Single Incision Laparoscopic Surgery

Single Incision Laparoscopic Surgery

Conventional laparoscopic surgery requires the insertion of 3-4 ports through which straight instruments are passed to perform the required surgery. Single incision laparoscopy attempts to perform these surgeries through a single small abdominal incision. Through this incision specialized ports are placed in the abdominal cavity and narrow telescopes ane special curved or flexible instruments are passed to perform the desired surgery.

The single incision laparoscopic surgery can be of the following types:

  • Single incision with one specialized port with multiple entry sites in that port for passing instruments
  • Single incision with multiple small ports.
  • Single incision with specialized port / conventional port with accessory 2.3mm instruments from the sides of the patient

Treatment

The following surgeries can be performed by single incision laparoscopy:

Laparoscopic hysterectomy : Hysterectomy involves removal of the uterus. Normal to slightly enlarged uteri can be removed by single incision laparoscopic surgery safely. Access to modern technology such as the harmonic scalpel (uses ultrasound waves to burn and cut tissue) ensures rapid and bloodless surgery

Laparoscopic ovarian cystectomy and oophorectomy or ovariotomy :Ovarian cysts or parovarian cysts (cysts separate from the ovary) can be safely removed by single port surgery. The cyst (following cystectomy) or the ovary (following oophorectomy or ovariotomy) can be removed through the same incision instead of creating an additional large incision to remove the tumor.

Laparoscopic management of ectopic pregnancy : Ectopic pregnancies are pregnancies lying outside the uterus usually stuck in the Fallopian tube or the ovary. The treatment involves removal of the organ (Fallopian tube or the ovary) or excision of the ectopic. The specimen can be removed through the single incision itself.

Laparoscopy for infertility or recurrent pregnancy loss : Since most cases of infertility or recurrent miscarriage require laparoscopy, single incision laparoscopy is ideally suited for these women. Minor procedures such as drilling of ovaries, cystectomy, puncture of small ovarian cysts, release of flimsy adhesions and cauterization of minimal endometriosis can be performed via single incision laparoscopic surgery.

Laparoscopic myomectomy : Single or multiple small superficial (pedunculated or subserous) fibroids can be removed by single incision laparoscopic surgery. Suturing of the uterus, although technically challenging, is possible with single incision surgery.

Other procedures such as laparoscopic prolapse repair and redical surgery for uterine or cervical cancers are feasible with single incision surgery but are technically cumbersome and offer no genuine advantage over conventional laparoscopy.

Advantages of single incision laparoscopy include:

  • Superior cosmesis
  • Less pain
  • Potentially lesser risk of hernia since the incision can be repaired in a better fashion compared to incisions in conventional laparoscopy

Video