Rajkumar Palaniappan, Dr, Chakravarthy Paramasivam, Dr, Janardhan Jakkula, Dr. Apollo Hospitals Chennai, Apollo Victor Hospitals Goa
Single Incision Laparoscopic Surgery (SILS) is the new age technique where laparoscopic surgery is performed through a single port rather than three or more ports as in conventional laparoscopy. It has gained immense popularity grabbing the attention of surgeons and patients alike all over the world. Feasibility of various procedures are tried worldwide in multiple centers and the ergonomics are modified accordingly.
Methods and Procedures:
Ergonomic difficulties, errors, umbilical pain and hernia seems to be the main concern among the surgeons in the post-operative period. A total of 104 patients who underwent SILS procedures between October 2009 and October 2010 were included in this preliminary study (Adhesiolysis -2, Appendicectomy-10, Cholecystectomy-33, Inguinal hernioplasty-11, Incisional Hernioplasty-5, Epigastric Hernioplasty-2, Nissen fundoplication-9, Heller’s cardiomyotomy-1, Anterior Gastrojejunostomy-1, Sleeve Gastrectomy-13, Sutured Rectopexy-2, Myomectomy-2, Total Hysterectomy-9, Oopherectomy-2, Orchidectomy-2). The endpoints analyzed were time taken in minutes, errors by global rating scale, pain using visual analog score, hospital stay in days, complications and conversion. The end points were analyzed to 156 laparoscopic surgeries performed during the same period in our department.
The total time taken was almost twice in SILS group (132 Minutes) as compared to 87 minutes by laparoscopy. Errors were more in SILS group (9/15) as compared to 13/15 in laparoscopic group. 5 minor complications were identified (2 necrosis, 2 infection, 1 stitch granuloma) in SILS group as with only 3 minor complications (2 infection, 1 hernia) in laparoscopic group. Pain score is less with SILS group (6) than the lap group (7) though there was no significant difference. There is no difference in the hospital stay in both groups with 2 conversions in SILS group and one in lap group.
The data collected is a part of the preliminary study and the statistical analysis is not yet arrived.
SILS is feasible for advanced procedures with results comparable to conventional laparoscopic surgery. Patient satisfaction is significantly better in SILS as it literally gives a scarless abdomen. Initial experience proves to be very promising. With the possibility of more instruments to come, SILS is all set to replace laparoscopy in selected cases. However long term multi-centric studies are required to prove their advantages over conventional laparoscopy.
Program Number: P481