Notes on Women's Health
Notes on Women's Health

SILS Surgery Provides the Potential for No Visible Scars

For many of my patients, the word “surgery” has a host of associated meanings: long hospital stays, time away from home/family/work, significant pain, lengthy recovery period … and visible scarring. I’m excited to say that scarring will become less of an issue for some of my patients in the next few months, when I will start providing a new service called SILS™.

What is SILS?

An acronym for single incision laparoscopic surgery, SILS made its way onto the medical scene in the late 1990s. You may have heard of by a different name: “belly button surgery”. SILS has risen to the forefront of abdominal surgery in recent years along with the development of related technology. While few physicians have received training so far, SILS is gradually catching on.

What are the advantages of SILS?

With SILS, only one umbilical incision is needed to perform the procedure. Using SILS technology, multiple instruments including the telescope can be placed through the incision. (In standard laparoscopy, the umbilical port is used only for observation through the “telescope”. In order to manipulate tissue and place sutures, standard laparoscopic techniques require the placement of two or three additional abdominal ports/incisions.) Compared to traditional port placement, SILS offers a lower risk of complications and additional postoperative pain.

How does SILS work?

Simply stated, SILS makes surgery less invasive. Instead of a six-inch incision required by traditional surgery (or even the three to four smaller half-inch incisions utilized in standard laparoscopic surgery), SILS surgery is accomplished through a single small incision in the belly button. A specially designed “SILS Port” instrument is then inserted into the abdomen. Soft and flexible, the SILS Port is equipped with three distinct openings which allows for the use of three surgical devices at the same time.

Which operations can be performed with SILS?

The following operations can be performed by SILS:

  • Removal of uterus (hysterectomy)
  • Removal of ovary (oophorectomy)
  • Removal of gallbladder (cholecystectomy)
  • Removal of appendix (appendicectomy)
  • Repair of paraumbilical or incisional hernia
  • Diagnostic laparoscopy with biopsy

As the technique and instrumentation are refined and developed, even more operations will be added to this list.

SILS for hysterectomies and oophorectomies

The SILS procedures I’ll be performing in the next few months will be primarily hysterectomies and oophorectomies. Hysterectomies typically fall into three categories — subtotal, total and radical — all of which can be performed using the SILS technique.

What are the benefits, risks and costs associated with SILS?

The potential benefits of SLS include less scarring, faster recovery and less pain. However, because SILS involves the use of specialized equipment, it is slightly more expensive than traditional laparoscopic surgery. Also, in 5% to 10% of cases, technical difficulties may prevent the operation’s safe completion via SILS. When this happens, I can simply add one or two ports and complete the procedure in the traditional laparoscopic manner. Very rarely, it may be necessary to convert to an open operation. Finally, there are the risks that are associated with the underlying procedure. These issues can all be discussed during your consultation.

Who can undergo SILS surgery?

Not all patients are candidates for the SILS approach. It depends on many factors, including:

  • the size of your liver or gallbladder,
  • your body mass index, and
  • previous surgeries.

Dr. John Garofalo, M.D., is a gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobgyn.com. Dr. Garofalo can be reached for a personal consultation at 203.855.3535.