Single Incision Laparoscopic Surgery (SILS) for Cholecystectomy using standard laparoscopic instrumentation: Advantages and benefits of a new surgical. Single-port laparoscopy (SPL), is a recently developed technique in laparoscopic surgery. SPL is accomplished through a single 20 mm incision in the navel ( umbilicus . "Novare Surgical Systems, Inc. Announces First Ever Single Port Laparoscopic Kidney Removal (Nephrectomy) Using RealHand(TM) HD Instruments". Single incision laparoscopic surgery (SILS) is a rapidly developing field that in the form of case series, with the first large randomised controlled trials due to be. In fact, he adds that a new procedure called the single-incision laparoscopic surgery (SILS) offers even greater benefits with one single cut. Single-incision laparoscopic surgery is a very exciting new modality in the field of minimal access surgery which works for further reducing the scars of standard.
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Flow diagram for the systematic review from the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Single-Incision Laparoscopic Cholecystectomy: A Systematic Review. Arch Surg. References were cross-checked to ensure capture of cited pertinent articles. Case reports and series of less than 4 cases were excluded.
Seven studies consisted of randomized trials and 11 of case-matched control series compared with SLC. The technical aspects of SILC were not standardized. Median follow-up time was 4 weeks, although 27 studies The overall median complication rate was 7. Three articles demonstrated significantly improved cosmesis after SILC. No definitive evidence suggests that such improvements can be gained by SILC. Complications are more common, may be underestimated owing to the lack of sufficient follow-up, and may be associated with a shift from safe practice.
Surgery remains the mainstay of treatment for biliary disease, and Navarra et al 1 first described the laparoscopic removal of a gallbladder through multiple first single incision laparoscopic surgery in a single periumbilical incision in Single-incision laparoscopic operations have emerged recently for a range of benign and malignant disease as a putatively less invasive alternative to conventional laparoscopic surgery.
The perceived benefits of single-incision laparoscopic operations compared with conventional laparoscopy include reduced wound pain, improved cosmesis, expedited return to routine activity, and higher patient satisfaction. Although the feasibility of single-incision laparoscopic cholecystectomy SILC has largely been established, 2 it remains unclear whether SILC represents an improvement in patient care, particularly because a large-scale adoption of such a technique would result in significantly higher costs in the treatment of gallstone disease.
The aim of this systematic review was to critically appraise the available cadillac dinosaurs android apps evaluating the efficacy and safety hack speed wifi g SILC and make comparisons where possible with standard laparoscopic cholecystectomy SLC. Because the strongest and probably the only arguments first single incision laparoscopic surgery SILC are the purported cosmetic benefit and reduced postoperative pain, we focused on these aspects in addition to examining the safety of the procedure.
We included adult human studies reporting outcomes of SILC and limited the search to any English-language article published through July 31, We excluded articles relating to single-incision procedures in a combination of operations unless data from the cholecystectomies could be extracted.
We cross-checked the references in all articles retrieved to ensure capture of cited pertinent articles. A flow diagram of the selection process according to the first single incision laparoscopic surgery on Preferred Reporting Items for Systematic Reviews and Meta-analyses is presented in the Figure.
The primary end point was morbidity as a result of the procedure. Secondary end points included cosmesis, pain, cost, learning curve, and safety with regard to the critical view. In total, we analyzed 49 studies that met the inclusion criteria with a total of patients. Most first single incision laparoscopic surgery the studies were case series. Two articles described fewer than 10 patients.
Articles were published from through Twenty-seven articles The remaining studies described follow-up at a median of 4 postoperative weeks range, 1 week to 26 months. Surgical technique and devices varied. Devices described included 3 trocars inserted through a single incision, specially designed multiluminal devices, magnetic forceps, improvised surgical gloves as ports, and robotic devices. Frequently the same article described outcomes using various techniques during the study period, and this heterogeneity made objective outcome comparisons difficult.
In total, 17 articles investigated postoperative pain. The timing of pain scoring also differed between studies, varying from 1 postoperative day and the 2-week follow-up.
The remaining 3 articles demonstrated significantly reduced postoperative pain in the SILC cohort. Subjective satisfaction scores were used in 5 articles. The study by Marks et al 34 incorporated a number of validated scores of cosmetic outcome. The point photographic series questionnaire demonstrated significant improvements in wound satisfaction with SILC compared with SLC at 2 postoperative weeks and 3 postoperative months.
However, this scoring system could introduce selection bias. The point body-image cosmetic score also showed significant cosmetic improvement with SILC.
A study by Ma et al 32 used a point score and found no difference between cohorts. The remaining article by Fumagalli et al 17 asked patients to subjectively evaluate their satisfaction with the scar. They described 1 patient 4. This finding may reflect the fact that a number of studies were performed with financial support from industry. Two studies reporting cost implications investigated an improvised surgical glove method and demonstrated significantly reduced costs compared with SLC.
