SILS

What is Single Incision Laparoscopic Surgery?


During laparoscopic operations the surgeon makes a small (about 1-cm) incision and places a short tube called a cannula through the abdominal wall. This cannula is connected to a special pump that pumps carbon dioxide gas. As the abdomen gets filled up with the gas, the abdominal wall is lifted up, thus providing the surgeon a space to work in. To look inside the abdomen, the surgeon passes a rod-like telescope through the cannula. The telescope is connected to a miniature video camera that picks up the picture of the inside of the abdomen and transmits it to a television screen. The surgeon then carries out the operation with the help of special, long instruments introduced inside the abdomen through other cannulas and by observing the picture of the operative site on the television screen. It is important to appreciate that the actual laparoscopic operation being carried out is more or less identical to the open procedure. The major difference is that the steps are performed with the help of specialised equipment and therefore can be carried out through small incisions.

In single incision laparoscopic surgery (SILS) only one incision of around 1.5 – 2cm is made at the umbilicus and the telescope as well as all the instruments are passed through that. There are two ways of performing SILS. Either the surgeon uses a specialised access device (access port) through which the telescopes as well as specialised roticulating instruments are passed inside the abdomen. These devices, however, are disposable and add substantially to the cost of SILS.

SILS using a specialized access device

Single-incision, multi-port approach for SILS

An alternate approach (which we prefer) is to pass multiple cannulas or tubes side-by-side through the same incision and introduce standard laparoscopic instruments through these cannulas. It is possible to perform many of the operations done by standard laparoscopic surgery using this “single-incision, multi-port” approach in a cost effective manner.

SILS cholecystectomy (removal of the gallbladder)
SILS appendectomy (removal of the appendix)
SILS excision of diseased small bowel
SILS oophorectomy or ovarian cystectomy (removal of ovary or ovarian cyst)

The operations that are currently performed using the SILS approach include:

In 5% to 10% patients it may not be possible to complete the operation by SILS due to technical difficulties. The surgeon places one or two additional cannulas and completes the procedure in the traditional laparoscopic manner. Very rarely, it may be necessary to convert to an open operation. Both these issues are always discussed with patients prior to surgery and they are made aware that conversion to traditional laparoscopy or indeed to open surgery merely represents a sound judgment on part of the surgeon in the interest of patient safety.

Using innovative techniques and indigenous instruments Dr Bhandarkar now offers his patients SILS at exactly the same cost as traditional laparoscopic surgery. So the patients can enjoy the benefits of this revolutionary surgery at no extra expense.

An almost invisible scar after a SILS operation

Less pain from the single, short incision after surgery
Shorter hospital stay
Shorter recovery time
Faster return to normal diet
Faster return to work or normal activity
Better cosmetic healing (almost invisible scar)

Dr Bhandarkar is a pioneer in the field of single incision laparoscopic surgery and has written several articles on SILS. He lectures extensively on the subject and trains other surgeons in this technique.

Publications and abstracts

  1. Bhandarkar DS, Katara AN, Mittal G, Udwadia TE. Single incision laparoscopic bilateral oophorectomy. J Minim Access Surg. 2011;7:87-9.
  2. Bhandarkar DS, Mittal G, Shah RS, Katara AN, Udwadia TE. Single incision laparoscopic cholecystectomy: how I do it? J Minimal Access Surg. 2011;7:17-23.
  3. Bhandarkar DS. Single incision laparoscopic cholecystectomy: a revolutionary surgical advance. The Ind Pract 2011;64:417-420.
  4. Bhandarkar DS, Katara A, Mittal G, Udwadia TE. Smoke evacuation in single incision laparoscopic surgery (Letter). Surg Endosc 2012; 26: 882-883.
  5. Mittal G, Bhandarkar DS, Katara A, Gandhi A. Single incision laparoscopic retrieval of migrated intrauterine contraceptive device. J Gynecol Surg 2012:28:64-66
  6. Behera R, Salgaonkar H, Bhandarkar DS, Gupta T, Desai S. Laparo-endoscopic single-site laparoscopic cholecystectomy in a pregnant woman. J Min Access Surg 2013;9:183-186.
  7. Bhandarkar D, Mittal G, Katara AN, Behera RR. Laparo-endoscopic single-site left adrenalectomy using conventional ports and instruments. Urology Annals (In print).

