Single incision multiport versus conventional laparoscopic inguinal hernia repair: A matched comparison

Abstract

Background:The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis.Materials and Methods:This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015.Results:Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups.Conclusion:S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month.

Robotic single‐port surgery: Preliminary experience in general surgery

“…The proposed advantages of single-incision over multiport laparoscopy include a reduced risk of wound infection, less postoperative pain, faster recovery, improved cosmesis, and body image. [5][6][7][8][9][10][11] For instance, the multicenter On the contrary, concerns have been raised regarding the steeper learning curve, prolonged operative time, and decreased visualisation/exposure of critical structures. These might result in a higher risk of serious complications such as bile duct injuries.…”

“…To further reduce operative trauma, SILS was developed. The proposed advantages of single‐incision over multiport laparoscopy include a reduced risk of wound infection, less postoperative pain, faster recovery, improved cosmesis, and body image 5–11 . For instance, the multicenter double‐blinded SPOCC‐trial randomized 110 patients to SILS cholecystectomy (SILS‐C) and laparoscopic multiport cholecystectomy (LMC).…”

“…SILS has demonstrated to be a safe and feasible alternative for both cholecystectomies and inguinal hernia repairs 1–5 . Reduced postoperative pain, recovery time, improved cosmesis and body image were some of the reported advantages of SILS when compared to standard multiport laparoscopy 5–11 . However, SILS never achieved large popularity in the surgical community due to technical limitations such as a reduced ability to triangulate, internal and external clashing, and ergonomic discomfort 12 .…”

Comparing clinical outcomes between patients receiving non-absorbable and delayed absorbable sutures for abdominal wound closure after laparotomy

“…1 Surgeons have long struggled to overcome postoperative difficulties related to wound closure using a variety of procedures and suturing materials. 2 Numerous investigations on sealing abdominal fascia with various sutures have been undertaken, but no definitive recommendations for improved results have been given. 3 Numerous considerations must be made while selecting suture, including knot tying, suture handling, cost efficiency, strength, and susceptibility.…”