SILS cholecystectomy concept is not popular in the UK,most Lap.Chole operations are performed by traditional 4,or 3 ports lap.chole. One study from the UK showed comparable results for SILS cholecystectomy but the time is longer.(.Chow A, et al.)
Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience.Surg Innov. 2009 .
The review showed comparable safety (Markar SR, Karthikesalingam A,et al.Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis.Surg Endosc. 2012.
The true benefit of single port is when it is necessary to:
a) To remove an XL Specimen (LIke a tumor or a solid organ)
b) to offer extra wound protection
c) to use large and/or curved Instruments
d) to MIX part of the endoscopic with Conventional Open Surgery
using just normal conventional open instruments.
Benefit for a normal lap chole ar only cosmetics and surpased by the NEW minilaparosocpic technique that uses LowFriction instruments.
Dear Deepraj,
Many thanks for your expert input,
I'm a fan of minimal access surgery and I think we should offer this kind of operation on condition that safety is not going to be less than traditional lap.chole and also resources and operative time are not going to be stretched!!.
I agree there are many ways to do cholecystectomy.The chosen technique will depends on surgeons' experience,local setting and some unavoidable politics within each department.
I'm aware of your technique and agree its cheap and no extra instruments cost is warranted.
My questions to you:
1.If you see this patient 2-5 years later and compare to another patient who have been done by traditional 3 or 4 ports technique ,what is the difference or the advantage from your perspective?by that time the traditional ports are inconspicuous.
2.The operative time : Most surgeons can do easy gall bladder in 20-25 minutes.What is your average operative time from pneumoperitoneum to closure of your single port?
3.What is your incidence of clinical umbilical hernia[this is the major concern of SILS].Studies quoting 2-3%.
4.What is your bile injury &bile leak incidence over the last 5 years? the field in the video you put on you tube is not comfortable for surgeons who are not SILS fan.
5.Are you applying SILS for each gall bladder?how would manage difficult gall bladder?what is the incidence of conversion to traditional lap.chole and to open chole?
6.Are comfortable with bile leak+/_ bleeding from your retraction stitch through the gall bladder and are you giving prophylactic antibiotics for each patient as you expect bile leak anyway?
I would be very grateful for your answers to these questions.
Thanks again
- Badges
- Science topic
- Similar topics
- Physical Sciences
- Physical Phenomena
- Luminescence
- Fluorescence