No study performed with the aid of industrial first single incision laparoscopic surgery declared financial implications. Eleven studies examined the effect of the learning curve on operating times Table 3. Apart from 1 study, 36 a consistently reduced operating time was observed in the authors' institutions after the introduction of SILC Table 4.
A plateau of operating time was achieved after a median 8. The study by Kravetz et al 26 concluded that operating times could be matched to SLC after 5 cases. One study 21 demonstrated consistent operating times for the 29 patients undergoing SILC, and another did not first single incision laparoscopic surgery any significant reduction in times.
Most studies reported operations that were performed by a single surgeon or group of consultant surgeons for whom the specialist area was often minimally invasive surgery. Some articles, however, described the procedure as performed by residents.
No study reported the nature of the residents' training. Frequently, studies reported local complications, but these were not defined. The overall rate of bile duct injury was 0. Four leaks were secondary to accessory ducts. Because follow-up after single-incision procedures was highly variable and in many cases was not documented, this figure may underestimate this complication in terms of diathermy injuries leading to delayed stricturing of the bile duct. In articles reporting follow-up patients4 instances of incisional hernia occurred, giving an overall rate of 0.
Because length of follow-up varied and was only 2 weeks in some articles, this figure may underestimate true incisional hernia rates. Thirty-four articles The article by Rawlings et al 43 investigated specifically the critical view of safety in the SILC of 54 patients. The group used a 3-point grading system, namely, first single incision laparoscopic surgery of only 2 ductal structures entering the gallbladder, a clear view of the Calot triangle, and separation of the base of the gallbladder from the cystic plate.
A study by Han et al 18 reported outcomes of SILCs performed using the improvised surgicalglove method. In their case series of 12 patients using the 3-trocar technique, Tacchino et al 47 also described poor views. Single-incision cholecystectomy was performed without the addition of extra ports not including transparietal sutures in Reasons for additional ports included insufficient views, dense adhesions, insertion of a choledochoscope, bleeding, inability of the instruments to reach from the umbilicus, and gallbladder-duodenal fistula.
One or more additional ports were required in a median of 8. The rate of open conversion across studies was 0. Ease of surgery was also affected by the indication. Although in all studies cholecystectomy was performed for benign disease, the presentation differed between uncomplicated gallstone disease and acute cholecystitis. Seventeen studies included patients with acute cholecystitis. Many series reported cholecystectomy after bariatric procedures, which will inevitably become increasingly common as the number of these procedures increases.
Twenty-six articles Such sutures frequently resulted in the intraoperative spillage of bile and reduced the mobilization of the Hartmann pouch during dissection. Although a source of debate in SLC, the routine use of intraoperative cholangiography has been described as resulting in reduced ductal injuries.
Intraoperative cholangiography was attempted selectively or routinely in 15 studies Success in performing intraoperative cholangiography was described in Technical innovation within surgery is laudable, and the progress that results is generally a consequence of the quest to achieve optimum outcomes for patients. However, the advances in surgical technique must improve or at least maintain and certainly not at the expense of established safe principles.
Perceived improvements in patient satisfaction with cosmetic outcomes and reduction of pain and surgical trauma must not increase complications or mandate deviations from safe surgical practice. The aims first single incision laparoscopic surgery this review were to assess morbidity and patient-specific outcomes after SILC and to make comparisons, where possible, with SLC. Advocates of SILC cite wayang golek kresna murka durka cosmesis and reduced surgical trauma and first single incision laparoscopic surgery pain as reasons for adopting this technique.
Despite this, the patient's perspectives of cosmesis and postoperative pain have been poorly investigated first single incision laparoscopic surgery are difficult to assess in an objective fashion.
In particular, the advent of the Internet makes this investigation difficult. Demands for the latest procedures are often based on information that is not based on evidence but first single incision laparoscopic surgery is driven by commercial interests or the biotechnology industry.
The most common complaint after SLC is related to the umbilicus. The SILC will inevitably create a bigger incision. Five studies 317283151 objectively investigating cosmetic outcomes of SILC compared with SLC and with differing outcomes lead to no firm evidence of this assumption. Only the study by Marks et al 34 used a validated scar questionnaire on which to base conclusions.
The issue of cosmesis sidesteps the issue of whether surgeons should suspect patient dissatisfaction with SLC scars and whether this issue can be improved. A study by Bignell et al 52 retrospectively investigated patients' satisfaction with cosmesis after SLC in patients using a validated scar questionnaire. This high rate of patient satisfaction with SLC is supported by other series. The assumption that implementing a single incision reduces postoperative pain is also not largely supported by the results of this review.
Thirteen studies have investigated pain and, of these, Increased pain with the SILC technique may be the result of lengthier operating times and subsequent abdominal wall tension that may improve with the learning curve. Difficulties arise in interpreting results because heterogeneity exists in surgical technique and the method and timing of pain scoring.