SILS for Gallstones, Mumbai

SILS for Gallstones

Patient Experience

Having a single incision laparoscopic cholecystectomy

Two words describe this procedure the best – ‘pleasant surprise’. How else can one describe it in a layman’s words? Options for me: to undergo an open surgery (cut along the stomach), regular laparoscopy or single…

I am 46-year-old businessperson from Lucknow and have been maintaining a very balanced, exercised and disciplined lifestyle.

I can’t forget the pain on the night of November 2, 2009 at around 2.30 in the night. The pain in my abdomen and back was immense and I was unable to move in any direction whatsoever……

Single incision laparoscopic cholecystectomy (SILC) is a revolutionary new way of performing laparoscopic surgery in which only one small (1.5 – 2 cm) incision is made to carry out an operation.

How is SILC different from traditional laparoscopic surgery?

Over the last decade laparoscopic surgery has replaced open surgery in the treatment of several diseases. In traditional laparoscopic surgery, the abdomen is filled with carbon dioxide gas to create a space for the surgeon to work in. Tubes called ports are then inserted through three to four small cuts, each measuring around ½ – 1 cm. A telescope attached to a camera inserted through one of the ports allows the surgical team to observe a magnified picture of the internal organs on a television screen. The surgeon carries out the surgery with the help of instruments introduced through the ports.

gallstones_1 — Four incisions for insertion of instruments in standard laparoscopic cholecystectomy

gallstones_2 — All instruments passed through one small incision at the umbilicus

In SILC, the surgeon makes only one incision of around 1.5 cm – 2 cm (commonly just below the navel) to allow placement of three thin ports side by side. Else, a specially designed port is inserted into the abdomen; this port carries the telescope as well as the laparoscopic instruments. The surgeon then carries out an operation identical to a traditional laparoscopic one.

How is SILC better for the patients?

As there is only one incision the patient experiences much less pain as compared to traditional laparoscopic surgery and recovers even faster. The small scar of healed incision practically fades away with time. All patients enjoy these benefits, but SILC is of particularly great cosmetic value to ladies (as most would prefer to have as few scars as possible) and to busy corporate executives who wish to recover rapidly from surgery so as to get back to work.

gallstones_3 — Four scars after standard laparoscopic cholecystectomy

gallstones_4 — Practically invisible scar after single incision laparoscopic cholecystectomy

Can SILC be offered to all patients with gallstones?

The surgeon would assess an individual patient to decide whether or not he / she are a suitable candidate for SILC. SILC may not be applicable to some patients, e.g.

Those who are very obese,
Those who have had multiple previous abdominal operations and
Patients who are likely to have grossly enlarged or thickened diseased organ e.g. an acutely inflamed gallbladder

Traditional laparoscopic surgery, of course, can be offered to all these groups of patients.

What happens if an operation cannot be completed by SILC?

In 5% to 10% patients it may not be possible to complete the operation by SILC due to technical difficulties. The surgeon places one or two additional ports 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.

What happens after SILC?

The patient does experience some amount of pain for about 12 to 24 hours after SILC depending on individual tolerance. Also, some nausea and vomiting is not uncommon in the first 12 hours. Patients are always given medications to relieve the pain and take care of the nausea. Usually, the patient is allowed to drink fluids within 6 to 8 hours of surgery and is able to have meals from the day after surgery. Activity is dependent on how the patient feels, but all patients are encouraged to get up and walk as soon as they are comfortable. Many patients are able to go home the day after surgery and around 20% go home 48 hours later. In general, patients recover completely within 7 to 10 days.

How soon can I resume work?

In our society patients often prefer to take things easy for weeks after any operation because of a fear that they may harm themselves by being active. After a single incision laparoscopic cholecystectomy the recovery is quite rapid. Soon after returning home the patients are allowed all activities they feel comfortable with. Depending on the nature of their job, most patients are able to return to work within ten to fifteen days following a laparoscopic cholecystectomy. Patients with light, desk jobs usually return in a few days while those involved in heavy lifting may require a little more time.

What are the costs involved in SILC?

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