Page 15 - WJOLS - Laparoscopic Journal

Sweta Tiwari

CHALLENGES OF SILS
It must be remembered that with in-line viewing, a move of
the camera often results in an inadvertent move of an
adjacent instrument. This can increase difficulty in
performing relatively simple tasks that require looking at
two sides of a structure. Put simply, the multiple instruments
and laparoscopes required for a procedure are competing
for the same space at the fulcrum of the entry port, causing
hand collisions externally and difficulty with instrument tip
manipulation internally. Instruments of differing lengths can
ameliorate some of this, but some learning on the part of
the surgeon still is required.
The major disadvantage of the single-port surgery is
limitation of movement due to the proximity of the
instruments to each other during operation. Suturing the
Fig. 1: Scarless SILS
vaginal cuff laparoscopically using a single-port is especially
complex due to the clashing of instruments.

AIMS

The aim of this study was to compare between multiple
incision and single incision laparoscopic hysterectomy. The
following parameters were evaluated for both multiple
incision and single incision laparoscopic hysterectomy.
• Method of patient selection
• Operative technique
• Operating time
• Intraoperative and postoperative complications
• Postoperative pain
• Postoperative recovery
• Cost-effectiveness
• Learning curve
Fig. 2: Scar of LAVH • QOL analysis
• Patient acceptance.
of abdominal wall. For the purpose of preventing this injury, MATERIALS AND METHODS
several methods have been recommended, such as
identifying vessels before trocar insertion using A literature review was performed using Springer link,
transillumination, trocar insertion in areas with low-risk of Highwire Press, BMJ, Journal of MAS and major general
vessel injury, and direct visual examination of the trocar search engines like Google, MSN, and Yahoo, etc. The
8,9
insertion sites after trocar removal. In SPLS, an ancillary search terms were used for multiple incisions and single
port does not need to be placed on the abdomen. Therefore, incision laparoscopic hysterectomy. Citations found in
epigastric vessel injury might be reduced. Second, the single- selected papers were screened for further references. Criteria
port approach through the umbilicus might offer better for selection of literature were the number of cases (excluded
cosmetic results in our subjective opinion. if less than 20), methods of analysis (statistical or non-
A 1.2 cm vertical intraumbilical skin incision caused statistical), operative procedure (only universally accepted
little scarring. Third, using SPLS seems to reduce the procedures were selected) and the institution where the
postoperative pain that results from skin incisions and study was done (specialized institution for laparoscopy were
penetrating muscles and fascia with assistant trocars. given more preference).

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JAYPEE