Scarless abdominal surgery – A Reality!!

A thirty-year old lady was referred to the casualty with sudden onset lower abdominal pain since one day. She underwent an ultrasound examination which indicated appendicitis. Following examination and blood tests, the diagnosis was confirmed and was advised surgery.

Appendicectomy can be done by open surgery technique or by laparoscopic technique. Over the last decade, laparoscopic surgery has become the accepted standard of care whenever feasible. Even in laparoscopy, the recent advance has been the advent of “Single Incision Laparoscopic Surgery” (SILS).

Dr Vijaykumar Malladi – a Fellowship trained laparoscopic surgeon who works at Fortis Hiranandani Hospital, Vashi and at MITR Hospital, Kharghar; performed the surgery at Hiranandani hospital, Vashi. He was assisted by Dr. A.K.Singal and Dr. Lovina Bhatia and operation theatre personnel. The surgery was finished uneventfully within one hour and the patient is now ready to go home.

SILS is a technically advanced laparoscopic procedure. Conventional laparoscopic surgery involves making 3-4 cuts to put in the telescope and instruments to perform the surgery. In SILS, a specially designed port helps to accommodate the telescope as well as the laparoscopic instruments. A single port typically costs upwards of 15000Rs and is to be used for one surgery only (one time use). Dr Malladi has innovated a silicon based single port, which is available for 2500Rs. At the end of surgery, as the incision gets buried inside the umbilicus, there is no scar visible after surgery. The other advantages include faster recovery and lesser post-operative pain. With advances in technology, this newer form of laparoscopic surgery is performed by only one incision. There are many ways this surgery is being performed. This lady underwent a SILS by a single incision through the navel. Currently, various procedures are being performed by this newer technique including removal of gallbladder (cholecystectomy), appendix (appendicectomy), hernia repair & diagnostic laparoscopy. In the future, more advanced laparoscopic surgeries may also be feasible with advances in technology and improved instrumentation becoming available.

Presently, SILS is offered after very careful assessment of patients. The possibility of conversion to conventional laparoscopic surgery is also explained before the procedure. SILS is better avoided in patients who have undergone multiple prior abdominal operations, who are very obese and those with acute diseases like gangrenous gallbladder or with pus collections. Lastly, issues related to SILS, including conversion to conventional laparoscopy or open surgery are discussed with patient and his / her relatives. The decision for conversion is made by surgeon using his sound judgment for patient safety.