Single incision laparoscopic surgery (SILS) is a minimally invasive surgical method where surgeons operate through one small incision, often concealed within the navel. This approach contrasts with traditional laparoscopy, which requires multiple points of entry. The primary goal of SILS is to reduce the trauma of surgical access while improving cosmetic outcomes.
Understanding the Procedure
A single incision laparoscopic procedure begins with the surgeon making an incision, about 2 to 3 centimeters long, within the umbilicus. This location is chosen for its cosmetic advantage, as the scar is often hidden. A specialized access port is inserted through this opening. This port has multiple channels, allowing a camera and several surgical instruments to pass into the abdominal cavity simultaneously.
Once the port is in place, the abdomen is inflated with carbon dioxide gas in a process called insufflation. This lifts the abdominal wall away from the internal organs, providing the surgeon with a clear view of the surgical field. The surgeon operates using instruments that are often longer and more flexible than those in standard laparoscopy, allowing them to work through the single entry point.
A technical challenge in this procedure is managing multiple instruments within a confined space. Surgeons use articulating instruments that can be bent and rotated to reach and manipulate tissues from various angles. This dexterity is necessary to replicate the movements that would otherwise be achieved through several separate incisions.
Common Surgical Applications
The single incision approach is used for various abdominal and pelvic procedures. One of the most frequent applications is cholecystectomy, the removal of the gallbladder. The technique is a viable option for patients with symptomatic gallbladder disease, offering a nearly scarless result. It is a common alternative to the standard four-port laparoscopic method.
Appendectomy, the removal of the appendix, is another common SILS procedure, especially for pediatric and adolescent patients. Studies show SILS appendectomy is technically feasible and safe for this group, with cosmetic outcomes being a primary advantage over conventional laparoscopy.
SILS is also utilized in more complex operations. These include bariatric procedures like sleeve gastrectomy and gynecological surgeries such as hysterectomies and oophorectomies. The applications for this procedure continue to expand with advancements in technology and surgical experience.
Comparing Surgical Approaches
The most distinct advantage of SILS is the cosmetic result. A single incision hidden in the umbilicus can be virtually scar-less, which contrasts with the multiple scars from standard multi-port laparoscopy. This benefit is a primary driver for patient interest. While some studies suggest other benefits like less blood loss, these are not universally established.
SILS presents a steeper learning curve for surgeons than multi-port laparoscopy. Maneuvering instruments through one port is technically demanding and can lead to longer operation times, especially for surgeons new to the technique. There is also a specific risk of developing an incisional hernia at the larger port site.
Patient selection is a factor for this approach. Ideal candidates have a lower body mass index (BMI) and no extensive prior abdominal surgery, which can cause complicating scar tissue. If difficulties arise during the operation, a surgeon may convert to a multi-port laparoscopy by adding more incisions to ensure patient safety.
The Patient Journey and Recovery
The patient journey begins with a pre-operative consultation to determine candidacy, where the surgeon evaluates the patient’s condition, anatomy, and health. If suitable, the procedure is scheduled and performed under general anesthesia. The hospital stay is often short and comparable to standard laparoscopy, with many patients discharged the same or the next day.
Post-operative care for the umbilical incision is straightforward. The small wound is often closed with absorbable sutures and surgical glue or tape, and patients receive instructions on keeping it clean and dry. Pain scores may be slightly higher immediately following SILS compared to multi-port surgery, but this is managed with medication.
Recovery timelines are often favorable, and some patients may return to normal activities sooner than after standard laparoscopy. Restrictions include avoiding heavy lifting for a few weeks to allow the incision site to heal. Follow-up appointments are scheduled to monitor the healing process.