Novel 'one-hole' surgery performed at USC
Minimally invasive surgery -- also known as laparoscopic surgery -- transformed medicine when it became popular about 20 years ago. The surgery allows doctors to fix things, or take them out, by inserting a tiny camera and small instruments through three or four small incisions. That's a whole lot better in terms of pain and patient recovery than having a six- or 10-inch incision in your belly.
Now comes a significant advance in laparoscopic surgery called single-incision laparoscopic surgery, or what doctors are calling SILS for short. This procedure involves only one small incision, typically through the belly button, to insert the instruments needed to do the job. The first such surgery was performed last year at Drexel University College of Medicine. Last month, surgeons at the University of Southern California performed the first SILS in the state, removing the gallbladder of a 20-year-old woman. According to the woman's surgeon, Dr. Namir Katkhouda, the patient experienced little discomfort, had a barely noticeable scar and went home two hours after the 45-minute procedure.
Katkhouda, a professor of surgery and chief of the Minimally Invasive Surgery Program at the Keck School of Medicine at USC, thinks single-incision laparoscopic surgery is a terrific advance that will eventually replace traditional laparoscopy. It can be used to remove a gallbladder or appendix, and some surgeons are trying the technique for hernia surgery and benign conditions of the esophagus, and for gynecological needs, such as removal of the uterus or ovaries. Inflamed organs and large masses will still require other surgical methods, he says.
"We are exploring a new world of surgery through one hole," says Katkhouda. "The single-port does limit surgical movement, and so the surgeon needs to be very precise. But as long as it is done in a safe environment with experienced doctors, I think this technique is very promising."
Single-incision laparoscopic surgery may steal a little thunder from advances in another new technique called natural orifice surgery, or NOTES. In NOTES procedures, no incision is needed. Surgeons instead advance their instruments through natural body openings: the mouth, nose, rectum or vagina. NOTES, however, is harder to perform, introduces possible new complications (such as infection) and is still largely experimental, Katkhouda says.
Single-incision laparoscopic surgery still needs to be studied in an academic setting before it becomes widely available. But, he says:
"There is a lot of excitement around SILS because there is no doubt that this will further minimize the invasive nature of surgery. It could replace traditional laparoscopy. I see it happening possibly in the next two years."
-- Shari Roan
Photo: Instruments are inserted through one hole in the belly button in this single-incision laparoscopic surgery to remove a gallbladder. Credit: Courtesy of Keck School of Medicine at USC
