1. Gasless Laparoscopic Surgery
SINGLE INCISION APPENDICECTOMY
Course content is available at

2. Most common abdominal emergency operation
APPENDICECTOMY
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Most common abdominal emergency operation

3. Advantages of SILS Almost invisible scar Reduced trauma
Improved patient satisfaction

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

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

6. 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.

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

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

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

10. Attempts of cost reduction for SILS
Improvised ports

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

12. 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

13. 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
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14. Holding the Appendix Long Kelly clamp Port closure needle
Suspensorary sutures
Special SILS instruments
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15. The procedure Energy source to divide the mesentry
Usual knotting with pusher

16. 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
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17. 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
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18. Advantages Surgery could be performed under regional anesthesia
Less expensive
More cosmetic scars
No complications of blind insertions
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19. 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
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20. Advantage of LLS to the Hospitals
Cleaning is simpler 4
Autoclaving less expensive 5
Total cost to patient & hospital much less 6
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21. 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.