Learning lessons for the future: assessments of demand and benefit are required in addition to training in single incision laparoscopic surgery. Response letter to: Pucher PH, Sodergren MH, Singh P, Darzi A, Parakseva P. Have we learned from lessons of the past? A systematic review of training fo... (original) (raw)
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Single-incision laparoscopic surgery (SILS): Current practice-based concerns
Surgery is a word married to precision, yet the practice of surgery remains an anathema to perfectionist. Pursuit of precision is benchmarked on various indices. ‘Patient-reported outcomes’ have become an acceptable metrics given the substantial progress on the clinical outcome measures. Surgery being a hybrid of science and arts, gives space for creativity culminating into innovations. Laparoscopic surgery has become the most recent licence for surgical innovations. Single-incision laparoscopic surgery (SILS) is an offspring of such innovating zeal. However, it is being viewed as if the surgeon is firing from the patient’s shoulder. Enthused with the success of laparoscopic surgery without any randomized studies, the proponents of SILS display no need for such studies for justifying SILS. Concerns about SILS emanate from the possibility of harm to patient negating the tenet of ‘Primum non nocere’. Surgeons have been known to be vindictive to their peers, hence the most honest criti...
Single Incision Laparoscopic Surgery Development at the Hospital Clinic: Our 4-Year Experience
International Journal of Clinical Medicine, 2015
Background: Single incision laparoscopic surgery (SILS) has still not replaced conventional laparoscopic surgery in many centers because of its special instruments requirements and training needs. In our Institution we introduced SILS procedures in a procedural stepwise manner, with progression to more difficult procedures only allowed if complete proficiency in low-complexity ones is achieved. Methods: We studied the evolution of performed SILS procedures in our Institution from the beginning of the program (mainly appendectomies, cholecystectomies, left adrenalectomies) and the results from these techniques. Results: Among 328 SILS procedures there were 148 appendectomies (24 by suprapubic access), 141 cholecystectomies, 32 left adrenalectomies, 6 diagnostic laparoscopies and 1 resection of Meckel's diverticulum. The majority of appendectomies accounted for non-perforated appendicitis cases and there were no significant differences between transumbilical and suprapubic access groups. In cholecystectomies the majority of patients were elective cases and oral intake could be resumed within the 6 postoperative hours. In left adrenalectomies no conversion to open surgery was required and there were no intraoperative or postoperative complications. Conclusions: Procedural stepwise approach in SILS is a valid, feasible and safe option that can be applied at any institution starting a SILS program.
International journal of surgery (London, England), 2013
Introduction: Single port/incision laparoscopic surgery (SPILS) is a recent innovation in minimally invasive surgery whereby operations are performed through a single point of entry. Despite the relative paucity of clinical data, the procedure is increasingly being used to minimise scarring and pain associated with the multiple entry points of traditional laparoscopic surgery. This study aimed to analyse the awareness, experience and opinions of British surgeons regarding SPILS. Methods: Electronic, 13-item, self-administered, anonymous questionnaire survey distributed via national/regional surgical mailing lists and websites. Results were collated and analysed with SPSS v17.0 for Windows (SPSS, Inc, Chicago, IL). Results: 342 fully completed responses received, including 72 (21%) Consultants and 189 (55%) higher surgical trainees. Overall 330 (96.5%) were aware of SPILS; there was no significant difference in awareness between grades. Only 37% had assisted or performed SPILS procedures. More consultants performed these than trainees (56.3 vs 32.0%, p < 0.05). Operative experience was limited, with only 6% of those undertaking SPILS performing 25 procedures, and 60% performing 5. 61.4% believed SPILS takes longer to perform, and 32.8% believed it has higher complication rate. Factors cited as limiting uptake included: lack of evidence (70%), insufficient training opportunities (78%), incorrect instrumentation (70%), increased cost (62%), and hospital policy (44.5%). Patient preference was considered to have negatively affected SPILS uptake by only 9% of respondents. A greater proportion of trainees (94.6% vs 78.9%) felt there were insufficient SPILS training opportunities (p ¼ 0.001). Conclusions: Although awareness of SPILS is high, operative experience is limited and negative perceptions regarding operating time and complications remain. The findings suggest future uptake relies strongly on the availability of evidence, training, instrumentation and reduced costs. Scientific studies are still awaited to assess effectiveness and provide clinical and economic evaluation.
