Video Lecture of Dr. R.K. Mishra about Single Incision Laparoscopic Surgery
Prof. R. K. Mishra Performing Single Incision Laparoscopic Surgery at World Laparoscopy Hospital
Single incision laparoscopic surgery (SILS) is a new technique that has now been utilized in many centers for minimal access surgery. We have previously detailed our initial experiences with the use of SILS for appendicectomy and cholecystectomy in the adult population. Now we have started performing even advanced surgery by single incision. The major difficulty with this new technique is the sacrifice that has to be made in terms of comfort and ergonomics. All patients and their parents were very satisfied with their operative management by SILS, and particularly enthusiastic in regard to the cosmetic outcome of single incision approach. On follow-up in World Laparoscopy Hospital, the umbilical scar was very difficult to visualize once healing had been completed.
Single incision laparoscopic surgery (SILS) or one port umbilical surgery (OPUS) or single port incision less conventional equipment-utilizing surgery (SPICES) or natural orifice trans umbilical surgery (NOTUS), or Embryonic Natural Orifice trans umbilical surgery (E-NOTES) or Single port access (SPA) surgery, also known as laparo endoscopic single-site surgery (LESS). A mixture of sharp and blunt dissection is used down to the linea alba which was incised in ohm shaped incision. The peritoneum is opened under direct vision in SILS without creating prior pneumoperitoneum.
Single Incision Laparoscopic Surgery is an advanced minimal access surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. Specialized equipment for SPA surgery falls into two broad categories; access ports and hand instrument. There are a number of different access ports including GelPOINT system from Applied Medical, the SILS device from Covidien, the R-Port and TriPort from Advanced Surgical Concepts and the Uni-X from Pnavel.
World Laparoscopy Hospital is now Pioneer in Minimal Access Surgery and at this specialized institute now most of the surgery is performed by single incision. Case selection is paramount for the success of SILS and at world laparoscopy hospital we performed single incision laparoscopic surgery for the cases which is not complicated and has minimum risk. Good ergonomics in single incision laparoscopic surgery need articulating instrument and high end energy sources like tissue response generator (Ligasure) and Ultrasonic dissector (Harmonic). World Laparoscopy Hospital is equipped with all the ultramodern equipment and we have one of the most modern infrastructure of Minimal Access Surgery in the World.
Advantages of Single Incision Laparoscopic Surgery are:
Ease of Tissue Retrieval ++++
Combination Procedure +++
Patient Acceptance ++++
Quality of life analysis ++
Standard Equipment ++
Do not violate natural orifices ++++
Surgeon’s Domain +++
Disadvantages of Single incision laparoscopic surgery
Pain ?? [Pain is more in SILS unless special precaution is taken]
Violating Principles of Ergonomics ???? [Always surgeon should be expert because ergonomics is compromised]
Hernia ?? [Chances of pain is more unless special measure is taken with instillation of local lignocain]
Wound Infection ??? [Chances of wound infection is more due to bigger incision]
Learning Curve ?? [Learning curve is more
Cost effectiveness ???
World Laparoscopy Hospital, is one of the first hospital in World United to perform a single-port surgery through the navel for variety of Procedures. This procedure signals another step forward for our internationally acclaimed training program and elevates our efforts to provide the best surgical care while improving patient recovery. The the possibility of coming through the surgery without scars is a secondary benefit to our community. However, applicability of SILS to every patient. This series of surgey performed in our hospital also adds further to the current literature demonstrating the applicability of SILS in uncomplicated surgical cases. In the future prospective studies with sufficient power are now warranted to demonstrate any statistically significant benefits over the standard laparoscopic method. These are most likely to be in terms of postoperative pain, port site complications, cosmesis, and patient satisfaction.