Single Incision Laparoscopic Surgery in Colorectal Procedure

SILS (Single Incision Laparoscopic Surgery) is a minimal invasive technique in which the surgeon operates almost exclusively through a single entry point, typically through the patient’s navel. In comparison to the traditional keyhole (Laparoscopic) surgery where 4 to 5 small cuts are made and an instrument is used at each entry point, in SILS, all instruments are placed through the small single incision [IMAGE 2,3,4].

The first SILS procedure across the Aster Group was administered at Aster Hospital, Al Qusais by Dr. Khalid Mohiuddin on a 53-year-old Sudanese patient.

When the patient visited the hospital, it was revealed that he was suffering from Diverticular disease for over 10 years. He presented recurrent symptoms of abdominal pain, distension and occasional change in bowel habits which affected his quality of life. Diverticular disease is a condition which commonly causes small bulges (diverticular) or sacs to form in the wall of the large intestine (colon) [IMAGE 1].

The conventional approach to such cases is to perform open Anterior Resection due to intense inflammation, adhesions and the involvement of ureters/bowels or bladder. Although Laparoscopic Colorectal Surgery is standard for all for benign or malignant disease, only experts can perform Laparoscopic Colorectal for complicated Diverticular disease. To offer the best recovery with less pain and early return to normal activity, the patient was suggested an Advanced Laparoscopic Surgery (Single Incision Laparoscopic High Anterior Resection – SILS) by Dr. Khalid.

On 27th October, the patient underwent SILS at Aster Hospital, Al Qusais. The procedure is an advanced keyhole surgery with a single cut, which leaves minimal scar. The surgery was challenging particularly because the patient had a previous perforated bowel which caused adhesion of the bowel to bladder and left side of pelvis. A standard medial to lateral approach was followed with high ligation of Inferior Mesenteric Artery and for tension free Anastomosis Splenic Flexure was taken down. The Anastomosis was accomplished by circular stapler. In expert hands with precise dissection and for those who have undergone structured Advanced Laparoscopic Colorectal training, like Dr. Khalid – this surgery can be performed without any temporary covering Ileostomy or Colostomy, like in this case.

Following the surgery, the patient was discharged within 48 hours and returned for clinical follow up a week later. The patient is extremely happy with the outcome of surgery and his improved quality of life. After looking at his belly, the patient continues to ask Dr. Khalid “have you really performed a bowel resection through my navel where the scar is barely visible.”

Dr. Khalid Mohiuddin 

Consultant Laparoscopic Colorectal & General Surgeon 

Aster Hospital, Al Qusais