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Ques: How Is Laparoscopic Cholecystectomy Performed?

Ans: Commonly, laparoscopic cholecystectomy (lap chole) is performed by four cuts (Multi port Cholecystectomy). These are:

  • An 11 mm (½ inch) cut in the belly button. Through this port, a telescope is inserted which projects the pictures of inside of the abdomen on the TV console.
  • Another 11 mm cut (port) in the upper part of the tummy close to the midline. Through this port instruments are used to dissect the gall bladder free from its attachments and clip the duct and artery of the gall bladder.
  • A 6 mm (¼ inch) cut in the upper part of the tummy on the right side.
  • Another 6 mm cut in the right upper abdomen halfway between port no 2 and 3.
  • Through ports number 3 & 4, instruments are used to pull and fix the gall bladder for dissection.

Ques: Why We Need To Improve On Multi Port Surgery?

Ans: Cervical Cancer is often asymptomatic in the early stages. The commonest symptoms are unusual vaginal bleeding (after sex, in-between periods or after menopause) and an unpleasant, smelly or blood-stained vaginal discharge. Other symptoms signalling the later stages of the disease are pain in the lower abdomen, blood in the urine, constipation and weight loss.

Ques: What Is Sils?

Ans: SILS stands for Single Incision Laparoscopic Surgery. In SILS, the number and size of cuts decrease and only one 12 mm cut is made inside the belly button and the entire surgery is performed through this small cut (Fig. 1). This 12 mm cut is not even visible (scarless surgery). In some patients, another small six mm cut may be required in the upper part of the tummy

Ques: What Are The Advantages Of Sils?

Ans:

  • The 12 mm cut is completely hidden inside the belly button and is not visible, significantly improving the cosmetic outcome.
  • The size of the cuts is one third: from two 11 mm and two six mm ports, it is one 12 mm (and sometimes one six mm) port. Cuts made in the fleshy part of the tummy are avoided and there-fore there is significant reduction in pain with faster recovery.
  • The tiny cut does not require any stitch and is approximated with a special glue. There are no marks of a stitch and it saves you from subsequent discomfort of stitch removal.
  • In the four port technique, four or more titanium (metal) clips are used for clipping the duct and the artery of the gall bladder. If CT scan, MRI, X-ray etc is required in future, the clips will interfere by causing artefacts. In SILS, with our technique no metal clips are used and subsequent CT/MRI can be done without any interference or disadvantage.

We make only one 12mm cut in the belly button and therefore, there is no increased chance for hernia formation in our technique.

Ques: Is Sils Applicable In All Cases?

Ans: SILS requires tremendous experience and skill to perform the surgery safely. Our team has perfected the technique and we perform more than 95% of our Gall bladder surgeries by SILS. It may not be suitable for patients who have acute infection or pus in the gall bladder, small contracted or thick walled gall bladder, jaundice, long standing disease, repeated attacks of pain, previous surgery etc. In such situations, (about 5 %), standard four ports may be required to perform lap chole.

Ques: Why Sils Is Not Practiced Commonly In All Centers?

Ans: SILS requires experience and special skills to handle multiple instruments through Single incision which is not easy to acquire. It also requires special inventory of instruments with maintenance cost. Without specialised training and skills it is difficult to perform SILS Chole. We at Fortis Memorial Research Institute, Gurgaon, are doing highest number of SILS Cholecystectomy in the country.

Ques: Is Sils A Uniform Technique?

Ans: SILS is done in many different ways. The most commonly practiced way is to make a 25mm cut in the skin and fascia. This however, increases the risk of subsequent hernia formation. We use a hybrid technique which has been developed by us and is novel to our team. This technique needs only a 12mm cut with no increased risk of hernia formation and causes significantly less pain.

Ques: What are the early symptoms of Cervical Cancer?

Ans: Belly button should be cleaned thoroughly with soap and water using finger for two-three days before surgery to remove any dirt or concretions.

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