Page 53 - WJOLS - Laparoscopic Journal

WJOLS

10.5005/jp-journals-10007-1118
REVIEW ARTICLE Comparison of Advantages and Disadvantages between SILS and NOTES
Comparison of Advantages and Disadvantages

between SILS and NOTES

Sarat Chandra Jayasingh
Assistant Surgeon, Department of Surgical Gastroenterology, SCB Medical College, Cuttack, Orissa, India

ABSTRACT

Minimal access surgery is the gold standard for several abdominopelvic procedures in the present era. The prime advantage with
minimal access surgery is the minimal surgical trauma in comparison to the conventional surgery. The other advantages of laparoscopy
like less operative time, less pain, early recovery and return to work and above all better cosmetics have been well proven.“Change is
constant in life,” SILS and NOTES are the two newly emerging novel techniques in laparoscopy. SILS is a new advancement in
laparoscopy, where the whole surgery is conducted through a single umbilical incision whereas NOTES is totally incisionless. In real
sense, the incision in NOTES is not externally visible because of the natural orifices like oral cavity, vagina, urethra and anus that are
used as entry sites. SILS have the advantages of better cosmetics, less blood loss, faster recovery, less complications, early return to
work, versatility, better patient acceptance and easy tissue retrieval, etc. The critics are high cost, need of high expertise and more
chances of port site hernia and infection. Similarly, NOTES has its edges over traditional laparoscopy surgery with the advantages of
highest cosmetic value (no visible scar), less pain, requirement of less immunosuppressant and less anesthesia, faster recovery, and
no external wound complications (hernia, hematoma and abscess). But it has also its own critics like questionable safety, unproven data
about complications, requirement of high expertise, low patient acceptance, requirement of advanced endoscopic instruments, difficulty
in closing internal wounds, intraperitoneal infection, gastrointestinal fistula and high cost. Poor acceptance is a major concern for
NOTES.
Aims: To explore the positive and negative aspects of above two procedures in order to find out the better option.
Keywords: SILS-single incision laparoscopic surgery, Natural orifice transluminal endoscopic surgery (NOTES).

SINGLE INCISION LAPAROSCOPIC c. ASC R-port, Ireland
SURGERY (SILS) d. Unix-X from Pnavel concepts.
SILS is an innovative advancement in the field of minimal Hand Instruments (Fig. 3)
access surgery in which the surgeon operates exclusively
through a single entry point, typically the umbilicus. It was a. Standard conventional laparoscopic hand instruments
performed in 2005 for acute appendicitis in department of b. Articulating hand instruments:
pediatric surgery in Turkey. Since then, it has been i. Cambridge endomanufactures autonomy laparoangle
appreciated and accepted all over the world and every articulating instruments.
laparoscopic surgeon today feels incomplete without a ii. Novare surgical manufactures real hand instruments
proper knowledge and understanding of SILS. There are with angle locking.
different names for SILS like SPA—single port access, A wide range of operations are now possible by SILS
LESS—laparoendoscopic single site surgery, OPUS—one like appendicectomy, cholecystectomy (Figs 4A to C),
port umbilical surgery, SPICES—single port incision less nephrectomy, hysterectomy, esophagoectomy, adrenalec-
conventional equipment using surgery, NOTUS—natural tomy, gastric bypass, fundoplication, hernia repair,
orifice transumbilical surgery, E-NOTES—embryonic splenectomy, colectomy, hepatic resection, cryoablation,
natural orifice transumbilical surgery. SILS can be tubal ligation, etc.
performed by many methods like:
i. With multiple facial punctures through single skin Advantages of SILS
incision. a. Better cosmetics
ii. By using additional transabdominal sutures for b. Less blood loss
stabilization of target organ. c. Faster recovery
iii. By using novel port access devices.
d. Less complications
e. Early return to work
Access Ports (Figs 1 and 2)
f. Versatility
a. SILS port from Covedien g. Better patient acceptance
b. GelPort system from applied medical h. Easy tissue retrieval.

World Journal of Laparoscopic Surgery, January-April 2011;4(1):67-72 67