SINGLE INCISION MULTI-PORT LAPAROSCOPIC SURGERY (SIMPLS), A NOVEL TECHNIQUE IN IRAQ
Keywords:Single Incision laparoscopic Surgery, SILS, Single Incision Multi-port Laparoscopic Surgery
Single incision laparoscopic surgery (SILS) is a natural evolution of minimally invasive surgery (MIS) era.The advent of SILS was in the field of gynecology 1969. The first published report in general surgery appeared in 1992 with appendectomies. The first report of SILS cholecystectomy came in 1997 in a letter to the editor in the British Journal of Surgery by Navarra.Curcillo et al., developed Single Port Access (SPA™) surgery in April 2007 as a novel and innovative platform of minimal access surgery. Saber et al. reported the first series of single-incision laparoscopic SG in 7 patients in 2008. SILS recently becoming an interest of both patients and minimally invasive surgeons. Purposes were esthetic (scarless surgery), minimize parietal trauma, less pain and fast patient postoperative recovery. Despite these advantages, there is a concerned report of complications. Aiming to overcome the SILS complications, this novel technique; Single Incision Multiport Laparoscopic Surgery SIMPLS innovated in Iraq.
To introduce SIMPLS (Single Incision Multiport Laparoscopic Surgery) as a novel technique in Iraq and assess safety, cost, aesthetic and any associated complications. To evaluate its use in some advanced laparoscopic procedures.
Materials and Methods
SIMPLS is a single surgeon prospective study conducted from Aug. 2009- Dec. 2016, in four hospitals in Iraq with the same laparoscopic platforms. Technique tested in different laparoscopic operative procedures on 129 different cases.
Cholecystectomy (n=76), sleeve gastrectomy (n=20), appendectomy (n=9), diagnostic laparoscopy (n=8), hydatid cystectomy liver (n=4), fundoplication (n=4), ovarian cystectomy (n=3), renal cystectomy (n=3), combined sleeve gastrectomy and hiatal hernia repair (n=1), and small bowel tumor(n=1). Time spend initiating ports ranging from 9-12 minutes. No much difficulty or struggle faced using standard laparoscopy instruments. Time spend in procedures noticed to be acceptable and less than SILS. P value couldn’t see any significant difference with SILS. No conversion was reported till today. The cosmetic outcome found to be extremely acceptable by patients.Specific complications and difficulties, one case difficult intra-corporal liver retraction, gall bladder retraction in a severely inflamed gall bladder, bleeding at (angle of His),hematoma and ecchymosis, no port incision infection, and no incisional hernia.
SIMPLS technique is introduced by the author as a novel procedure in IRAQ 2009. Similar technique started few years before in some countries in the word. Benefits of the procedure: technically feasible, reproducible for expert devoted surgeons, shorter time ports initiation, excellent esthetic results, lowest cost, not associated with incisional hernia. I advise wider practice, more trials to confirm these findings and I suggest it for interested experienced minimally invasive surgeons.
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