Page 17 - Journal of World Association of Laparoscopic Surgeons

ORIGINAL ARTICLE
Study of Feasibility of Single Incision Laparoscopic Surgery

with Conventional Instruments

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Pankajkumar J Zanwar , Jitendra T Sankpal , Mukund B Tayade , Ajay H Bhandarwar , Shubham D Gupta , Jasmine
R Agarwal 6
AbstrAct
Aim: To evaluate the feasibility and safety of single incision laparoscopic surgery using conventional laparoscopy instrument set.
Materials and methods: Patients admitted in General Surgery Department of Gokuldas Tejpal Hospital, affiliated to Sir Jamshedjee Jeejeebhoy
Group of Hospitals, Mumbai, during January 2015 to June 2016 for appendicitis and symptomatic gallstone disease were included in study.
Forty cases were enrolled in study and prospective observational study was performed.
Results: Total 40 cases included, 21 cases of appendicitis and 19 cases of symptomatic cholelithiasis. Mean age of appendectomy group was
28.71 ± 9.69 years and mean age of cholecystectomy group was 36.71 ± 10.48 years. In our study, mean operative time for single-incision
laparoscopic (SIL) appendectomy was 42.04 ± 5.74 minutes. Postoperative fever was noted in three cases (14.25%). Mean postoperative pain
as per visual analog scale (VAS) score taken after 24 hours on POD 2 was 2.14. Average postoperative stay in hospital was 2.14 days, and port-
site infection occurred in one case (4.17%). Patient satisfaction score obtained on the scale of 1–10 on 1-month follow-up was 7.95, while scar
cosmesis score was 7.9. In our study, 19 cases underwent SIL cholecystectomy, of which 7 were male (36.8%) and 12 were female (41.2%), and
mean age of patients was 36.71 years. Mean operative time in our study was 75.21 min, mean postoperative pain taken on POD 2 as per VAS
score was 2.91, mean postoperative hospital stay was 2.1 days, and port-site infections occurred in 2 cases. Postoperative fever was noted in 2
cases, and postoperative patient satisfaction score obtained at 1-month follow-up was 7.73 and scar score of 7.84 on the scale of 0–10. No case
required drain placement and conversion.
Conclusion: single-incision laparoscopic surgery (SILS) can be performed using conventional laparoscopic instruments, though it has more
operative time, comparable postoperative hospital stay, causes less pain, and has significantly more patient satisfaction regarding postoperative
scar and cosmesis.
Clinical significance: Since SILS has more patient acceptance and satisfaction, it can be offered to all patients undergoing laparoscopic surgery,
irrespective of unavailability of special instruments and financial constraints, as it can be performed using conventional laparoscopic instruments.
Keywords: Laparoscopy instrument set, Single incision laparoscopic surgery, Visual analog scale.
World Journal of Laparoscopic Surgery (2019): 10.5005/jp-journals-10033-1365

IntroductIon
1–6 Department of General Surgery, Grant Medical College and Sir JJ
Since the introduction of laparoscopy in surgical practice, it has
evolved over the years from diagnostic laparoscopy to advanced Group of Hospitals, Mumbai, Maharashtra, India
form and many complicated surgeries are now being performed Corresponding Author: Pankajkumar J Zanwar, Department of
laparoscopically. Laparoscopic procedures are now considered General Surgery, Grant Medical College and Sir JJ Group of Hospitals,
as gold standard in surgical practice for common surgeries like Mumbai, Maharashtra, India, Phone: +91 9975483248, e-mail: pankaj_
zanwar@yahoo.com
cholecystectomy, appendectomy, and diagnostic laparoscopy, etc.
The field of minimal invasive surgery has experienced an How to cite this article: Zanwar PJ, Sankpal JT, Tayade MB, et al. Study of
explosive growth in the last two decades. Though the art of Feasibility of Single Incision Laparoscopic Surgery with Conventional
Instruments. World J Lap Surg 2019;12(1):15–18.
surgery has gone through a complete evolutionary process due
to antisepsis, antibiotics, anesthesia, and concept of aseptic Source of support: Nil
surgery spread over centuries, the field of laparoscopic surgery has Conflict of interest: None
witnessed major changes only in recent past.
The introduction of minimally invasive surgery has drastically techniques representing scar less surgery are trans-umbilical
changed the way in which surgeons treat the patients. Initially they single-incision laparoscopic surgery (SILS) and natural orifice
relied on their direct senses like vision and touch to diagnose the transluminal endoscopic surgery (NOTES). 1
diseases, monitor the condition of patients, and perform invasive SILS has received increasing attention in recent years. In
procedures, but now minimal access surgery has changed the entire abdominal surgery, it is an area targeted for intensive investigations.
scenario. Modern surgical methods are aimed at giving cure along Laparoendoscopic single site surgery (LESS), one-port umbilical
with using minimally invasive techniques, with the patient’s safety surgery (OPUS), and single-port access surgery (SPA) are
never compromised. synonymous with that of SILS. 2
During the era of laparoscopic surgery, common trend has Several operations have thus been until now performed
been toward less invasive techniques and a natural extension of the by SILS technique including cholecystectomy, appendectomy,
trend is to perform operations without scars. The most prominent splenectomy, and sleeve gastrectomy and many more. Many studies

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