The Rise and Fall of Single Incision Surgery at Community Hospital Teaching Program

W. Borden Hooks III, MD, Khoi Le, MD, Thomas V Clancy, MD, William W Hope, MD. New Hanover Regional Medical Center.

 Single incision laparoscopic surgery (SILS) has recently become one of the promising new techniques for use in laparoscopic surgery. Initial reports touted the safety and potential improvement in cosmesis and pain. The success of any new technology depends on quality outcomes as well as the implementation by the surgical community at large. The purpose of this project was to evaluate our surgeons experience and implementation of single incision laparoscopic surgery.
Following IRB approval, a retrospective review of all single incision surgeons performed at our hospital from 5/2009 to 6/2012 was performed. Demographic information, indication for surgery, type of procedure, conversion rates, morbidity, and mortality were documented and descriptive statistics were performed.
During the study period, 12 surgeons (8 general surgeons and 4 gynecologist) performed 164 cases and 175 procedures. Cases included cholecystectomy (50%), appendectomy (29%), gynecologic surgery (13%), and other (8%). Six of the 11 surgeons performed only 1 single incision case. Conversion rate was 6.9%. One surgeon performed 64% percent of all cases and is still currently performing SILS. Morbidity rate was 3.7% with no perioperative mortality.
Several surgeons at our institution evaluated the SILS procedures with only 1 surgeon continuing to perform the procedure regularly. The low adoption rate in our community is likely multifactorial and requires further study.

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