SILS: Single Incision Laparoscopic Surgery

10-09-09 will be a memorable day for me and Springfield Institute! Reason? It was the day when I successfully completed a Single Port Laparoscopic procedure for a major surgery wherein one third of the stomach and the uterus was removed via a single key-hole on the umbilicus (navel). I am of the firm conviction that it is India’s and possibly Asia's first procedure involving SILS and a partial gastrectomy and a hysterectomy The patient, a 46 yr old lady, presented to me with severe anemia (low hemoglobin in the blood) and a history of excessive menstrual bleed. Her BMI was 39 and further investigations showed that she had a bleeding polyp in her stomach and considering the best interests of the patient, she required a surgery that involved removing at least 2/3rd of her stomach (which would also be a bariatric procedure to reduce weight) and also a complete removal of the uterus.

Why is this relevant?

The surgical specialty field is an evolving continuum. The attitude towards surgery, the surgical approach as well as the instrument and gadgets of surgery aren’t the same in a time span of even a few months! Up to about 10 years back surgery means knives and scissors and traditionally abdominal surgeries were very much 'invasive', meaning it was done via a big incision down the middle of the stomach which lead to a lot of bleeding, wound infection, extended hospital stay and a longer recuperation time but with the advent of second generation surgical techniques like laparoscopy all that changed for the good!

What is laparoscopy (key-hole surgery)?

In a conventional laparoscopic technique, the surgeon gains access to the intra-abdominal organs by means of at least 3 (and up to 6) one centimeter key-holes. Through one, a camera is inserted and the remaining 2 have a pair of scissors and dissector which help the surgeon do the needful.

3rd generation surgery?

We are surely and steadily on the verge of another paradigm shift. A third generation surgical procedure known as SILS-Single Incision Laparoscopic Surgery is done using only one small key-hole of just 1 and a half cms done exactly on the navel and all the required instruments are passed through it. While this new procedure may seem a bit unorthodox, the safety and care of the patient is in the forefront as this technology is fully patient friendly!

Transfer of Technology!

Earlier it took at least 4-5 years to know/learn new surgical skills from the affluent West and only a few privileged persons could gain the knowledge. But SILS happened in 3-4 months of it being introduced in the West. Now SILS is the standard procedure for removal of the gall bladder and the appendix, but even major surgeries like removing a portion of the stomach can be done and in India.

Advantages of this ‘Belly button’ surgery:

a) Blood loss is minimal

b) Patient tolerance and discomfort is reduced

c) Hospital stay is reduced as patient can be ambulant and take oral feeds on the very same day!

d) Newer technology doesn’t necessarily mean higher cost! In fact the treatment costs are reduced by at least a third.

f) Though this is the first of a kind here in India, this emerging technique doesn’t require a corporate hospital set up and can be done at your neighbourhood hospitals.

g) Hitherto, one had to travel abroad for sophisticated surgery, but with the advent of rapid technology transfer along with globalization we can have it done conveniently at home reducing on the travel cost and hassles of traveling.

e) Last but not the least, cosmetically there is absolutely no scar!