Single Incision Laparoscopic Surgery (SILS)

The initial hype about NOTES is over!

This is such good news that I couldn't resist starting with it. :)

I wrote twice about this topic and not only my opinion didn't change, I noticed that the general perception regarding NOTES is meanwhile clearly negative. Even people who are usually more open to new approaches share this position now.

Surgeons need new challenges though and the Single Incision Laparoscopic Surgery (SILS) is offering some. Recently I was on Grand Rounds where a general surgeon from a private practice shared his thoughts and experience with the auditorium about SILS. I was hoping that he would focus more on review of the (still scarcely) available data. He decided to just present some of his cases though: just cholecystectomies.

Here are my impressions from this talk:

• The problem with the free choice of angle for the instruments ("triangulation") is addressed by developing angulating instruments which are not perfect but do the job for the most part.
• The total length of the single incision is probably the same as the sum of the lengths of the incisions if a conventional laparoscopic approach would have been chosen.
• No difference in postoperative pain and/or management requirements was reported.

Overall I am not sure about the benefit from the SILS other than excitement on the site of the patient having been operated on the bleeding edge of contemporary surgical knowledge. A single but substantially bigger scar on the umbilicus is not necessarily prettier than 3-5 smaller scars distributed over the torso. And the surgeons pay for this by limiting their choice of angle for the instruments and working with generally crappier instruments. The whole thing is very expensive making first steps in surgery but this would admittedly improve with the time.

The most important thought I had was: NOTES should be dying now. SILS might be expensive and have questionable advantages but it does not break basic surgical principles as NOTES does.