small incision.

Health and cosmetic benefits – Since there are fewer incisions, there is less possibility of infection, less scarring and better cosmetic results.

Faster recovery times – The surgery is recognized as minimally invasive to cause shorter recovery times.

Single-incision surgery has been given a panoply of acronyms and names, including single-incision laparoscopic surgery (SINGLE INCISION LAPAROSCOPIC SURGERY), single-port access (SPA) surgery, laparoscopic endoscopic single-site surgery (LESSS), single laparoscopic incision transabdominal (SLIT) surgery, one-port umbilical surgery (OPUS), natural orifice transumbilical surgery (NOTUS), and embryonic natural orifice transumbilical endoscopic surgery (E-NOTES). SINGLE INCISION LAPAROSCOPIC SURGERY continues to be described since the late 1990s, you start with appendectomy and cholecystectomy. Since that time, the technique has been applied to multiple surgical treatments, including gastric banding, sleeve gastrectomy, splenectomy, nephrectomy, colectomy, and adrenalectomy. Studies have shown that smaller incisions, including smaller port size, decrease morbidity both in appendectomy and cholecystectomy patients. In comparing patients undergoing needlescopic versus conventional laparoscopic appendectomy, the needlescopic group were built with a shorter hospital stay (1.3 days vs. 3.2 days), reduced narcotic requirements, and faster go back to work (8 days vs. 17 days) than controls. In a similar study pertaining to cholecystectomy patients, the group with downsized trocars reported less incisional pain within the first postoperative week. Based on the outcomes of these studies, it seems logical that eliminating multiple incisions/port sites would further decrease associated morbidity. However, no prospective, randomized study demonstrating clear advantage over standard laparoscopy has been reported.

The tenet of single-incision laparoscopic surgery is to lessen the quantity of incisions to one, typically at the umbilicus, for multiple trocar placements. This can be done in a number of ways: a single umbilical skin incision with skin flaps to insert ports through multiple fascial punctures as explained Curcillo, or even the utilization of newly developed systems, like the Uni-X™ Single Port System (Pnavel Systems, Inc., Morganville, Nj), Surgiquest AnchorPort®, TriPort™ (Advanced Surgical Concepts, Wicklow, Ireland), or GelPort® (Applied Medical, Rancho Santa Margarita, California) requiring a larger but single fascial incision for passage of multiple instruments. The necessary proximity of the trocars in a fixed position illustrates among the disadvantages of those techniques.

The freedom of the hands is comparatively restricted, which causes clashing from the instruments, and also the fixed port in the umbilicus potentially creates an extended distance towards the surgical site. This really is somewhat contradictory towards the traditional teaching of triangulation of instrumentation in laparoscopy, creating a steep learning curve. Thus, the possible lack of triangulation, pneumoperitoneum leaks, and instrument clashing happen to be referred to as real disadvantages of the procedure. Furthermore, there isn’t any long-term data that has examined morbidity of single-incision laparoscopic surgery. Multiple, closely placed fascial punctures have the possibility for hernia, and wide skin flaps created to accommodate multiple trocars may lead to seroma formation. Still many surgical treatments have been performed safely using these techniques, and variations have been described. As new instruments are developed to accommodate the new paradigm of SILS, chances are that technical difficulties is going to be minimized.

Since SINGLE INCISION LAPAROSCOPIC SURGERY procedures are relatively new and in evolution, many techniques happen to be described but no widely accepted standard exists. SILS was first adapted to cholecystectomy and once the strategy was proved to be effective and safe for basic laparoscopic procedures, it was put on a few of the technically simpler bariatric procedures. Laparoscopic gastric banding was one of the obvious transitional procedures since the significant incision necessary for the adjustment port offers the needed space to place multiple trocars. However, laparoscopic banding was more technically difficult due to the camera angles required for dissection of the retrogastric tunnel, the requirement for retraction of an often-fatty liver from a longer distance, and the requirement for suturing.

As surgeons gained more experience, the technique became more sophisticated, and cosmesis was improved by placing the incision within the umbilicus. With this particular change, the distance from incision to the surgical field increased and also the angle of dissection became more technically challenging. Some have modified this technique by adding a small, second incision for retraction or using specialized ports. With tries to overcome these obstacles, multiple techniques and instruments have been developed. Since the primary benefit of SINGLE INCISION LAPAROSCOPIC SURGERY seems to be cosmetic, most agree that the umbilicus may be the preferred incision site; however, it’s at this time how the techniques diverge.