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WJOLS

Different Types of Single Incision Laparoscopy Surgery (SILS) Ports

Fig. 3: Alternative to SILS Port

Fig. 5: AnchorPort

these advantages have to be evaluated by further studies.
At SAGES conference in 2009, almost 500 cases of single
incision laparoscopic cholecystectomy were reported. 23-25
The main factor for safety of single incision laparoscopy
surgery depends on the surgeon himself. There is a steep
learning curve required for the safety of the procedure.
One of the surgical teams has advised a “stepwise down”
Fig. 4: Triport and Quadraport 26
approach. One article has given a good list of problems
and solutions seen during single incision laparoscopic surgery
length that allows upto four instruments to be used (Table 2). 27
simultaneously.

Table 2: Problems in SILS
ANCHORPORT (R) (BY SURGIQUEST)
Problems
• Clashing of instruments
Surgiquest has developed a port called AnchorPort (R), • Lack of ideal operative ports
which is used in single incision laparoscopy procedure. It • Interference and deflection of laparoscope's light source by
operating instruments
has an integrated elastometric, stretchable cannula system • Interference of wires or tubing that connect perpendicularly to
that goes into elongated adjustments according to the instruments (i.e. cautery)
patients’ abdomen wall thickness (Fig. 5). It also has a • • Difficulty with retraction of organs or structures
Change of surgeon's mindset
distal tip where it anchors the cannula to the abdominal wall • Lack of time and patience to learn
and prevents it from coming out. • Loss of proprioception due to crossed instrument.
Whatever might be the choice of ports, the most Solutions
important thing is safety of the patient. Any surgery • • Use of curved, reticulating, or flexible instruments
Use of very low-profile trocars
performed by single incision laparoscopy can be done by • Staggering heights and heads of trocars
• Use of novel multichannel ports
the conventional laparoscopic instruments or sometime you • Use of a laparoscope with a light source on the back of the
require special specifically designed laparoscopic camera
instruments. The choice of the ports depends on the surgical • • Use of a flexible-tip endoscope
Use of an extra-long 5 mm angled laparoscope (50 cm)
team, cost factor, and the availability of these ports. Most • Use of a 908 adaptor for the light source (for sharp change in
of the studies indicate the main advantages of single incision • its direction parallel to the laparoscope)
Use of instruments that connect at their distal ends, any
laparoscopy surgery ports, which include less postoperative necessary wires or tubing (i.e. cautery)
pain, less chance of infection, and less chances of port site • Use of extra-long bariatric size instruments
• Use of retracting sutures
hernias. Multiport laparoscopy surgery has a published data • Continuous medical education.
22
on port site hernias with an estimate of 0.14%. But all Contd.
World Journal of Laparoscopic Surgery, January-April 2011;4(1):47-51 49