Single incision laparoscopic surgery - Dr.Amit Garg

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SINGLE INCISION LAPAROSCOPIC SURGERY

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Single incision laparoscopic surgery (SILS) or Single Incision Gastrectomy is an advanced, minimally invasive (keyhole) procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s umbilicus (navel). Special articulating instruments and access ports are used to enter into the abdomen.
SILS has been commonly used for:

  • cholecystectomy
  • weight-loss surgery for both sleeve gastrectomy

Advantages:

  • Less recovery time
  • Less incisional pain
  • Single, virtual scar less incision through the belly button
  • Reduced postoperative pain

Less invasive because surgery is done laparoscopically.

 

FAQs

Unlike traditional open surgery, which requires larger incisions, laparoscopic surgery uses small incisions (typically 0.5-1 cm). This leads to less pain, quicker recovery, and minimal scarring.

  • Cholecystectomy: Removal of the gallbladder.
  • Appendectomy: Removal of the appendix.
  • Hernia Repair: Repair of hernias in various parts of the body.
  • Hysterectomy: Removal of the uterus.
  • Bariatric Surgery: Weight loss procedures such as gastric bypass or sleeve gastrectomy.

  • Smaller incisions and less scarring
  • Reduced pain and discomfort post-surgery
  • Shorter hospital stays and faster recovery time
  • Lower risk of infection

While generally safe, risks include infection, bleeding, injury to surrounding organs, and complications related to anesthesia. In rare cases, a laparoscopic procedure may need to be converted to an open surgery.

Not all surgeries can be performed laparoscopically. Complex cases or emergency situations may require traditional open surgery for better access and visibility.

Preparation typically involves pre-operative assessments such as blood tests and imaging studies. Patients may be advised to fast for a certain period before the surgery and to stop certain medications.

Depending on the surgery and your medical history, tests such as blood work, EKG, or imaging (e.g., ultrasound or CT scan) may be required.

Some medications may need to be adjusted or temporarily stopped. Always consult with your healthcare provider regarding which medications are safe to take before surgery.

Recovery time varies depending on the procedure and individual factors but is generally faster than open surgery. Most patients return to normal activities within a week or two.

Pain is typically less severe than after open surgery and can usually be managed with over-the-counter pain medications. Some patients experience shoulder pain due to the gas used during the procedure, which usually resolves quickly.

Dietary guidelines vary depending on the type of surgery. For many procedures, patients start with a liquid diet and gradually progress to solid foods as tolerated.

Keep incisions clean and dry. Follow your surgeon's instructions for dressing changes and watch for signs of infection, such as redness or discharge.

Most patients can resume light activities within a few days and return to work within 1-2 weeks, depending on the type of surgery and individual recovery.

Yes, follow-up appointments are essential to monitor recovery, remove stitches if necessary, and address any complications.

Laparoscopic surgery is generally associated with fewer long-term complications compared to open surgery. Most patients recover fully without lasting effects.

Light walking is encouraged soon after surgery to promote circulation. More strenuous exercise should be avoided for at least 4-6 weeks or until cleared by your surgeon.

The initial cost of laparoscopic surgery may be higher due to specialized equipment and training. However, reduced hospital stays and quicker recovery often result in lower overall costs.

TYPES OF LAPAROSCOPIC SURGERY

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This surgery is usually performed to treat infected appendix.
If not done at appropriate time, the appendix can get deprived of its blood supply and form pus inside. Simple infection can turn into life-threatening complication in no time, so early examination by a doctor is crucial.

Common symptoms of appendicitis are -

  • Pain in the right lower abdomen (Can start near navel and shift or spread later)
  • Nausea or vomiting
  • Fever
  • But all these symptoms may not be present and others may be present. Hence examination by your doctor is very crucial to diagnose or rule-out appendicitis.
  • It usually occurs in teenage but no age is immune.

Advantages of Laparoscopic Appendicectomy over Open Surgery -

  • Smaller incision (cut) and scar.
  • Better visualization of inside abdomen so as to diagnose any other pathology.
  • Lesser pain, quicker recovery and discharge from hospital.

This surgery is performed to remove gall bladder.

It is indicated in following conditions -

  • Gall bladder containing stones which are causing symptoms (sometimes even without symptoms).
  • Gall bladder containing large polyps.
  • Infected gall bladder.

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This surgery is performed to remove stones from common bile duct (CBD)
once they slip from gall bladder.

Advantages of Laparoscopic over Open CDB Surgery:

  • Lesser pain
  • Quicker recovery
  • Quicker return to work
  • Smaller cuts so more cosmetic
  • Lesser chances of wound infection
  • Lesser chances of incisional hernia in later life

All kind of hernia can now be treated using laparoscopy:

  • Inguinal Hernias
  • Ventral Hernia / Incisional Hernia
  • Diaphragmatic Hernias
  • Hiatus Hernia etc.

Advantages of Laparoscopic Hernia Repair over open surgery:

  • Smaller cut - more cosmetic
  • Bigger mesh can be inserted - so may have less chances of recurrence.
  • Requires just three small holes for even both side groin hernias.
  • Covers all kinds of holes for groin hernias as opposed to open surgery.
  • Quicker recovery.
  • Earlier return to work.

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This surgery is done for patients suffering from hiatus hernia and / or
severe Gastro-Esophagial Reflux Disease (GERD).

The indications are:

  • Dependence upon PPIs (Acidity lower drugs like Omeprazole) for relief of symptoms.
  • Food pipe complications, such as erosive esophagitis (redness), stricture, Barrett’s esophagitis etc.
  • Respiratory complications like recurrent pneumonia, bronchiectasis etc.
  • Most cases of Type 2 Hiatus Hernia will need surgery.

Achalasia is a primary esophageal motility disorder of unknown origin, characterized by lack of esophageal peristalsis and failure of the lower esophageal sphincter to relax appropriately.

Now laparoscopic treatment is considered the treatment of choice over endoscopic dialatation. It gives long lasting results with minimum recurrance.

Advantages of Surgical treatment over Endoscopic dialatation:

  • Good relief from symptoms from a single sitting laparoscopic surgery.
  • Low risk of complications.
  • Good long term results.

Diagnostic Laparoscopy means to do laparoscopy to make a diagnosis.

This can be done in many conditions such as -

  • Emergency - To rule out loss of blood supply to bowel, perforation of bowel, bleeding from any organ, injury to any organ etc.
  • In Cancers to see the extent of primary cancer and its spread.
  • Many other conditions when other tests like ultrasound, CT scan etc. either could not find the disease or there is doubt regarding thier findings.
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