Sils
- 1. Single Incision L APAROSCOPIC S URGERY (SILS) C OLORECTAL Resection Nick Rieger Assoc Professor University of Adelaide
- 2. SILS Urology Renal transplant Cholecystectomy Gastric band surgery Colectomy
- 3. SILS
- 4. SILS Colectomy and literature 2 recorded cases Remzi FH , Kirat HT , Kaouk JH , Geisler DP . Single-port laparoscopy in colorectal surgery. Colorectal Dis. 2008 Oct;10(8):823-6. Epub 2008 Aug 5. Bucher P , Pugin F , Morel P . Single port access laparoscopic right hemicolectomy. Int J Colorectal Dis. 2008 Oct;23(10):1013-6. Epub 2008 Jul
- 5. Colectomy ?? HOW Open Incision Laparoscopic assisted Laparoscopic Hand assisted Total laparoscopic SILS Endoscopic submucosal excision NOTES ?? Robotic ??
- 8. Case Experience: Dr Rieger 7 cases from 28/11/2008 until 10/3/2009
- 9. 0/10 T2N0 Caecum 22 74 5 1/7 T2N1 Caecum 25 73 6 21 Benign (2 cm) Ascend 28 60 7 3/16 carcinoid Ileal Liver 2nd 24 69 4 26 Benign (5 cm) Caecum 23 76 3 0/12 T3N0 Splenic 21.5 63 2 0/10 T1N0 Caecum 23 83 1 Nodes Path Tumour BMI Age Patient
- 10. bacteraemia 11 115 5 Nil 4 80 6 Nil 5 88 7 Nil 6 75 4 Nil 4 90 3 Nil 4 75 2 Nil 4 100 1 Complication Stay Op Time Patient
- 11. SILS. Why Bother? Cosmesis Smaller single incision (2.5-4.5 cm) Length of stay ??? Less risk hernia Less risk tumour implantation Stepping stone to NOTES
- 12. SILS: Indications Benign neoplasm of colon Carcinoma of colon (small) Tumour size less than incision (2.5cm) Thin patient
- 13. SILS: Ideal Indications Right sided pathology proximal to the hepatic flexure Left sided pathology distal to the mid-transverse colon and proximal to the sigmoid colon. Small bowel pathology
- 14. SILS: Disadvantages 2 operating ports Instrument clash Loss of tissue triangulation Learning curve of flexible instrumentation No 90 degree staplers for transection rectum
- 16. Operative Considerations Table Anaesthesia Trocars Instruments Anastomosis Oncologic principles
- 17. SILS : Trocars 1 X 5-12mm Bluntport Plus (Covidien,) 2 X 5mm Dexide Threaded Trocar (Covidien)
- 18. SILS : Instruments 30 degree 10 mm camera Roticulator Endo Mini-Shears 5mm (Covidien) Straight non-disposable atraumatic bowel grasper. Alexis® Wound retractor; small. (Applied Medical) Ligasure Advance (Covidien) Vicryl endoloop (Ethicon) DST GIA 80 – 3.8mm stapler and cartridge reload. (Covidien)
- 21. Port site hernia
- 22. SILS: Post Operative Care DVT prophylaxis Opiate Analgesia (PCA or S/C) Oral analgesia Mobilise Day 1 Urine catheter out early (24 hours) Early introduction of fluids (first 24 hours) and diet (second 24 hours if fluids tolerated) IVT out once fluids tolerated
- 23. Conclusions SILS colon resection is feasible. Can be achieved with the same or reduced cost as standard laparoscopic resection. Very specific indications