Single Port Surgery
Reducing the size and number of standard laparoscopic ports in common operations like gallbladder, hernia, appendix and Nissen’s fundoplication surgery is hugely beneficial to patients in terms of less post-operative pain and quicker recovery. No need to mention that cosmesis is much better after Needlescopic surgery than standard laparoscopic or robotic-assisted laparoscopic surgery. The scars are minimal and not very obvious on a fleeting glance. Needlescopic surgery is superior to “Single Port Laparoscopy” (SPL) or “Single Incision Laparoscopic Surgery” (SILS), as far as safety and operative times are concerned.
Single Port Surgery
In SPL and SILS, a single 3-5 cm cut is made near the belly button, and a sizeable multi-channel port is placed through this in the abdomen. The camera and all the instruments as passed through this port to perform the operation. If surgery is not possible this way, then additional ports can be placed on other sites of the abdominal to perform the operation.
Issues with Single Port Surgery
Department of health in the United Kingdom sought advice on the safety and status of Single port surgery whilst Professor Nisar served as an executive council member in the Association of Laparoscopic Surgeons Great Britain and Ireland (ALSGBI), London, United Kingdom. The advice that was given on the safety and status of SILS / SPL and its comparison to standard laparoscopic surgery is as follows:
- Overcrowding of the instruments through one tight port.
- Limited views, difficult dissection, and mobilisation due to compromised access to the target organ.
- An increased risk of port-site hernia compared to standard laparoscopic surgery, Needlescopic surgery.
We do have the skills and facility to offer both surgeries in our hospital. There is certainly a role for SPL approach in some cases; however, all the pros and cons are discussed with the patients who are suitable for this approach and who see an advantage with this type of surgery.
Comparison Table of various Techniques (in order of preference
|Gallbladder Surgery Technique||Total size of cuts|
|Cosmetic Mini Scar Less (MSL) Laparoscopic Cholecystectomy “Amir-Kennedy Cholecystectomy Technique”||1.4cm||14mm||0.55 inch (Just over half an inch)|
|Needlescopic Cholecystectomy||1.6cm||16mm||0.63 inch|
|Laparoscopic Cholecystectomy||3cm||30mm||1.2 inches|
|Robotic Assisted Laparoscopic Cholecystectomy||3cm||30mm||1.2 inches|
|SILS (Single Incision Laparoscopic Surgery)||4.5cm||45mm||1.8 inches|
|e-NOTES (embryonic Natural Orifice Transluminal Endoscopic Surgery)||4.5cm||45mm||1.8 inches|
|Open Cholecystectomy||20cm||200mm||8 inches|