Gasless Laparoscopic Surgery SINGLE INCISION APPENDICECTOMY Course content is available at http://mdcurrent.in/courses/

Most common abdominal emergency operation APPENDICECTOMY This template can be used as a starter file for presenting training materials in a group setting. Sections Right-click on a slide to add sections. Sections can help to organize your slides or facilitate collaboration between multiple authors. Notes Use the Notes section for delivery notes or to provide additional details for the audience. View these notes in Presentation View during your presentation. Keep in mind the font size (important for accessibility, visibility, videotaping, and online production) Coordinated colors Pay particular attention to the graphs, charts, and text boxes. Consider that attendees will print in black and white or grayscale. Run a test print to make sure your colors work when printed in pure black and white and grayscale. Graphics, tables, and graphs Keep it simple: If possible, use consistent, non-distracting styles and colors. Label all graphs and tables. Most common abdominal emergency operation

Advantages of SILS Almost invisible scar Reduced trauma Improved patient satisfaction

Microsoft Engineering Excellence Progress of SILS Single special ports One incision and 3 ports Single incision over appendix Microsoft Confidential

Problems with SILS Appendicectomies Technically very challenging even for surgeons with SILS experience

Disadvantages of SILS Steep learning, as instruments are held with unfamiliar hands Cluttering of hand instruments This is another option for an Overview slides using transitions.

Bryon F et al. Study Technically more difficult Previous SILS experience helpful but not LAP experience

Rules of LS broken for SILS Triangulation Crowding of instruments Baseball diamond concept of port placement

Disadvantages of SILS Expensive Steep learning curve Simple tasks are made difficult This is another option for an Overview slides using transitions.

Attempts of cost reduction for SILS Improvised ports

The advantages of Lift laparoscopy SILS No special ports Conventional instruments Easier learning

Position of the patient Head down Table rotated so that the right side is up A sand bag could be placed under the right gluteal region

Umbilical opening Two towels clips are used for holding the lower edge of umbilicus as shown in the figure. They are held up and an incision is made towards the half near the umbilicus. The upper portion of the umbilicus is held with the towel clip and S shaped retractors are used for retraction while deepening the incision This is another option for an Overview slides using transitions.

Holding the Appendix Long Kelly clamp Port closure needle Suspensorary sutures Special SILS instruments This is another option for an Overview slides using transitions.

The procedure Energy source to divide the mesentry Usual knotting with pusher

Advantages of LLS The size of the incision is much smaller There is no need for trocars The edges of the incision could be stretched The instruments could be passed one at a time Add a case study or class simulation to encourage discussion and apply lessons.

Advantages Less pain after surgery Shoulder pain is not present Less pain medication needed Faster post-operative recovery period Surgery is more precise and safer Less risk of infection Add a case study or class simulation to encourage discussion and apply lessons.

Advantages Surgery could be performed under regional anesthesia Less expensive More cosmetic scars No complications of blind insertions Add a case study or class simulation to encourage discussion and apply lessons.

Advantage of LLS to the Hospitals Regional anesthesia => less expense 1 Less capital and Maintenance expenses 2 Less disposables used and hence less charges 3 This is another option for an Overview slide.

Advantage of LLS to the Hospitals Cleaning is simpler 4 Autoclaving less expensive 5 Total cost to patient & hospital much less 6 This is another option for an Overview slide.

Summary Gas less single incision laparoscopic appendicectomy is a simple procedure that surgeons learning the art of gas less laparoscopic surgery could start with. It is far simpler to learn when compared to the standard laparoscopic single incision laparoscopic surgeries.