Single Incision Laparoscopic Surgery (SILS)

Overview

A single incision laparoscopic surgery is a surgical technique in which a bowel resection is performed using a small 'open' incision, usually at the site of the belly button or umbilicus, through which a device is placed in the abdominal wall allowing small entry ports, usually four in number, to be placed, and the procedure can then be completed laparoscopically, also known as 'key hole surgery.

When the benefits of keyhole surgery but just one incision are needed, single incision laparoscopic surgery is widely employed in right hemicolectomy and small bowel resection.

The hazards of a single incision laparoscopic surgery include, but are not limited to, wound infection, hernia, bowel join leaking, and bleeding, as well as the patient's heart (arrhythmia), lungs infection, kidneys and urine system, and venous system (deep vein thrombosis, pulmonary emboli).

The hospital's anaesthetic section organizes pain relief well after the surgery. Fluids and the restoration to a regular diet are regulated by your doctor's standard regimen as well as your specific circumstances.

What is Single Incision Laparoscopic Surgery (SILS)?

How is SILS Different from Traditional Laparoscopic Surgery?

Laparoscopic surgery has largely replaced open surgery in the treatment of various disorders during the last decade. Traditional laparoscopic surgery involves filling the abdomen with carbon dioxide gas to create a working area for the surgeon. Port tubes are then placed via three to four tiny incisions, each measuring around 0.5-1 cm. The surgical team may see a magnified image of the inside organs on a television screen thanks to a telescope coupled to a camera introduced through one of the ports. The surgeon performs the procedure using tools introduced through these ports.

In SILS, the surgeon makes only one incision of around 20mm (commonly just below the navel) to create a specially designed port through which he inserts both the telescope as well as the laparoscopic instruments. The surgeon then carries out an operation identical to a traditional laparoscopic one.

What Surgeries are Performed Using Single Incision Laparoscopic Surgery (SILS)?

Today, many routine operations may be performed laparoscopically. The difficulty of your problem will determine if you are a candidate for laparoscopic surgery. Some complex conditions may need open surgery to treat. However, because to its cost-saving benefits and superior patient outcomes, laparoscopic surgery is quickly becoming the chosen default approach for a rising number of routine surgeries. The list includes:

• Small tumor removals.
• Biopsies.
• Urethral and vaginal reconstruction surgery.
• Orchiopexy (testicle correction surgery).
• Rectopexy (rectal prolapse repair).
• Hernia repair surgery.
• Esophageal anti-reflux surgery (fundoplication).
• Gastric bypass surgery.
• Cholecystectomy (gallbladder removal) for gallstones.
• Appendectomy (appendix removal) for appendicitis.
• Colectomy (bowel resection surgery).
• Abdominoperineal resection (rectum removal).
• Cystectomy (bladder removal).
• Adrenalectomy (adrenal gland removal).
• Nephrectomy (kidney removal).
• Splenectomy (spleen removal).
• Radical nephroureterectomy (for transitional cell cancer).
• Whipple procedure (pancreaticoduodenectomy) for pancreatic cancer.
• Gastrectomy (stomach removal).
• Liver resection.

Can SILS be Used in Other Parts of the Body Outside the Abdomen & Pelvis?

In various parts of the body, minimally invasive surgical methods are employed. The approach may be identical outside of the abdominal and pelvic areas, but it's named something different. Through a keyhole incision in the chest cavity, a surgeon may use a thoracoscope to inspect your lungs. An arthroscope may be used by a surgeon in the knee region. The scopes are labelled differently depending on what area of the body they are inspecting, but they are all modified variants of the same item.

Is Single Incision Laparoscopic Surgery (SILS) A Major Surgery?

The words "major surgery" and "small surgery" do not have defined meanings. Healthcare personnel use them in a variety of ways to express how complex and/or hazardous they believe one procedure is relative to another, as well as to establish expectations for the recovery period. If you question them about laparoscopic surgery, you may get varied replies depending on the type of procedure and how extensive it is.

On the one hand, because the incisions are tiny and the organs are not exposed, laparoscopic surgery is considered less invasive. Furthermore, the types of surgeries that may be performed laparoscopically are often less difficult. Surgeries that prove to be more involved than predicted may be unable to be done safely using the laparoscopic procedure and must be changed to open surgery, which is major surgery.

