Single Incision Laparoscopic Surgery

What is single incision laparoscopic surgery (SILS)?
SILS 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 SILS 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 ½ – 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 SILS, 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 (e.g. the SILS 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.

Which operations can be performed with SILS?

Currently, the following operations can be performed by SILS

• Removal of gallbladder (cholecystectomy)
• Removal of appendix (appendicectomy)
• Repair of paraumbilical or incisional hernia
• Removal of ovary (oophorectomy)
• Diagnostic laparoscopy with biopsy
   

As the technique gets refined and better instrumentation becomes available, the surgeons will be able to carry out many more operations today carried out by traditional laparoscopic surgery using the SILS approach.

How is SILS better for the patients?

As there is only one incision the patient experiences much less pain as compared to traditional laparoscopic surgery and recovers faster. The healed incision leaves practically no scar, thus making SILS cosmetically a superior option. All patients enjoy these benefits, but SILS 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 SILS be offered to all patients?

The surgeon would assess an individual patient to decide whether or not he / she are a suitable candidate for SILS. SILS may not be applicable to some patients, e.g.

Those who are very obese,
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
 

Traditional laparoscopic surgery, of course, can be offered to all these groups of patients.

What happens if an operation cannot be completed by SILS?

In 5% to 10% patients it may not be possible to complete the operation by SILS due to technical difficulties. The surgeon places one or two additional ports and completes the procedure in the traditional laparoscopic manner. Very rarely, it may be necessary to convert to an open operation. Both these issues are always discussed with patients prior to surgery and they are made aware that conversion to traditional laparoscopy or indeed to open surgery merely represents a sound judgment on part of the surgeon in the interest of patient safety.

What are the costs involevd in SILS?

As SILS involves the use of specialized equipment, it is marginally more expensive as compared to traditional laparoscopic surgery. However, this small extra cost is more than offset by the benefits that the patient reaps.

This is meant for information purposes only.

It is not a substitute for a valid opinion from a medical professional.