SINGLE INCISION LAPAROSCOPIC SURGERY- A NEW CONCEPT :SINGLE INCISION LAPAROSCOPIC SURGERY- A NEW CONCEPT DR.JOHN.AC.THANAKUMAR MS,MNAMS,FRCS,FRCS,FIAGES,Dip.MIS(Fr) Senior Consultan,HOD, www.lapsurgeon.org DR.K.KAMALAKANNAN MS,D.MAS(Delhi) Senior Registrar, Dept of Minimal Access & Bariatric Surgery Global Hospitals and Health City, Chennai


VARIOUS TERMS FOR SILS :VARIOUS TERMS FOR SILS Single Port Access (SPA) Single Incision Laparoscopic Surgery (SILSTM) One Port Umbilical Surgery (OPUS) Single Port Incisionless Conventinal Equipment-utilizing Surgery (SPICES) Natural Orifice TransUmbilical Surgery (NOTUS) LESS


Definition :Definition SILS is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel First performed for the treatment of acute appendicitis in the dept. of pediatric surgery in Turkey in 2005.


Method in SILS :Method in SILS General anesthesia, insufflated and laparoscopic visualization Special trocar Rotatable instruments Articulating handles Flexible laparoscope Harmonic scalpel


Advantages of SILS :Advantages of SILS No visible scar like a traditional multi-port laparoscopic approach. Less post-operative pain, Less blood loss, Faster recovery time, Less complications, Early return to work, and Better cosmetic results.


Negative Side :Negative Side Expensive trocar Expensive instruments Needs practice Should be already a good lap surgeon Team work


CLINICAL TRIALS :CLINICAL TRIALS Cleveland Clinic for clinical trials Geneva University Hospital (Switzerland) for visceral surgery


OUR CASE STUDY :OUR CASE STUDY 2 Cases - Single incision laparoscopic cholecystectomy. 3 Cases - Single incision laparoscopic appendicectomy.


SILS - Cholecystectomy :SILS - Cholecystectomy 43 yr female admitted with abdominal pain and indigestion for 1 month. Vitals – Stable, Afebrile. Systemic Examination: Abdomen – Soft, Tenderness present over epigastric, right hypochondric region, No mass palpable, BS(+)


Slide 10:Investigations: USG Abdomen: Multiple gall bladder calculi, largest one measuring about 1.8 cms, CBD normal. CBC,LFT are normal. Diagnosis – Chronic calculous cholecystitis. Procedure - Single incision laparoscopic cholecystectomy.


SILS - APPENDICECTOMY :SILS - APPENDICECTOMY 30 yr male patient admitted with abdominal pain and vomiting since 3 days. Vitals – Stable, Afebrile. Systemic Examination: Abdomen – Soft, Tenderness present over right iliac region, No mass palpable, BS(+)


Slide 12:Investigatoins: USG Abdomen – Features suggestive of acute appendicitis. CBC – Normal. Diagnosis: Acute appendicitis. Procedure: Single incision laparoscopic appendicectomy.


DIFFERENCE B/W SILS VS TRADITIONAL LAPAROSCOPIC SURGERY :DIFFERENCE B/W SILS VS TRADITIONAL LAPAROSCOPIC SURGERY SILS Single incision No visible scar Better cosmetic results Special instruments Instruments are expensive Cost is more Needs more practice TRADITIONAL LAP. SURGERY Multiple incision Two or Four permanent scars No need for special instruments. Cost not more.


SINGLE INCISION vs TRADITIONAL LAPAROSCOPIC CHOLECYSTECTOMY :SINGLE INCISION vs TRADITIONAL LAPAROSCOPIC CHOLECYSTECTOMY


SINGLE INCISION vs TRADITIONAL LAPAROSCOPIC CHOLECYSTECTOMY :SINGLE INCISION vs TRADITIONAL LAPAROSCOPIC CHOLECYSTECTOMY


Our Modification :Our Modification No special trocars No special instruments Cost not more Time not more Same instruments, same team with better advantages


Slide 29:Just as energy is the basis of life itself, So is innovation the vital spark Of all human change, improvement and progress.


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