1. Single Incision Laparoscopic (SILS) Surgery Guy Nash

2. Background Traditionally surgeons made big open incisions 1990’s Minimally invasive surgery decrease wound problems In Last years NOTES and SILS decrease number of incisions Dermatomes (wound pain levels) 10 4 2

3. SILS also known as… SPA - Single Port Access NOTUS - Natural Orifice Trans Umbilical Surgery eNOTES – embryological Natural Orifice Surgery TUES - Trans Umbilical Endoscopic Surgery OPUS - One Port Umbilicus Surgery SPL - Single Port Laparoscopic SIMPLE - Single-incision multiport laparoendoscopic

4. Proposed advantages of SILS over traditional laparoscopic surgery Improved cosmesis Decreased postoperative pain Lower hernia rate Fewer adhesions to wounds Earlier discharge (now only median 3 days for right hemicolectomy done laparoscopically) Earlier return to work Currently laparoscopy has shown great benefits, these may be improvable…..

5. Evidence of improving lapaparoscopic plus enhanced recovery benefits to my patients, showing their hospital stays after right hemicolectomy

6. SILS Appendicectomy I carried out recently, patient was discharged well 2 hours later

7. SILS: Incisional Hernia repair Shows ports via single 1.5cm incision