Our Summary

This research paper reviews a type of surgery called Single-incision laparoscopic surgery (SILS) that only needs one small cut to operate, which was developed in the 1990s. It’s been popular for simple operations like gall bladder removal, but hasn’t been used much for complex surgeries involving the liver, pancreas, and bile duct (collectively known as hepatopancreatobiliary or HPB surgeries) due to concerns about the effectiveness of the tools, the cost, and safety.

However, the paper mentions that advanced laparoscopic HPB surgeries have been found to be as safe for patients as traditional open surgeries for conditions like liver, pancreas, and pancreaticoduodenectomy (which is a major surgery to remove part of the pancreas and other organs).

But for these complex HPB surgeries, SILS has only been used in a few minor cases. In fact, there haven’t been any reported cases of using SILS for a pancreaticoduodenectomy.

The paper also shares the authors’ own experiences using SILS for HPB surgeries over three years, focusing specifically on the technical details of how these surgeries are performed.

FAQs

  1. What is Single-incision laparoscopic surgery (SILS) and when was it introduced?
  2. What are the challenges faced in the application of SILS in complicated hepatopancreatobiliary surgeries?
  3. Has Single-incision laparoscopic pancreaticoduodenectomy been reported in any cases?

Doctor’s Tip

A doctor might tell a patient considering laparoscopic surgery to expect a quicker recovery time, less pain, and smaller scars compared to traditional open surgery. It is important to follow post-operative care instructions carefully to ensure a successful recovery.

Suitable For

Patients who are typically recommended laparoscopic surgery include those who require minimally invasive abdominal surgery for conditions such as cholecystectomies, minor liver resections, distal pancreatectomies, and pancreaticoduodenectomies. Patients with hepatopancreatobiliary (HPB) cancer may also be recommended for laparoscopic surgery, although advanced laparoscopic HPB surgeries for malignancy are still relatively uncommon and may be limited by technical and safety concerns. Overall, laparoscopic surgery may be recommended for patients who can benefit from the potential advantages of minimally invasive surgery, such as reduced pain, shorter recovery times, and improved cosmetic outcomes.

Timeline

Before laparoscopic surgery:

  1. Patient consults with a surgeon to discuss the need for surgery and the potential benefits of laparoscopic surgery.
  2. Patient undergoes pre-operative tests and evaluations to ensure they are a suitable candidate for laparoscopic surgery.
  3. Patient receives instructions on how to prepare for the surgery, including fasting and medication guidelines.

During laparoscopic surgery:

  1. Patient is administered anesthesia to ensure they are comfortable and pain-free during the procedure.
  2. Surgeon makes a small incision in the abdomen and inserts a laparoscope (a thin tube with a camera) to view the internal organs.
  3. Surgical instruments are inserted through additional small incisions to perform the necessary procedure, such as gallbladder removal or tumor resection.
  4. Surgeon carefully performs the surgery while monitoring the patient’s vital signs and overall well-being.

After laparoscopic surgery:

  1. Patient is monitored in the recovery room to ensure they are stable and waking up from anesthesia properly.
  2. Patient may experience some pain or discomfort at the incision sites, which can be managed with medication.
  3. Patient is instructed on post-operative care, including wound care, activity restrictions, and follow-up appointments.
  4. Patient may experience a faster recovery and shorter hospital stay compared to traditional open surgery due to the minimally invasive nature of laparoscopic surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with laparoscopic surgery compared to traditional open surgery for my specific condition?
  2. How experienced are you in performing laparoscopic surgery for hepatopancreatobiliary (HPB) cancers?
  3. What are the potential benefits of laparoscopic surgery for my HPB cancer compared to traditional open surgery?
  4. Will I have a shorter recovery time and less pain with laparoscopic surgery?
  5. Are there any specific pre-operative preparations or restrictions I should be aware of for laparoscopic surgery?
  6. How long will the surgery take and how long will I need to stay in the hospital afterwards?
  7. Will I have a scar after the surgery and if so, how big will it be?
  8. What is your success rate with laparoscopic surgery for HPB cancers?
  9. Are there any long-term effects or considerations I should be aware of with laparoscopic surgery for HPB cancers?
  10. Do you recommend any specific follow-up care or monitoring after laparoscopic surgery for HPB cancers?

Reference

Authors: Chuang SH, Chuang SC. Journal: World J Gastroenterol. 2022 Jul 21;28(27):3359-3369. doi: 10.3748/wjg.v28.i27.3359. PMID: 36158268