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Laparascopic Surgery and SILS

What is laparoscopic surgery?

It is known commonly as keyhole surgery. It is often an alternative to ‘open’ surgery. It involves doing most or all part of the operation through multiple small cuts on the abdomen. So instead of a large cut, four or five small cuts (five to twelve millimetre in length) are made on your abdomen into which small plastic tubes (ports) are inserted which facilitate the operation. Carbon dioxide gas is pumped into the abdomen and a telescope and camera helps visualised the inside of the abdomen for surgery. After completion, the diseased bowel is taken out through a small cut on the abdomen.

 

What are the advantages of having keyhole surgery?

  • Less pain after the operation
  • Smaller scars
  • Reduced risk and severity of wound infection.
  • More rapid recovery from surgery meaning quicker return home to normal activities

 

What are the risks of keyhole surgery?

Laparoscopic surgery will only be done if the same quality of surgery can be assured as open surgery. There are many reasons why laparoscopic surgery would be difficult or should not be attempted. Those will be discussed by your surgeon prior to surgery.

Laparoscopic surgery shares most of the same risks associated with open surgery such as injury to other organs in the abdomen including the small intestine, bladder, ureters (tubes draining urine from the kidneys to the bladder) or spleen. The risks will be discussed by the surgeon prior to surgery. You will be asked to make an informed decision and asked to sign a consent form prior to agreeing to surgery.

 

When do you change keyhole surgery to open surgery?

Due to the complexity of the approach, keyhole surgery tends to take a longer time than traditional open surgery but about 90% of operations can still be completed by keyhole technique. In some cases, the operation cannot be completed through keyhole incisions due to issues of safety. Safety is of paramount importance and is the commonest consideration to change the decision to change from keyhole to traditional open surgery. If this does happen, it means that the recovery would be the same as it would be for that for traditional open surgery. This will be discussed with you before your operation.

 

What can you expect after keyhole surgery?

In hospital
After laparoscopic surgery you will find that you are able to resume daily activities sooner because you will feel more comfortable and your recovery will be quicker. The drips and tubes you have been connected to will be removed within the first 48 -72 hours. You will be encouraged to eat and drink and move around as soon as you feel able to do so (some patients do this on the day after surgery). You will likely be part of the Enhanced Recovery programme.

Recovery
Work - if you work, you may return when you feel ready and when your GP says you are fit enough. In the early period you may tire very easily. It is important to gradually increase your activity before going back to work. You may be able to negotiate returning to work part-time if your employer agrees.

Driving - your doctor (GP or hospital consultant) will tell you when it is safe for you to start driving again. You are advised to contact your insurance company and seek advice.

 

What is single-incision laparoscopic surgery (SILS)?

This is a new variation of keyhole surgery. Instead of making multiple cuts in the abdomen, a slightly larger single cut is made and a single port is inserted to gain access to the inside of the abdomen for the operation. The SILS technique is broadly similar to keyhole surgery but some specialised instruments are used in this technique. This technique has been shown to be a suitable alternative to standard laparoscopic surgery. However, it is technically more demanding due to all of the surgical instruments being placed in one smaller incision.

 

What are the advantages of having SILS?

The advantages of SILS are similar to that of traditional keyhole surgery (using multiple tiny cuts). There are many national and international studies currently being undertaken to see if they have any further advantage over the traditional keyhole surgery. It is felt that the advantage are most likely less pain after the operation, lower rates of wound infection, better cosmetic appearance and earlier return to normal activity.

 

What are the risks of SILS?

There are no additional risks to you compared to traditional keyhole surgery.

 

Can I have SILS?

Surgeons who had the necessary training and a dedicated surgical team assisting them are critical to perform (SILS). SILS may not be the right approach for every patient and the surgeon will discuss these matters prior to operation.

Your consultant surgery will be able to answer any further questions you may have about the surgical techniques available to you.