Study of Feasibility of Single Incision Laparoscopic Surgery with Conventional Instruments

Abstract

Aim: To evaluate the feasibility and safety of single incision laparoscopic surgery using conventional laparoscopy instrument set. Materials and methods: Patients admitted in General Surgery Department of Gokuldas Tejpal Hospital, affiliated to Sir Jamshedjee Jeejeebhoy Group of Hospitals, Mumbai, during January 2015 to June 2016 for appendicitis and symptomatic gallstone disease were included in study. Forty cases were enrolled in study and prospective observational study was performed. Results: Total 40 cases included, 21 cases of appendicitis and 19 cases of symptomatic cholelithiasis. Mean age of appendectomy group was 28.71 ± 9.69 years and mean age of cholecystectomy group was 36.71 ± 10.48 years. In our study, mean operative time for single-incision laparoscopic (SIL) appendectomy was 42.04 ± 5.74 minutes. Postoperative fever was noted in three cases (14.25%). Mean postoperative pain as per visual analog scale (VAS) score taken after 24 hours on POD 2 was 2.14. Average postoperative stay in hospital was 2.14 days, and port-site infection occurred in one case (4.17%). Patient satisfaction score obtained on the scale of 1–10 on 1-month follow-up was 7.95, while scar cosmesis score was 7.9. In our study, 19 cases underwent SIL cholecystectomy, of which 7 were male (36.8%) and 12 were female (41.2%), and mean age of patients was 36.71 years. Mean operative time in our study was 75.21 min, mean postoperative pain taken on POD 2 as per VAS score was 2.91, mean postoperative hospital stay was 2.1 days, and port-site infections occurred in 2 cases. Postoperative fever was noted in 2 cases, and postoperative patient satisfaction score obtained at 1-month follow-up was 7.73 and scar score of 7.84 on the scale of 0–10. No case required drain placement and conversion. Conclusion: single-incision laparoscopic surgery (SILS) can be performed using conventional laparoscopic instruments, though it has more operative time, comparable postoperative hospital stay, causes less pain, and has significantly more patient satisfaction regarding postoperative scar and cosmesis. Clinical significance: Since SILS has more patient acceptance and satisfaction, it can be offered to all patients undergoing laparoscopic surgery, irrespective of unavailability of special instruments and financial constraints, as it can be performed using conventional laparoscopic instruments.