Description

Introduction Single-port laparoscopic surgery, also known as single-incision laparoscopic surgery (SILS), represents a significant advancement in minimally invasive surgical techniques. By utilizing a single entry point, typically at the umbilicus, this approach reduces the number of incisions compared to traditional multi-port laparoscopy. Single-port laparoscopy has been successfully applied to procedures such as cholecystectomy (gallbladder removal), appendectomy (appendix removal), and tubal ligation (female sterilization). This article explores the techniques, benefits, challenges, and outcomes associated with single-port laparoscopic cholecystectomy, appendectomy, and tubal ligation. Single-Port Laparoscopic Cholecystectomy Overview Cholecystectomy, the surgical removal of the gallbladder, is commonly performed to treat gallstones, cholecystitis, or other gallbladder-related conditions. Single-port laparoscopic cholecystectomy involves accessing the abdominal cavity through a single incision, usually 1.5–2.5 cm long, made at the navel. Specialized instruments and a flexible or angled laparoscope are used to navigate the confined space and perform the procedure. Technique 1. Access: A single umbilical incision is made, and a specialized port (e.g., SILS port or multi-channel port) is inserted to accommodate the laparoscope and instruments. 2. Dissection: The gallbladder is carefully dissected from the liver bed, and the cystic duct and artery are clipped and divided. 3. Extraction: The gallbladder is removed through the umbilical incision, leaving a nearly invisible scar. 4. Closure: The incision is closed with absorbable sutures. Benefits - Cosmetic Appeal: The single incision, hidden within the umbilicus, results in minimal visible scarring. - Reduced Pain: Fewer incisions may lead to less postoperative pain compared to multi-port techniques. - Faster Recovery: Patients often experience shorter hospital stays and quicker return to normal activities. Challenges - Technical Difficulty: The limited working space and instrument crowding can make the procedure more complex, requiring advanced surgical skills. - Learning Curve: Surgeons need specialized training to master single-port techniques. - Operative Time: Single-port cholecystectomy may take longer than multi-port procedures, particularly during the surgeon’s learning phase. Outcomes Studies indicate that single-port cholecystectomy is safe and effective, with complication rates comparable to traditional laparoscopy (e.g., bile duct injury rates of <1%). Patient satisfaction is high due to the cosmetic benefits, though operative times may be slightly longer (approximately 60–90 minutes vs. 45–60 minutes for multi-port). Single-Port Laparoscopic Appendectomy Overview Appendectomy, the removal of the appendix, is typically performed to treat acute appendicitis. Single-port laparoscopic appendectomy uses a single umbilical incision to access and remove the inflamed appendix, offering a minimally invasive alternative to open surgery or multi-port laparoscopy. Technique 1. Access: A single incision is made at the umbilicus, and a multi-channel port is inserted. 2. Identification: The appendix is located using a laparoscope, and surrounding tissues are carefully mobilized. 3. Removal: The appendix is ligated at its base, divided, and extracted through the umbilical port. 4. Closure: The incision is closed, leaving a minimal scar. Benefits - Minimal Scarring: The single incision enhances cosmetic outcomes, which is particularly appealing to younger patients. - Lower Infection Risk: Fewer incisions may reduce the risk of surgical site infections. - Outpatient Potential: Many patients can be discharged on the same day, depending on the severity of appendicitis. Challenges - Anatomical Variations: The appendix’s variable position can complicate single-port access. - Instrument Clashing: The confined space increases the risk of instrument interference, requiring precise coordination. - Complex Cases: Perforated or gangrenous appendicitis may necessitate conversion to multi-port or open surgery. Conclusion Single-port laparoscopic cholecystectomy, appendectomy, and tubal ligation offer compelling benefits, including improved cosmetic outcomes, reduced postoperative pain, and faster recovery. While technical challenges and a steeper learning curve exist, the procedures are safe and effective in the hands of skilled surgeons. As technology advances and surgeon expertise grows, single-port laparoscopy is poised to become a cornerstone of minimally invasive surgery, delivering enhanced patient satisfaction and clinical outcomes.