Since its origin in the early 1990's, Laparoscopic surgery has rapidly become the new standard of care for surgical intervention. In recent years there has been a concerted effort to reduce even further the morbidities that are associated with the more "traditional" laparoscopic surgical approach. Two forms have evolved.
- Endoluminal and Natural Orifice Surgery (NOTES).
- Single Port Access Surgery / Single Incision Laparoscopic surgery (SILS), LaparoEndoscopic Single Site surgery (LESS)
NOTES (operating via the bladder, vagina or natural orrifices) is still very much in its infancy and Bristol Laparoscopic Associates would consider potentially dangerous. By using a single small incision (SILS) sited through the lowest border of the navel, BLA surgeons are now taking minimally invasive surgery to a new level. This approach affords patients a much improved outcome with minimal pain, better cosmesis yet with no apparent difference in the efficacy of the surgery.
BLAs co-founder Mr Tony Dixon is one of only a handful of UK surgeons now offering these procedures as routine.
Single-port surgery (SILS/LESS) 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 even further and the cosmetic result improved. If the incision is made in the umbilicus (bellybutton), the scar is usually hidden and nearly invisible. Because SILS/LESS usually results in fewer complications and allows a more rapid recovery, we frequently discharge our patient’s home the same day!
Whilst this access to the abdomen is unique, the actual surgical procedure that takes place inside the body is similar to that of conventional, well-proven laparoscopy.
SILS/LESS surgery is relatively easy for experienced and pragmatic laparoscopists to adopt and can be applied to many 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, LESS/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/LESS leaves little or no scarring; in-fact, it is almost impossible to identify the scar!
The final cosmetic effect is fantastic (SILS/LESS cholecystectomy shown above and SILS/LESS TME rectum shown below). ???
In addition to the improved cosmesis, it is our perception that our patients require a lighter anaesthetic and report less pain and discomfort. In view of this they eat sooner and have a significantly faster recovery compared with those undergoing traditional laparoscopy, even when carried out within an enhanced recovery programme. These apparent advantages require confirmation in randomised controlled trials. ???For surgeons however, SILS/LESS is much more challenging; the surgeon has less freedom of movement with all instruments using the same entry point. Specially designed flexible instruments, can in some instances help to overcome that limitation.
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).
What operations have BLA done using SILS/LESS?
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 or LESS may be suitable in your case. Alternatively give us a call.?