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This less invasive surgical technique has generated excitement, criticism and a great deal of discussion since surgeons first started doing them few years ago. It is a challenging approach and still is performed by relatively few surgeons. Clinically, this surgery has yet to show any advantage over traditional laparoscopy in terms of pain or patient recovery. Even the cosmetic appeal - which leaves one scar neatly hidden in the navel is questioned by some because even the scars left by traditional laparoscopy are hard to detect a year after the surgery. So then , where does it stand and where is it headed to? Is it a fad that will fall by the wayside or will it be a progression to Natural Orifice Translumenal Endoscopic surgery? (NOTES)? Will it be embraced by the patients, surgeons and the health industry to become the standard of care?
Although there is an improved cosmetic result from this surgery ,there are not a whole lot of patients who are asking for it. It is mainly driven in part, by the industry and in part by the desire of doing less invasive operations and the surgeons wanting to keep their skills on the cutting edge. Less invasive surgeries require unique and high skill set and it should be attempted only by surgeons who have tremendous experience. It should be done on educated patient population who can understand that there are almost no proven benefits. The good part of it is , if you cant get it perfect you can always add another port and fall back on the standard technique, so that the surgery is not compromised in anyway.
Limitations of instrumentation like internal retracting system, scopes with flexible tips etc are still not widely available. Visualization is a problem. Since it is parellel with the working instruments, the field of view is limited in relationship to where the instruments are and where the target tissue is. Specialy surgeries on the foregut requires a good liver retracting system and it becomes difficult with a single incision technique. Gall bladder, appendectomies and colectemies are best for this approach. Also sleeve gastrectomies and gastric banding. Technologies such as robotics have the opportunity to take away some of the technical dfficulties of single incision laparoscopic surgery.
The reality is, although time consuming and difficult , Single Small Incision Laparoscopic surgery is here and some motivated surgeons are utilizng this on selected patients and the skills developed may enable them to bridge to the next technique ! With new techniques and surgeons not having to touch their patients during surgery, we hope the healing and anointing will still be there flowing through these instruments !

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