Our Early Experiences With Single-incision Laparoscopic Surgery
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2010
Background: Most of the laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. Single-incision laparoscopic surgery (SILS) is a new laparoscopic procedure. Herein we would like to present our experiences.
Single-Incision Laparoscopic Surgery and the Necessity for Prospective Evidence
Journal of Laparoendoscopic & Advanced Surgical Techniques, 2010
Laparoscopic surgery has become the standard approach for most thoracic, abdominal, and pelvic procedures in adults and children. We now know that laparoscopy has proven benefits; however, at its introduction, laparoscopy was adopted without appropriate clinical evidence to justify the approach as an alternative to open surgery. In continued efforts to increase the benefits of minimally invasive surgery to their patients, surgeons have innovated new techniques to further decrease the impact of the operation on patients. These innovations range from decreasing the size of ports and instruments to the current group of techniques termed ''scarless'' surgery. In the current era of evidence-based medicine, it is the surgeon's responsibility to prove that the benefits outweigh the risk before new techniques are widely applied to patients. This article seeks to review the history of laparoscopic surgery, apply lessons learned to the evolution of single-incision laparoscopic surgery, and make a statement urging for sound prospective evaluation.
Turkish Journal of Surgery, 2020
Objective: Over the last decade, surgeons have started to think of the ways in which to further reduce the trauma of surgery and improve cosmesis. Consequently, many surgeons have yielded to single incision laparoscopic surgeries (SILS) in order to maximize operative and postoperative outcomes. This study aimed to highlight the feasibility and challenges of different procedures by presenting our data about different fields of abdominal SILS practices with long term follow-up. Material and Methods: We retrospectively analysed an observational cohort of 155 patients who underwent surgery for different indications using the SILS technique. Results: Of the 155 SILS procedures: 75 (48.4%) were cholecystectomies; 22 (14.2%) were splenectomies; 17 (11%) were hernia repairs; 11 (7.1%) were appendectomies; 8 (5.2%) were partial colon resections; 8 (5.2%) were adrenalectomies; 6 (3.8%) were distal pancreatectomy & splenectomies; 3 (1.9%) were subtotal gastrectomies; 3 (1.9%) were partial liver resections; and 2 (1.3%) were Nissen fundoplications. Ten (6.5%) early and 3 (1.9%) late postoperative complications were detected. No mortality or late morbidity (> 30 days) was detected due to SILS procedures. Conclusion: SILS is a feasible technique in experienced hands for specific procedures. Meticulous patient selection is also important for good cosmetic results and outcomes.
Training of Future Surgeons in Minimally Invasive Surgery Needs Intensification: A Multicentre Study
Openventio Publishers, 2018
Introduction The advent of minimally invasive surgery with its many benefits for both patients and surgeons has meant that increasingly more operations are nowadays performed laparoscopically. With the current study, we aim to look at the exposure trainee doctors and in particular first year trainees, currently have in laparoscopic surgery. Materials and Methods A 16-question survey was circulated to the first-year trainee doctor cohort of 13 UK Hospitals. The questionnaire focused on confidence with 5 basic laparoscopic skills, undergraduate teaching and postgraduate teaching. Results A total of 64 responses out of 302 questionnaires sent were returned. Of the respondents, 63.5% had General Surgical placements. General confidence with basic laparoscopic skills was low with only 33% of respondents reporting confidence with these skills, whereas only 25% of respondents received adequate teaching on laparoscopic skills during medical school. At postgraduate level, only 8% of responden...