Advanced Single Incision Laparoscopic Surgery

Advanced Single Incision Laparoscopic Surgery : 

Advanced Single Incision Laparoscopic Surgery Dr John Thanakumar President IAGES 2012-14 Minimal Access, Bariatric and GI Surgery Global Hospital, Chennai www.lapsurge.org Email: drjact@gmail.com Tel:00-91-9443709158

Limitations of SILS: 

Limitations of SILS • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Mindset: 

Mindset Everyone is looking for the sure thing. The way to do that is to go with a proven quantity, a remake of something you have already seen. • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Standard Laparoscopy Principles: 

Standard Laparoscopy Principles • Central position of target • Triangulation of camera and operating ports • Port position • Axis of the instrument to the optical axis • 30 o - ideal • Both should be at equal azimuth angles • Wider angles increase execution time • No difference in force or work done Azim uth ang le • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Covidien Entry: 

Covidien Entry • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Multi Trochar Techniques( Disposable): 

Multi Trochar Techniques( Disposable) • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Single incision, Multi Trochar: 

Single incision, Multi Trochar Our earliest cases

Multi Trochar Port Devices (Disposable): 

Multi Trochar Port Devices (Disposable) Covidien Device P Navel Trochar • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Multi Trochar Port Devices (Reusable): 

Multi Trochar Port Devices (Reusable) S Portal with EndoCone-Cuschieri • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Flexible hand instruments : 

Flexible hand instruments Novare Flexible Handles as well as Shafts of Hand instruments • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Giovanni Dapri Telescope & instruments: 

Giovanni Dapri Telescope & instruments • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Modified Laparoscopes: 

Modified Laparoscopes Olympus EndoEye at SILS hysterectomy • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Advanced SILS: 

Advanced SILS • Tying • Suturing • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

How to tie with SILS: 

How to tie with SILS Single handed knotting • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes J Minim Access Surg. 2011 Jan-Mar; 7(1): 112–115.JT and Pravin John www.youtube.com/watch?v=6xzBvJ1ehYA

Needle holder( Disposable): 

Needle holder( Disposable) Covidien Endo stitch • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

SILS in Gastric Volvulus: 

SILS in Gastric Volvulus www.youtube.com/watch?v=_o9hEsdjdgk

SILS Appendectomy with single handed knotting: 

SILS Appendectomy with single handed knotting www.youtube.com/watch?v=4WzaHMiU05E

SILS Achalasia with Fundoplication: 

SILS Achalasia with Fundoplication www.youtube.com/watch?v=6P7H4sFDIng&list=UU8KZuXlWWO3QzoR3u0edsGQ&index=19&feature=plcp www.youtube.com/watch?v=21NRYf94Vm0&list=UU8KZuXlWWO3QzoR3u0edsGQ&index=68&feature=plcp

SILS Splenectomy: 

SILS Splenectomy www.youtube.com/watch?v=8GLt-0_KQyE&list=UU8KZuXlWWO3QzoR3u0edsGQ&index=35&feature=plcp

Gastric Stapling in SILS: 

Gastric Stapling in SILS http://youtu.be/ronqfnRZgmw

SILS Right Hemicolectomy: 

SILS Right Hemicolectomy www.youtube.com/watch?v=qJGVVx_qDH4

SILS AP resection-Rectal Ca: 

SILS AP resection-Rectal Ca www.youtube.com/watch?v=pW_35gqsj5c

SILS Total Colectomy and Stapling: 

SILS Total Colectomy and Stapling www.youtube.com/watch?v=Wq4FFIbNiPg

TEMS Rectal Carcinoma using SILS port: 

TEMS Rectal Carcinoma using SILS port www.youtube.com/watch?v=bSjmCdjwvZw

SILS in Incisional Hernia: 

SILS in Incisional Hernia www.youtube.com/watch?v=8Wfz-tTBs5o

SILS in Groin Recurrent Hernia: 

SILS in Groin Recurrent Hernia www.youtube.com/watch?v=1V5Wo2AOaxA

SILS Total Hysterectomy BSO & Suturing Vaginal Vault: 

SILS Total Hysterectomy BSO & Suturing Vaginal Vault www.youtube.com/watch?v=nQxJsL77cRY

SILS in Ectopic Pregnancy: 

SILS in Ectopic Pregnancy www.youtube.com/watch?v=XP0KEI8yXU4

SILS Dermoid Cyst of Ovary: 

SILS Dermoid Cyst of Ovary www.youtube.com/watch?v=MbhJW_5M2Qk

Is SILS expensive: 

Is SILS expensive Costs • Economic • Ecologic • Educative • Ergometric • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

SILS limitations: 

SILS limitations • Cost • Hernia of port site • Complications of the critical angle • Not for complicated cases • Instrument limitations • Learning Curve • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

Conclusions: 

Conclusions For selected Laparoscopic Surgeons For selected Procedures For selection among common procedures Patients may demand Importance is to cut down no of ports ? Is it going to be for low economic pt ? Is it going to be popular • Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes

PowerPoint Presentation: 

• Mindset • Entry • Entry Devices • Trochar • Laparoscope • Hand Instruments • Techniques • Improvisation • Training • Alternate routes www.youtube.com/watch?v=Jkf3Bf4lK9Y www.lapsurge.org www.lapsurgeon.b logspot.com Thank you