There’s nothing like a good clickbait title and image to get you to the post. And today I’m going full on with no holds barred to give my hyper opinionated view about single port surgery - so strap in.
Back in the late 90’s some people came up with an idea to make multiport laparoscopic surgery “Better.” They decided that sticking a massive port at the umbilicus was way better than sticking lots of little ports around the abdomen.
Then they thought that crossing over instruments and working like inverted chopsticks through that port would actually be a good idea. They even came up with a funky name - SILS (Single Incision Laparoscopic Surgery) - was that SILS or SILLY ? I struggle to remember because it was a fad. Oh of course there are some die hard surgeons today that persist with it… but… but…
I get the idea - less scars is better, and it was a stepping stone to “No Scars” as we had a flourish of NOTES and NOS coming onto the scene.
But step forwards over 20 years and all I ask is “Where is it now?” Why didn’t SILS take off and dominate the world of laparoscopy?
Well in my opinion it was a solution looking for a problem. And that never bodes well. The idea was “The gallbladder or specimen is coming out of the umbilical port - so just make it bigger and put all, the instruments through that one port. No more small scars around the abdomen. You don’t even see the umbilical scar if done right…”
But talk about taking something difficult and making it ten times more difficult for virtually no gain. Manual lap for most people is hard to master - but now crowd your instruments in one point - cross them - invert them and add some flexion. And you just made that stupid hard.
Now as the crossing over - and the management of instruments is hard - some bright spark at a robotics company decided that much of that complication of movements can be removed if you just make SILS robotic. Give people three flexible instruments and a 3D flexible camera and it all becomes easy… right?