What is Single-Incision Laparoscopy Surgery (SILS)?
Single-incision laparoscopic surgery (SILS) is the most advanced form of minimally invasive laparoscopic surgery in which a single incision is made on the abdomen rather than multiple keyhole incisions as in standard laparoscopy or keyhole surgery.
Laparoscopy is a minimally invasive surgical procedure performed using a laparoscope, a thin fibre-optic instrument with a camera and lens attached to it. A traditional laparoscopic surgery uses several small keyhole incisions of around 3 to 5 cm to enter into the abdomen and carry out the required surgical correction with the aid of a laparoscope and miniature instruments. SILS involves making only one small incision on the belly button and inserting both a laparoscope and miniature instruments to perform a surgical correction thereby enabling minimal muscle trauma, fewer complications, and shorter hospital stays compared to traditional laparoscopic surgery.
Indications for Single-Incision Laparoscopy Surgery (SILS)
Single-incision laparoscopic surgery (SILS) is mainly indicated for its several advantages over traditional laparoscopic surgery. SILS may be indicated for conditions and surgeries, such as:
- Biliary dyskinesia
- Biliary pancreatitis
- Porcelain gallbladder
- Gallbladder stone removal
- Appendix surgery
- Bariatric surgery through sleeve gastrectomy
Preparation for Single-Incision Laparoscopy Surgery (SILS)
Pre-procedure preparation for single-incision laparoscopic surgery (SILS) will involve the following steps:
- A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
- You will be asked if you have allergies to medications, anaesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements that you are taking.
- You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to surgery.
- You should not consume any solids or liquids at least 8 hours prior to surgery.
- You will be placed on a special diet prior to surgery and laxatives may be used to clean out your bowel.
- You may be instructed to shower with an antibacterial soap the night prior to surgery to help lower your risk of infection after surgery.
- Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Single-Incision Laparoscopy Surgery (SILS)
Single-incision laparoscopic surgery (SILS) is usually performed under general anaesthesia. Your surgeon makes a small incision at the navel or belly button. A SILS port is inserted through the single incision at the belly button to create a single entry point for the laparoscope and instruments. The port is a flexible and soft instrument enabled with features to perform the surgical procedure. A laparoscope (tube with a light and a miniature camera) is introduced into the abdomen. The camera is connected to a monitor, which allows your surgeon to get a magnified view of the operating field. A harmless gas is pumped into the abdominal cavity to expand the viewing area of the abdomen giving the surgeon a clear view and room to work. Miniature surgical instruments are inserted and through the help of images displayed on the video monitor your surgeon carries out the required surgical correction accordingly. After the procedure, the single incision is closed with stitches and covered with bandages.
Postoperative Care and Recovery
In general, postoperative care instructions and recovery after single incision laparoscopy surgery (SILS) will involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anaesthetic reactions to the medications and anaesthesia used. Your nurse will also monitor your blood oxygen level and other vital signs as you recover.
- You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
- Medications may also be prescribed as needed for symptoms associated with anaesthesia, such as vomiting and nausea.
- Walking and moving around in bed is strongly encouraged as it lowers the risk of blood clots and pneumonia. It also helps to stimulate your bowels and assist with passing gas.
- Antibiotics are prescribed to address the risk of surgery-related infection.
- Your diet is slowly advanced post-surgery. You will start with clear liquids and then progress to having normal solid foods, as tolerated.
- It is important to keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking for a specific period of time as it can negatively affect the healing process.
- Refrain from strenuous activities and lifting anything heavier than 10 pounds for the first couple of months. Gradual increase in activities over a period of time is recommended.
- Eating a healthy low fat, high fibre diet is strongly recommended to promote healing and a faster recovery as well as drinking 8 to 10 glasses of water daily to prevent constipation. Laxatives or stool softeners may also be recommended as needed.
- Most patients are discharged within a couple of days. You will need to take off work at least a week or two to rest and promote healing. You may take a month or two until you begin to feel back to normal.
- Walking is a good exercise and is strongly recommended to improve your endurance.
- Refrain from driving until you are fully fit and receive your doctor’s consent. Most patients can resume driving around 2 to 4 weeks following surgery.
- You will be able to resume your normal activities within a couple of weeks but may have certain activity restrictions.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Benefits of Single-Incision Laparoscopy Surgery (SILS)
Some of the benefits of single-incision laparoscopic surgery (SILS) over conventional laparoscopic surgery include:
- Faster recovery time
- Minimal discomfort
- Minimal trauma to skin and muscles
- Single incision/cut
- Minimal pain
- Lower risk of infection
- Lower risk of major nerve injury
- No visible scar
- Shorter hospital stay
- Better overall cosmetic results
Disadvantages of Single-Incision Laparoscopy Surgery (SILS)
Some of the disadvantages of single incision laparoscopy surgery (SILS) include:
- Proximity of instruments to one another during the surgery
- Restricted degrees of freedom of movement
- The number of ports that can be utilised
Risks and Complications of Single-Incision Laparoscopic Surgery
Single-incision laparoscopic surgery (SILS) is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as:
- Hematoma (accumulation of blood in the wound)
- Seroma (accumulation of clear fluid in the wound)
- Damage to surrounding soft tissue structures, such as nerves, vessels, and organs
- Post-procedure pain
- Blood clots
- Allergy/anaesthetic reactions