Presentation on theme: "Single Incision Laparoscopic Surgery"— Presentation transcript:
1Single Incision Laparoscopic Surgery Dr Anish NagpalLaparoscopic and GastrosurgeonAnya Gastro SurgicentreAhmedabad
2What is SILS?Laparoscopic surgery through the umbilicus with a single incisionAdvanced minimally invasive procedure in which the surgeon operates thru a single incsion :mostly tthru the umbilicsuMore Surgery with LESS or No IncisionScarLESS Surgery
3The Idea behind SILS!!As a bridge b/n NOTES and Lap. Surgery
4NOTES Natural Orifice Trans Endoscopic Surgery Access to the abdominal cavity is required for diagnostic and therapeutic endeavors for a variety of medical and surgical diseases.Historically, abdominal access has required a formal laparotomy to provide adequate exposure.Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates abdominal incisions and incision-related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology.
5Innovative surgical endoscopists Innovative Medical endoscopists
6Surgical site infections Hernia formationAdhesions areAdditional prospective benefits derived from an incisionless technique are minimization of anesthesia and analgesia and lowered patient apprehension to elective surgeries
7From Germany,Seifert described the first documented case of NOTESin 2000, in which a posterior gastrotomy was createdwith an endoscopic needle-knife, enabling retroperitonealpassage of the endoscope to perform a pancreaticnecrosectomy in 3 patients too ill to tolerate formaldebridement
8Drs Reddy and Rao from India further validated the feasibility of NOTES by performing a NOTES appendectomyin a human.40
9Several inherent technical challenges to NOTES exist, including creating a viscerotomy, manipulating intraabdominal organs, and safely closing the viscerotomy.the physiologic effects of orificial contaminates may be catastrophic
10Acronyms LESS- Laparo Endoscopic Single Site Surgery SPA- Single Port AccessNOTUS- Natural Orifice Trans Umbilical SurgeryTUES- Trans Umbilical Endoscopic SurgerySIMPLE- Single Incision Multi Port Laparoendoscopic SurgeryScarLESS SurgeryEtc……..
11Rationale or Principles Less Is MoreLessen the trauma of AccessLessen the residual scarGive the patient max. cosmetic benefit
12Alleged SILS Benefits • Reduced surgical site infection • Reduced visible scarring• Reduction in pain & analgesics• Quicker recovery time• Reduction in hernias, adhesions• Advantages in the morbidly obese
13HistoryLaparoscopy can be dated to over 100 years ago when George Kelling from Dresden, Germany introduced a cystoscope into the peritoneal cavity of a living dog and insufflated air to enhance the view.
14History of SILSSILS was described as early as 1992 by Pelosi who performed a single-puncture laparoscopic appendectomyIn 1997 Navarra et al. performed a laparoscopic cholecystectomy via two transumbilical trocars and three transabdominal gallbladder stay suturesRefinement of equipment and technique have recently brought SILS into the mainstream.
15Documented SILS - First TurkeyDept. of Pediatric SurgeryAppendicectomy2005
16Procedures performed• Adrenalectomy • Appendectomy • Nephrectomy (partial pp y and donor) • Cholecystectomy • Gastrectomy • Prostatectomy • Pyeloplasty • Gastrostomy • Intestinal • Splenectomy stoma • Varicelectomy • Hemicolectomy (right) y Chamberlain et al. J Gastrointest Surg 2009.
17Preliminary outcomes• Unpublished data suggests no significant cosmetic advantage, cost-effectiveness, or pain postoperatively between single incision surgery and standard LC. • Longer OR time and suspected higher incidence of umbilical hernias Navarra G et al. Surg Endoc 2008.
18We have yet to learn… • Objective reporting of postoperative data such as cosmetic result, pain scores, lengthof stay, return to work, hematoma andhernia formation have NOT been reported.• No Prospective Randomized Trials yetreported (limited enthusiasm to carry out)
19Equipment - PortsOptions3 Low profile 5mm portsSILS Port or similar
26Equipment - Telescope5mm 30 degree scope most commonly used Improvements: Variable angulation telescope - EndoChameleon (0 – 120 degree) Light produced by super bright LED bulbs at the head of the telescope Light source entering back of camera head (Reduces extra-abdominal clashing)
27Laparoscopic Surgery- Multiport SILSDifficult but possibleminor traumaModerate Pain, passes in short termMoreChances of Skin InfectionLOS- few days4–5 small scars, less visible; good effectPatient quite satisfied of his lookCumbersome, no specialists in this areaLow, minimal trauma to the tissuesMinimal PainLack of skin incisions—rare cases of infectionLOS -A few daysNo scars—perfect effectPatient very satisfied of his look
29Challenges Cost Learning curve Data Questions that need to be answered by wellconstructed large seriesEquivalent safety?Additional advantages over accepted laparoscopyother than cosmesis?Optimal technique?Cost?
30Single Port Summary• Variety of techniques and innovative devices available • Feasibility established, outcomes are not • Patients deserve transparency with respect to innovative surgical procedures
31The possibility of performing truly scarless, safe, more effective, and at the same time less painful and minimally invasive surgery is so tempting for doctors and, what is actually more important, for patients that it will encourage the medical world to make every effort to make this dream come true.