Single Incision Laparoscopic Surgery (SILs) in Gynaecology by Jaf Abu - Gynae Solution.

Jafaru Abu, MD

Consultant Gynaecological Oncology Surgeon, Nottingham University Hospitals

United Kingdom

History • 1911 – First laparoscopy in the US with a proctoscope

• 1972 – Cliffe Wheeles described single puncture technique

• The 1980s – Laparoscopy takes off!!! – Video developments in the television industry

– Laser surgeons – New tools – clips, bipolar, staples, suturing, etc.

• 1987 – first laparoscopic hysterectomy in France

• 1988 – Harry Reich performed first laparoscopic lymphadenectomy

• 1989 – Reich performed first laparoscopic hysterectomy using the bipolar

• 1989 – laparoscopic prostate cancer staging

• The late 1980s/early 1990s – laparoscopic egg retrieval, ectopic, adhesiolysis, endometriosis, cystectomies

Present

• 2005 – Da Vinci Robot

– Hysterectomy, myomectomy, tubal reanastomosis, cancer surgery

In the da Vinci system (see image above), the surgeon sits at the viewfinder (left) and remotely manipulates probes and instruments on actuator arms over the operating table.

Recent

SILs port • 2009 – SILs

SILs

• Generally, laparoscopic procedures are performed via two or more incisions

• Single incision laparoscopic procedures are performed via a single incision in the umbilicus representing a significant evolution in the field of surgery

SILs

Laparoscopy traditionally offers better patient outcome compared to open operative procedures, including :

– less pain, – improved cosmesis and recovery period,

SILs procedures have the potential to dramatically extend these benefits

SILs Procedure

• The SILs port is a single, flexible port that is fixed through a small incision

• Through this single port the camera and two other operating instruments can be introduced:

– Blood vessel sealing device – Graspers

Gynaecological procedures that can be performed with SILS

• BSO

• Salpingectomy

• Adhesiolysis

• Hysterectomy

• Endometriosis treatment

• Treatment of benign ovarian cysts

• Sterilisation

• Diagnostic laparoscopic procedures

• In very experienced hands: pelvic lymphadenectomy, omentectomy and even radical hysterectomy.

Incision sites

SILS Post operative scarring