On the other hand, laparoscopic surgeries include organ removals, and you'd be right if you assumed that any organ removal required major surgery. These types of surgeries entail inherent hazards regardless of how they are performed, such as bleeding, injury to surrounding organs, internal scarring, and so on. However, they are also frequent and have a high success rate, and the recovery durations will be shorter and easier with the laparoscopic procedure.

How Safe is Single Incision Laparoscopic Surgery (SILS)?

It is at least as safe as open surgery, and some risks are decreased. Infection, blood loss, and postoperative problems such as wound separation and incisional hernia are reduced with smaller wounds. Laparoscopic surgery reduces direct contact between the surgeon and the patient, lowering the risk of germ transmission between the two. It also lessens the hazards of extended bed rest, such as blood clots, by minimizing post-operative recovery time.

Evidence for Single Incision Laparoscopic Surgery (SILS)

SILS is a developing field, with most publications to date focusing on case reports or short case series discussing the viability and technical problems of various operations. There have been very few studies comparing SILS to standard laparoscopic procedures, and there is a need for randomized controlled trials to definitively prove that SILS is no different from standard laparoscopic surgery in terms of completion rates and complications, but with the added benefit of being more cosmetic, resulting in lower morbidities such as pain.

Several research organizations in the United States have registered randomized controlled trials and are presently recruiting subjects. Studies comparing traditional laparoscopic cholecystectomies, appendectomies, and colectomies to the SILS equivalents are among them. They claim to provide much-needed answers but will take years to complete.

Other problems in previous research have limited their impact. Low sample size, selection bias, and difficulties blinding participants are examples of these. The great majority of studies had a very well selected SILS sample of non-complicated patients, limiting their generalizability substantially. Cholecystectomy and appendectomy are the procedures with the greatest documented evidence.

Who Can Have Single Incision Laparoscopic Surgery (SILS)?

With a few exceptions, those who are candidates for robotic surgery are typically good candidates for single port surgery. Furthermore, patients who are not candidates for standard robotic surgery (those who have had several major abdominal procedures, significant pulmonary or cardiac problems, or morbid obesity) may be candidates for a single-port procedure. When deciding on the optimal technique, your surgeon will assess your general health as well as the severity of your disease.

How Should I Prepare for Single Incision Laparoscopic Surgery (SILS)?

• Your healthcare expert will walk you through the process. Any questions you have, ask him or her.
• You may be asked to sign a consent form approving the surgery. If anything is unclear, read the form carefully and ask questions.
• Your provider will ask about your medical history. He or she may also do a physical examination on you. This is to ensure that you are in excellent health prior to the surgery. Blood testing and other diagnostic procedures may also be required.
• You must fast for 8 hours before to the surgery. This frequently entails no eating or drink after midnight.
• Inform your healthcare practitioner if you are sensitive to or allergic to any medications, latex, tape, or anesthetic medications (local and general).
• Inform your doctor about all of the medications you are taking. This covers both OTC and prescription medications. Vitamins, herbs, and other supplements are also included.
• If you have a history of bleeding issues, inform your physician. Inform your provider if you are using any blood-thinning medications, aspirin, ibuprofen, or other blood-clotting medications. You may need to discontinue these medications prior to the operation.
• Inform your healthcare practitioner if you are pregnant or suspect you are pregnant.
• You must remove any piercing jewelry around your naval (belly button).
• Depending on the operation, you may be asked to take an oral laxative to cleanse your colon before the procedure, or you may have a solution injected into your rectum and lower intestine (a cleaning enema) a few hours before the procedure. You may also be given an antibiotic.
• Before the treatment, you may be given a sedative to calm you. This is dependent on the sort of laparoscopy performed. If this is an outpatient operation, someone must drive you home.
• Your healthcare provider may have other instructions for you based on your medical condition.

How is Single Incision Laparoscopic Surgery (SILS) Performed?

