Page 18 - Journal of World Association of Laparoscopic Surgeons

Study of Feasibility of Single Incision Laparoscopic Surgery with Conventional Instruments
are done till date to evaluate the feasibility of SILS and all these study 24 hours postoperatively. Analgesics were given if VAS score was >5.
reports have indicated that the SILS technique is safe and feasible in The mean VAS profile on day 1 postoperatively was calculated based
the population undergoing these surgeries and that the operative on the scores. Time to pass flatus was noted, and patients taking
time with this new technique is reasonable. 1 >24 hours after surgery to pass flatus were noted as to have ileus.
This study is performed in a tertiary care institute having Patients having fever more than 99°F were noted. Dressing was
conventional laparoscopic instrument set. Till now in our hospital, not changed unless there is soakage. Patients were discharged from
no study has been conducted to study feasibility of SILS. The hospital as soon as they were adequately mobilized and taking full
purpose of our study was to present our experience with SILS and diet with adequate pain relief.
to evaluate the feasibility and safety of it prospectively. Postoperative hospital stay was measured from the date of
surgery to the date of discharge. Patients were asked to follow-up
on postoperative day 7 at 1 month and 6 months postoperatively.

MAterIAls And Methods Suture removal was on postoperative day 7 in all cases. Time to
Setting: Patients admitted in General surgical ward of Gokuldas return to normal activity was noted in all patients. Patients were
Tejpal Hospital, affiliated to Grant Government Medical College and reassessed on all the occasions, and wound infection and port-
Sir JJ Group of hospitals, Mumbai for appendicitis and symptomatic site herniation were checked. During follow-up, all the patients
gallstone disease. in the outpatient clinic, at 1 month after surgery, answered two
Sample size: 40 cases, 21 cases of appendicitis and 19 cases of questions: “How much satisfied with the surgery are you?” and
symptomatic cholelithiasis. “How satisfied are you with the scar of the surgery?” These short
Period of study: January 2015–June 2016. questions pretended to know about the degree of satisfaction
Study design: Prospective observational study. and the surgical scar cosmetic result in terms of score from 0 to
10. In this scale, 0 indicates not satisfied at all and 10 indicate
Inclusion Criteria excellent.
Patients willing to participate in the study, patients more than Responses given by patient were noted in case record sheets.
12 years of age (male and female), elective cholecystectomy and All patients were followed up till 6 months after surgery and were
appendectomy, and fit for general anesthesia. assessed for development of incision related complications like
port-site hernia.
Exclusion Criteria

Patients not willing to participate in the study, patients less than observAtIons And results
12 years of age, acute abdominal emergency, pregnancy, unfit for
general anesthesia and/or pneumoperitoneum, multiple previous The following facts and figures are observed from our study
abdominal surgeries, and any mass suspicious of malignancy (Fig. 1).
Study population included total 40 patients, out of which
21 were cases of appendicitis and 19 were cases of symptomatic

conductIon of study cholelithiasis. Study included 14 male and 26 female patients, out of
Patients were selected for the study after taking careful detailed which appendicitis group consists of 7 males and 14 females while
history, clinical examination, laboratory investigations, and cholelithiasis group included 7 males and 12 females. A maximum
ultrasound examination as described above. The patients eligible number of patients in appendicitis group were from age group
for the study were selected, informed, and explained regarding 21–30 years while cholelithiasis group were 6 cases each in 31–40
the above study and a proper informed, valid, and written consent and 41–50 years of age group.
taken for participation in the trial. Mean age of patients in appendicitis group was 28.71 ± 9.69
Patients were kept nil by mouth after 10 pm the previous day years, while in cholelithiasis group, it was 36.71 ± 10.48 years.
of surgery. Patients were shaved and prepared; and informed, Mean operative time for single-incision laparoscopic (SIL)
valid, and written consent for surgery taken. All patients were appendectomy was 42.04 ± 5.74 minutes, while for SIL chole-
informed preoperatively regarding the possibility of conversion cystectomy, it was 75.21 ± 7.51 minutes.
to conventional multiport laparoscopy or open surgery depending Intraoperative findings were as shown in Table 1.
on intraoperative findings and complications. Proper consent Intraoperative adhesions of small/large bowel or omentum
regarding the same was also taken. were found in 12 cases out of 40 (30%). Hemorrhage was noted
All patients received preoperative dose of antibiotic. Patients in 2 cases out of 40 (20%). In cholecystectomy group, one patient
were operated by experienced laparoscopic surgeons of the had bile leak due to perforation of gallbladder intraoperatively
hospital with experience of >50 SILS procedures done previously. (5.26%). Common bile duct (CBD) injury did not occur in any patient.
All incisions were infiltrated with local anesthetic at the end of the Conversion to conventional multiport laparoscopy was not needed
procedure. in any cases (Tables 2 and 3).
Duration of surgery was measured from the time of incision Postoperative ileus was noted in 7 patients out of which 4 were
to the time of closure. Patients were started on liquid diet on the from appendectomy group and 3 were from cholecystectomy
evening of surgery and full diet on the next morning of surgery. group. Postoperative fever more than 99°F was noted in
All patients were encouraged to mobilize as early as possible. Inj. 5 patients, 3 of which belong to appendectomy group and
Diclofenac sodium 50 mg IM was given as analgesic postoperatively
on demand by the patient as guided by the visual analog scale (VAS)
in which the pain experienced by the patient was graded by the
patient on a scale of 1–10 and recorded every 6 hours for the first Fig. 1: Scale for scar score and patient satisfaction score

16 World Journal of Laparoscopic Surgery, Volume 12 Issue 1 (January–April 2019)