Could this be the kindest cut of all?

Laparoscopic surgery is passe. This is the age of single incision laparoscopic surgery or SILS. Over the last two years this procedure has gained enormous popularity globally, with a recent US study showing patients are willing to travel across states to get their surgeries done by the SILS approach. Dr G Srikanth, surgical gastroenterologist, Manipal Hospital, speaks with DNA about this procedure and its advantages.

What is single incision laparoscopic surgery (SILS)? How different is it from keyhole surgery? 
In traditional laparoscopic surgery, multiple small (0.5 to 1.2 cm) cuts are made to perform the surgery. Through one of the cuts, a laparoscope is passed for vision and other cuts are to facilitate the passage of instruments to perform the procedure. For eg, in gall bladder removal surgery four such incisions are made. However, in SILS, only a single umbilical incision is used to perform the procedure. Special devices are available that can be passed through this incision and the laparoscope and other instruments can be passed through the channels available in this device to perform the procedure.

How is this advantageous? Does it reduce the recovery process?
The SILS procedure has all the advantages of a traditional
laparoscopic procedure compared to an open operation, ie less postoperative pain, early recovery, less wound-related complications and an early return to normal activity and work. In addition, it gives an excellent cosmetic result with no visible scar after a month of surgery as the scar gets buried in the natural umbilical scar. It is an improvement over the existing laparoscopic procedures. We have been performing SILS procedures without any special device and this has helped us perform the procedures at a cost similar to the traditional laparoscopic surgery.

Which major surgeries can be performed by using this method?
We have performed 65 procedures till date. We have performed cholecystectomy (gall bladder removal), appendicectomy and hernia repair. In the last two months we have performed more advanced procedures such as splenectomy, adrenalectomy, distal pancreatectomy and hemicolectomy. The urology department has now adapted this approach and has performed simple ephrectomy, radical nephrectomy and recently, kidney donor operation.

Can complex surgeries be performed using this method?
We have demonstrated the feasibility of very complex advanced SILS procedures. We have developed several innovative techniques to overcome the challenges during SILS procedures. However, it requires careful selection of patients who can undergo SILS procedure.