• A general anesthetic will be administered to relax your muscles and avoid pain during operation.
• A tiny incision in the abdomen or near the navel is made by the surgeon. They expand your abdomen to make it easier to see your organs. Then, through this little incision, your physician inserts the robot with the camera and other essential tools and performs the procedure.
• The duration of the process is determined by the type of surgery.
• You'll normally spend approximately an hour in a recovery room after surgery. After that, you'll be observed in the outpatient surgery unit for a while.
• You may be able to leave the hospital that day, depending on the kind and extent of the surgery.
• You won’t be able to drive for 24 hours after surgery. Make sure you have someone available to pick you up and stay with you for those first 24 hours.
• Follow any discharge instructions you are given, including those regarding your activity levels and making a follow-up appointment.

What Happens After Single Incision Laparoscopic Surgery (SILS)?

You'll be transported to a postoperative recovery room, where your vital signs will be monitored until you awake. You may require a different type of pain medication at this stage. One typical adverse effect of laparoscopic surgery is gas discomfort caused by residual carbon dioxide in the body. It may feel as if it is in your shoulders. This is because it stimulates a nerve that sends pain signals to the shoulder. This is typical and will pass in a day or two.

Depending on your unique procedure and how your body responds, you may be able to go home the same day or you may need to stay overnight. When you return home, your healthcare team will teach you how to care for yourself. This covers wound care, drain care, and food instructions, particularly if you had abdominal surgery. Before you leave, you'll also arrange a follow-up appointment to check on your recovery and have your fluid drain removed, if you have one.

Advantages of Single Incision Laparoscopic Surgery (SILS)

Single-port surgery leaves low to no scarring and may decrease issues that are prevalent following traditional open and even classic laparoscopic abdominal surgery.

The advantages of single-port surgery include:

• You might be a candidate for single-port surgery even if you’re not eligible for traditional laparoscopic or robotic surgery.
• Your surgeon can perform multiple procedures at the same time, using the same single incision. For example, your surgeon can remove the prostate and part of the kidney, which would otherwise require two incisions or two surgeries.
• People report less pain with single-port surgery.
• You will not need narcotics for pain relief.
• You may leave the hospital on the same day of your surgery.
• Your recovery should be faster. You can be back to your regular daily routine shortly after the procedure.
• Cosmetically, the scars from your surgery will be almost invisible

Disadvantages of Single Incision Laparoscopic Surgery (SILS)

Because all instruments use the same entrance site, the single-port method is more difficult than standard laparoscopy or robotic surgery because your surgeon has less range of movement. Make certain that your surgeon performs these operations on a regular basis and that they are conducted in a facility that does many of these procedures each year.

Risks & Complications 

• Trocar injuries.

There is some risk of damage from the first trocar insertion since it may be put blindly before the laparoscope is introduced. Complications are uncommon but significant. They are as follows:

• Blood vessel injury.
• Bowel injury.
• Nerve injury.
• Port-site hernia.

• Insufflation complications.

Some patients may respond badly to the carbon-dioxide gas used to inflate the abdominal cavity during the surgery. Prior to surgery, you will be evaluated for any cardiopulmonary disorders that would put you at risk of these consequences. Complications include:

• Hypercapnia (carbon dioxide retention).
• Pneumothorax (collapsed lung).
• Subcutaneous or mediastinal emphysema (air trapped under the skin or in the chest cavity).
• Hypothermia.

• General surgical risks.

All surgeries come with certain general risks. These include:

• Allergic reaction to anesthesia.
• Internal adhesions from scar tissue.
• Excessive bleeding.
• Wound infection.

When Should I See My Healthcare Provider?

Your surgeon may recommend single-port surgery for a variety of diseases affecting various body areas. Before you leave the operation center, ask your care team when you should call them and when you need seek emergency treatment.

In general, you should contact your healthcare practitioner if you experience any of the following symptoms following surgery:

• Changes in urination, including frequent urination or changes in urine color.
• Edema (swelling) in the legs, lower back or face.
• Increasingly high blood pressure.
• Nausea or vomiting.
• Brain fog.

Conclusion

Single-incision laparoscopic surgery, or SILS, is a growing medical area with significant benefits. It is a minimally invasive technique with excellent aesthetic outcomes. Previously, practically any sort of surgery required physicians to create extensive incisions.

Less invasive surgical procedures are becoming increasingly common. This enables surgeons to get better results. Improvements in this sort of surgical approach allow patients to be more comfortable. They also have a faster recovery time. This approach is replacing the requirement for open surgery in many clinical circumstances.