- Single Port Access Surgery / Single Incision Laparoscopic surgery (SILS), Laparo Endoscopic Single Site surgery (LESS)
NOTES (operating via the bladder, vagina or natural orrifices) is still very much in its infancy and Bristolsurgery.com would, at this moment in time consider it to be potentially dangerous.
By using a single small incision (SILS) sited through the lowest border of the navel, Bristolsurgery.com director Mr Tony Dixon has now taking minimally invasive surgery to a new level; his approach affords patients a much improved outcome with minimal pain, better cosmesis yet with no apparent difference in the efficacy of the surgery. Tony is one of only a handful of UK surgeons now offering these procedures as routine: cholecystectomy and colectomy. He has the largest experience (>200 cases) of SILS colectomy in the world and now offers it as routine.
Single-port surgery (SILS) is a form of laparoscopic surgery. In traditional laparoscopic surgery a laparoscope connected to a video camera is inserted through a small incision in the abdomen. Three or five additional small incisions are then used to introduce further “ports” in which instruments are inserted to conduct the surgery e.g., remove the gallbladder, appendix or a segment of bowel. SILS utilises three access ports within one port placed in the umbilicus i.e., there is only one incision. This way, the invasiveness of laparoscopic surgery can be reduced and the cosmetic result improved. If the incision is made in the umbilicus (bellybutton), the scar is usually hidden and nearly invisible.
Because SILS usually results in fewer complications and allows a more rapid recovery, we frequently discharge our patient’s home the same day! 43% of colectomies are discharged home within 24 hrs of surgery!
Whilst this access to the abdomen is unique, the actual surgical procedure that takes place inside the body is identical to that of conventional, well-proven laparoscopy.
SILS surgery is a relatively easy technique for experienced and pragmatic laparoscopists to adopt and can be applied to most of the procedures where laparoscopy is currently used on a routine day-to-day basis. Although it is still at the beginning of its development, SILS surgery has already been performed in many applications.
What are the advantages and disadvantages of Single-Port Surgery?
Because it uses only one port and one incision (through the umbilicus or bellybutton) to both carry out the surgery and remove the resected specimen, SILS leaves little or no scarring; in-fact, it is almost impossible to identify the scar!
The final cosmetic effect is fantastic (SILS cholecystectomy shown above and SILS TME rectum shown below). The rectal cancer patient was discharged home the following morning! He was back at work within two weeks.
See superior cosmesis below (SILS restorative proctocolectomy - ileoanal pouch after ileostomy closure and steroid withdrawl); looks like an appendicectomy!
Bellow is a picture of a young woman who has had both a SILS ventral mesh rectopexy and a colectomy for slow transit constipation
In addition to the improved cosmesis, it is our perception that our patients require a lighter anaesthetic (not much more than is given for a colonoscopy) and report less pain and discomfort. In view of this they tend to eat sooner and have a significantly faster recovery compared with those undergoing traditional laparoscopy, even when carried out within an enhanced recovery programme (43% discharged home within 24hrs of colectomy v 20%).
These apparent advantages require confirmation in randomised controlled trials.
For surgeons however, SILS is much more challenging; the surgeon has less freedom of movement with all instruments using the same entry point.
What are the disadvantages of Single-Port Surgery?
There are no real disadvantages, provided that is your surgeon is experienced with single port surgery and advanced laparoscopy. The surgery may take slightly longer compared to standard laparoscopic surgery (our first SILS/LESS laparoscopic gallbladder removal took 35 minutes rather than our usual 20 minutes; for colorectal resection the times were similar if not faster).
What operations have Bristolsurgery.com done using SILS?·
- Cholecystectomy i
- Right hemicolectomy for cancer & Crohn's
- Extended right hemicolectomy
- Anterior resection for cancer & diverticular disease
- TME rectum for cancer
- Proctocolectomy & ileostomy for Ulcerative Colitis
- Proctocolectomy & ileo anal pouch for Ulcerative Colitis
- Surgery for Crohns (including recurrent disease)
- Surgery for complicated diverticulosis (colovesical fistula)
- Ventral Rectopexy
- TEP hernia repair
Nephrectomy (Mr Mark Wright of BLA)
Who is a Candidate?
Potentially anyone. Patients may not be suitable if they have had multiple abdominal operations or are morbidly obese; both conditions limit visibility and movement inside the abdomen. If you too have to undergo surgery, why not ask your GP or surgeon if SILS may be suitable in your case. Alternatively give us a call.?