Book chapters

  1. Bhandarkar DS. Single incision laparoscopic surgery. In Comprehensive laparoscopic surgery. 2nd Edition. Deshpande SV, Dalvi AN, Bhandarkar DS,Deshpande AA, Thaper PM. (Editors). 2012.
  2. Bhandarkar DS. Laparo-endoscopic single-site surgery. In, Clinical GI Surgery. Ed. Haribhakti S 2012 (In print).

Presentations, invited lectures & videos

  1. Bhandarkar DS, Mittal G, Katara A, Udwadia TE. Single incision laparoscopic surgery – preliminary experience. Mid Annual Research Day of Hinduja Hospital, Mumbai, 2009.
  2. Bhandarkar DS. Single incision laparoscopic cholecystectomy using conventional instruments. CME Session, ASICON 2009, Coimbatore, 2009.
  3. Bhandarkar DS. Single incision laparoscopic surgery. GPA CME, Mumbai 2010.
  4. Bhandarkar DS. Single incision laparoscopic surgery – specialised or conventional instruments? Just Controversies, Mumbai 2010.
  5. Bhandarkar DS. Single incision laparoscopic cholecystectomy. Annual Conference of the International College of Surgeons – Indian Section, Amritsar, 2009.
  6. Bhandarkar DS, Mittal A, Shah RS, Katara A, Udwadia TE. Laparo-endoscopic single-site cholecystectomy using the puppeteer technique: comparison of acute and non-acute cases. ELSA 2011, Singapore, 2011.
  7. Bhandarkar DS, Behera RR, Shah R, Katara AN, Udwadia TE. Single-surgeon experience of 225 laparo-endoscopic single-site cholecystectomy using conventional instruments. AMESCON 2012, Dubai, 2012.
  8. Bhandarkar DS. Single incision laparoscopic surgery. 12th FIAGES Course, Ooty, 2011.
  9. Bhandarkar DS. Single incision laparoscopic surgery. 13th FIAGES Course, Ahmedabad, 2011.
  10. Bhandarkar DS. Single incision laparoscopic surgery – a revolution. CME of Deccan Surgical Society. Karad, 2011.
  11. Bhandarkar DS. Reduced port surgery. 14th FIAGES Course, Mumbai, 2011
  12. Bhandarkar DS. Single incision laparoscopic surgery. 17th FIAGES course, Gurgaon, 2011.
  13. Bhandarkar DS. Single incision laparoscopic surgery for the beginners. 19th AMASI Skills Course, Aurangabad, 2011.
  14. Bhandarkar DS. Reduced port laparoscopic surgery, mini-laparoscopy and single incision laparoscopic surgery: assessing the evidence. Reduced Port Surgery Live Operative Workshop and CME, Delhi, 2011.
  15. Bhandarkar DS. Single incision laparoscopic surgery. 18th FIAGES Course, Bhubaneswar, 2011.
  16. Bhandarkar DS. Errors and complications in single incision laparoscopic surgery. FLIP11SIL Conference, Mahabalipuram, 2011.
  17. Bhandarkar DS. Single incision laparoscopic surgery. 20th FIAGES Course, Lucknow, 2011.
  18. Bhandarkar DS. Single incision laparoscopic cholecystectomy: why, when and how? BILICON 2011, Mumbai, 2011.
  19. Bhandarkar DS. Single incision laparosocpic surgery – basics, difficulties and complications. First Fellowship Course in Advanced Laparoscopic Surgery, Indore, 2012.
  20. Bhandarkar DS. Errors and complications in single incision laparoscopic surgery – prevention and management. IAGES 2012, Ahmedabad, 2012.
  21. Bhandarkar DS. Single incision laparoscopic cholecystectomy – overcoming challeges. IAGES 2012, Ahmedabad, 2012.
  22. Bhandarkar DS, Mittal G, Katara A, Udwadia TE. Single incision laparoscopic cholecystectomy: Master Video. Annual Conference of Indian Association of Surgical Gastroenterology, Mumbai, 2009.
