Page 18 - WJOLS - Laparoscopic Journal

Recent Advances in Laparoscopic Hysterectomy: Journey from Multiple Incision to Single Incision Hysterectomy

use of the laparoscopic procedure in complicated cases like
complicated broad ligament or posterior cervical myoma,
endometrioma, multiple previous laparoscopy, huge uterus,
etc.

OPERATING TIME AND SILS
In almost all the literature, the operating time of SILS were
found to be more than that of multiple incision laparoscopic
hysterectomy. The difference in mean operating time ranged
from 100 minutes (57-155 minutes) in SILS compare to 30
to 90 minutes in multiple incision. The operating time also
depends on the experience of the surgeon and the competence
of their team. 20
Fig. 11: Closure of skin incision In considering operating time, the exact identification of
the timing of the start of the procedure and its conclusion
POSTOPERATIVE PAIN vary. In general, the time should be calculated from the
insertion of first trocar to the end of skin suturing. Cox
It is proved that single incision laparoscopic procedures
cause less or same postoperative pain than their conventional et al defined operating time as the time from incision to wound
10
counterparts. In this study, none of the literature reviewed closure. Tate et al calculated the time as use of anesthesia
11
found which can describe pain score comparison between to the administration of a reversal agent.
SILS and after laparoscopic procedure. Generally, SILS is more time-consuming for the
following reasons:
POSTOPERATIVE RECOVERY AFTER SILS • Triangulation of the instruments
• Time taken due to lack of expertise.
It was seen that the postoperative recovery was similar in
SILS and multiple incision hysterectomy. Although, SILS
is newer procedure and the number of SILS hysterectomy VARIATION IN POSTOPERATIVE
performed by most of the gynecologists are less compare IMMUNITY LEVEL
to multiple incision so further study is require to draw any
conclusion in this regard. All surgery and anesthesia can cause depression of cell-
mediated immunity in the postoperative period, including
SILS AND PORT WOUND INFECTION reduction in the number of circulating lymphocytes,

The risk of wound infection is more in SILS compared to impairment of natural killer cell cytotoxicity, depression of
the multiple incision procedure it should be cautioned that T-cell proliferation, and diminished neutrophil function.
the definition of wound infection varies between studies. Animal and clinical studies have shown that laparoscopic
The reason of more port wound infection is bigger defect surgery impairs a patient’s immune state less than open
in abdominal wall and due to open technique of entry more surgery. Cell-mediated immunity is less impaired after
chances of hematoma and necrosis. Some studies have multiple incision laparoscopic hysterectomy than after single
shown increased incidence of postoperative intra-abdominal incision laparoscopic hysterectomy. The reason is probably
abscess after SILS as compared to and multiple incision the level of Interleukin 6 after SILS is more than that after
hysterectomy. It could be due to difficulty in localizing the multiple incision laparoscopy surgery. 12
hematoma site after SILS.
COST-EFFECTIVENESS OF SILS
SILS IN COMPLICATED CASES OF
HYSTERECTOMY SILS is costlier than multiple incision laparoscopic
Due to the risk of intra-abdominal abscess formation there hysterectomy as the port is costlier and the surgeon has to
is a strong controversy among gynecologists regarding the use the disposable instrument made by standard companies.

World Journal of Laparoscopic Surgery, May-August 2010;3(2):67-74 71