Single-incision laparoscopic surgery (SILS) is an advanced, minimally invasive (keyhole) procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's umbilicus (

navel The navel (clinically known as the umbilicus; : umbilici or umbilicuses; also known as the belly button or tummy button) is a protruding, flat, or hollowed area on the abdomen at the attachment site of the umbilical cord. Structure The u ...

). Special articulating instruments and access ports eliminate the need to place trochars externally for triangulation, thus allowing the creation of a small, solitary portal of entry into the abdomen. SILS has been used for several common surgical procedures including

hernia A hernia (: hernias or herniae, from Latin, meaning 'rupture') is the abnormal exit of tissue or an organ (anatomy), organ, such as the bowel, through the wall of the cavity in which it normally resides. The term is also used for the normal Devel ...

repair, cholecystectomy and

nephrectomy A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant pro ...

. The SILS technique has also been used in weight-loss surgery for both sleeve gastrectomy and – more recently – for

laparoscopic Laparoscopy () is an operation performed in the abdomen or human pelvis, pelvis using small Surgical incision, incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few ...

adjustable gastric banding (LAGB). __TOC__

The adjustable gastric band

The development of the

adjustable gastric band A laparoscopic adjustable gastric band, commonly called a lap-band, A band, or LAGB, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to decrease food consumption. Adjustable gastric band s ...

in the mid-1980s was a watershed in the treatment of

obesity Obesity is a medical condition, considered by multiple organizations to be a disease, in which excess Adipose tissue, body fat has accumulated to such an extent that it can potentially have negative effects on health. People are classifi ...

. The father of the gastric band is generally agreed to have been

Lubomyr Kuzmak Lubomyr Kuzmak (born August 2, 1929) was a pioneer within the Bariatric surgery, bariatric surgical community inventing the Adjustable gastric band, adjustable silicone band. Education and the early years Lubomyr Kuzmak was born August 2, 1929, ...

(1929–2006), a Ukrainian born surgeon who had emigrated to the US in 1965. In 1986, Kuzmak reported on the clinical use of the “adjustable silicone gastric band” (ASGB) via open surgery. The next major step was the advent of laparoscopic (keyhole) surgery in the late1980s, which represented a revolution in

abdominal surgery The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, liver, e ...

. The original Kuzmak ASGB was unsuitable for laparoscopic implantation and underwent extensive modification, eventually emerging as the modern LAP-BAND. The first laparoscopic implantation of the LAP-BAND was performed by Belachew and Favretti in September 1993 and since then, approximately 400,000 implants have been performed worldwide. Until now, the laparoscopic technique required 5 incisions (4 × 5 mm and 1 × 5 mm), with visible scars. SILS is the next logical step in the progression of laparoscopic surgery and offers the prospect of one incision with no visible scars. In the case of adjustable gastric banding, most SILS implants to date have utilized a 4 cm incision below the patient's left rib. However, other surgeons have been able to locate a single incision in the umbilicus – trans-umbilical gastric banding – which leaves no visible scar on the external

abdominal wall In anatomy, the abdominal wall represents the boundaries of the abdominal cavity. The abdominal wall is split into the anterolateral and posterior walls. There is a common set of layers covering and forming all the walls: the deepest being the vi ...

. On February 14, 2009, the UK's first SILS implantation of a gastric band was performed by the pioneering surgeon Professor Franco Favretti and his Healthier Weight team. The patient, a 50-year-old female, received a gastric band (LAP-BAND) implanted through the umbilicus. The patient made an excellent recovery and was discharged the following day. Post-operative review at 8-weeks confirmed excellent weight loss with no visible evidence of the previous surgery.

Benefits of SILS gastric banding

While the technique is in the early stages of development, it is clear that a SILS approach to gastric banding offers a number of attractive benefits, including: * Reduced risk of wound infection (1 wound versus 5) * Less post-operative pain and reduced use of medication * More rapid mobilization and recovery * No visible scars

References

{{DEFAULTSORT:Sils Gastric Banding Surgical procedures and techniques