  23. Bhandarkar DS, Mittal G, Katara AN, Udwadia TE. Single incision bilateral laparoscopic oophorectomy. 9th Biennial Congress of IAGES, New Delhi, 2010.
  24. Bhandarkar DS. Single incision laparoscopic adrenalectomy. Annual Conference of IASO, Mumbai, 2010.
  25. Mittal G, Bhandarkar DS, Katara A, Udwadia TE. Laparo-endoscopic single-site left adrenalectomy. MASICON 2011, Mumbai, 2011.
  26. Mittal G, Bhandarkar DS, Katara A, Udwadia TE. Single-incision retrieval of migrated intrauterine contraceptive device. MASICON 2011, Mumbai, 2011.
  27. Bhandarkar DS, Mittal A, Shah RS, Katara A, Udwadia TE. Laparo-endoscopic single-site cholecystectomy using the puppeteer technique: comparison of acute and non-acute cases. ELSA 2011, Singapore, 2011.
  28. Bhandarkar DS, Mittal A, Shah RS, Katara A, Udwadia TE. Laparo-endoscopic single-site cholecystectomy using the puppeteer technique: comparison of acute and non-acute cases. ELSA 2011, Singapore, 2011.
  29. Bhandarkar DS, Mittal G, Katara A, Gandhi A. Single incision reterieval of intrauterine contraceptive device. ELSA2011, Singapore, 2011.
  30. Bhandarkar DS, Mittal G, Katara A, Udwadia TE. Laparo-endoscopic single-site adrenalectomy. ELSA2011, Singapore, 2011.
  31. Bhandarkar DS, Behera RR, Katara AN, Udwadia TE. Laparo-endoscopic single-site left adrenalectomy. AMESCON 2012, Dubai, 2012.
  32. Bhandarkar DS, Behera RR, Shah R, Katara AN, Udwadia TE. Single-surgeon experience of 225 laparo-endoscopic single-site cholecystectomy using conventional instruments. AMESCON 2012, Dubai, 2012.
  33. Behera RR, Bhandarkar DS, Desai D, Joshi A, Katara A, Udwadia TE. Laparo-endoscopic single-site surgery in management of small bowel pathology. IAGES 2012, Ahmedabad, 2012.
  34. Bhandarkar DS. Single incision laparoscopic surgery. Invited Lecture. University of Pecs, Pecs, Hungary, 2012.
  35. Bhandarkar DS. Single incision laparoscopic surgery. Invited Lecture. Continuing Surgical Education Program. Rajkot Surgical Society, Rajkot, 2012.
  36. Bhandarkar DS. Single incision laparoscopic surgery. Invited Lecture. Somaiya Medical College, Mumbai, 2012.
  37. Bhandarkar DS. Single incision laparoscopic cholecystectomy. 23rd FIAGES Course, Aurangabad, 2012.
  38. Bhandarkar DS. Single incision laparoscopic surgery. 24th FIAGES Course, Patna, 2012.
  39. Bhandarkar DS. Reduced port surgery – tips and tricks. Just Innovations, Mumbai, 2012.
  40. Balusamy S, Behera RR, Salgaonkar H, Bhalerao- Gandhi A, Bhandarkar D. Single incision laparoscopic adnexal surgery. Annual Conference of MOGS, Mumbai, 2013.
  41. Salgaonkar H, Balusamy S, Sharma P, Bhalerao- Gandhi A, Bhandarkar D. Laparo-endoscopic single-site adnexal surgery. AMASICON 2013, Indore, 2013. (Best Paper Prize)
  42. Bhandarkar DS, Single incision laparoscopic surgery in the obese – pros and cons. Bariatric Surgery Master Class, Pune, 2013.
  43. Bhandarkar DS. Reduced port surgery – tips and tricks. MASICON 2013, Nasik, 2013.
  44. Bhandarkar DS. Single incision laparoscopic surgery – is there any evidence? NAIMAS, New Delhi, 2013.
  45. Bhandarkar DS. Single incision laparoscopic surgery. 31st FIAGES Course, Pune, 2013.

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