What is Single incision Laparoscopic Surgery?
Traditional laparoscopy requires 3 to 4 incisions ranging from 5 to 10 mm to perform the surgery. Single incision laparoscopic surgery is performed using a single incision of 20 to 25 mm in the umbilicus to perform the surgery.
How is it performed?
There are several ways of performing single incision laparoscopic surgery. One method is to use commercially available devices such as the SILS port, Gel Port and Triport. In this technique a single incision measuring 2 to 2.5 cm is made in the umbilicus. The incision is extended into the abdominal cavity by cutting the rectus sheath and the peritoneum and the device is then fixed in place. Carbondioxide insufflation is done. Trocars measuring 5mm to 10mm is placed into the port to introduce a laparoscope and instruments to perform the surgery.
The second method is performed by not using any special device but using only trocars that are generally used during traditional laparoscopic surgery. After making the skin incision measuring 2.5 cm, the skin is detached from the rectus sheath and a space with a distance of about 1.5 cm is created all around the incision so as to release the skin from the rectus sheath. An instrument called a Verres needle is used to pass carbon dioxide into the abdominal cavity. The aim is to separate the abdominal wall from the abdominal organs. A trocar with a rubber band attached to it is inserted into the abdomen in middle of the incision. A laparoscope attached to a camera is passed into the abdomen and video images captured by the video camera are displayed on a video monitor.
A powerful light source is channeled into the abdominal cavity for illumination purpose. Another 2, 5mm trocars are placed lateral to the first trocar on either side to allow passage of instruments such as laparoscopic scissors and graspers to perform the surgery.
At the end of the surgery, all the instruments are removed and the CO2 gas is released. The umbilicus is then reconstructed.
What are the advantages and disadvantages of these 2 different techniques?
The advantage of using commercially available devices is that devices are designed to fit into the abdominal incision tightly so as to prevent leakage of carbon dioxide. It is also easy to change trocars from 5mm to 10mm trocars during the surgery. However, these devices are expensive and not reusable.
The distances between the trocars are also small making surgery especially suturing difficult. The advantage of using just the trocars is that this technique is cheaper because no extra device is necessary. The trocars can also be placed quite far apart, so there is more space, and so dissection and suturing is easier. However, the disadvantage is that, if the incisions made in the rectus sheathe is large, leakage of carbon dioxide may cause surgery to be difficult. It is also more difficult to change trocars that are already placed in the abdomen.
Advantages of single incision laparoscopic surgery?
The many advantages of traditional laparoscopic surgery also benefits single incision laparoscopic surgery. This includes:
- Less postoperative pain
- Quicker return of bowel function.
- Quicker return to solid food.
- Quicker return to daily activities.
- Reduced chance of scar formation in the abdomen.
- Reduced infection rate.
- Reduced bleeding during surgery.
- Shorter hospital stay.
Video magnification offers the surgeon a better view of diseased organs and its surrounding vessels. The added benefit of single incision laparoscopic surgery is that there will be only 1 scar and it is hidden in the umbilicus. Due to a single incision, the postoperative pain is also believed to be lesser than traditional laparoscopic surgery.
What are the disadvantages?
It is technically more demanding for the surgeon to perform this surgery. There is crowding of instruments in the umbilicus and there will be limitations in the movement of instruments (triangulation).
Suitable candidates for single incision laparoscopic surgery?
Single incision laparoscopic surgery in gynaecology is usually performed for uncomplicated cases such as:
- • Diagnostic laparoscopy and dye test
- • Laparoscopic tubal ligation
- • Laparoscopic salpingoophrectomy for ovarian cysts
- • Laparoscopic cystectomy for ovarian cysts
- • Laparoscopic salpingectomy for ectopic pregnancy
- • Total Laparoscopic Hysterectomy
- • Laparoscopic myomectomy
Consultation provided to InfoMed Magazine by:
Dr. Sevellaraja Supermaniam MBBS (Mal) FRCOG (UK) FICS (USA) Master of
Reproductive Medicine (Sydney)
Consultant Obstetrician and Gynaecologist and Subspecialist in Reproductive
Medicine (NSR) Mahkota Medical Centre, Melaka, Malaysia.