Scarless Gynecological Operations
DR. ZOYLA ALMEIDA, Northwest Medical Center, Margate, Florida.
By Alfredo Arango
An innovative technology now permits gynecological operations without leaving visible scars. This technique, known as Single Port Laparoscopy (SPL) or LaparoEndoscopic Single-Site (LESS), avoids those ugly six inch scars required by open surgeries, as well as the half-inch, three or four incisions resulting from the traditional laparoscopies and robotic surgery.
“The field of surgery is changing greatly, heading towards ever-less invasive surgeries. It all began in the 1980’s with the introduction of laparoscopy. In the past five years we have seen considerable development in robotic surgeries. We now perform laparoscopic surgery which we call “scarless,” because it is performed through the umbilicus with only one incision which, when it is closed, it is hidden within the navel,” says Dr. Zoyla Almeida, who subspecializes in gynecological oncology and is affiliated with the Northwest Medical Center in Margate, Florida. The expert explains that the navel is an ideal access port because it is where the abdominal planes connect, namely, the skin, the fat, and the fascia that surround and protect the internal organs.
“The advantages to surgery performed through the umbilicus are the same as those in traditional laparoscopy and robotic surgery, including less bleeding and less pain. However, the greatest advantage is cosmetic. As a woman, I fully understand how important it is for women to be able to put on a bikini and show off a scarless abdomen, that there is no visible sign of surgery when wearing a bathing suit,” adds the specialist, who performs 20% to 25% of her surgeries using the single site technique.
The determining factor for performing this technique is the condition of each patient, explains Dr. Almeida, who is a native of Ecuador and studied medicine in Philadelphia and Miami.
The new single-site surgical technique is indicated in the removal of the uterus (hysterectomy) and/or ovaries, endometriosis, ovarian cysts, and in some fibroids, depending on their location. The fibroids that can be removed through the navel are the ones found in the exterior of the uterus.
This technique can also be used simultaneously during several procedures. The results of a study presented at the 38th Global Congress of Minimally Invasive Gynecology, in Orlando, Florida, indicated that the: “Laparoendoscopic single-site (LESS) surgery has gained increased acceptance among surgeons in various specialties. The universal nature of port placement in the umbilicus during LESS surgery may enable concomitant procedures to be performed in these surgical specialties via this single incision. This case report presents a 37-year-old woman who underwent concomitant LESS cholecystectomy and hysterectomy to treat a symptomatic fibroid uterus and symptoms of cholelithiasis. The surgical procedure was performed in approximately 3 hours without any complications, and the patient was discharge to home 18 hours after the procedure. This case demonstrates that increasingly complex concomitant procedures can be performed using a LESS surgical approach.”
If the fibroids are within the muscle or too far within the uterus, another type of surgery is preferred because the uterus must be sutured and repaired.
Not all patients are candidates for the single-site incision through the navel. “This technique is not recommended in cases of cancer because more dissections are necessary. Robotic surgery is applied in cancer surgery, as long as there is no metastasis,” clarifies Dr. Almeida.
Using the innovative technology that has made possible gynecological operations through the umbilicus, several surgical instruments are introduced through a small tube in an area of two centimeters and not through several incisions as in the traditional laparoscopy. Among the key instruments invented for these operations, is a 5 millimeter camera with a special angled tip that turns 360 degrees.
Several companies are producing the technology for single site surgeries in the umbilicus, and each company calls it by a different name: Covidien makes the Single Incision Laparoscopic Surgery (SILS); Applied Medical makes the Single Site Laparoscopic Surgery (SSL); and Olimpus makes the Scarless.
The makers explain that operating through a single incision through the umbilicus, instead of using three or four different parts of the abdomen, not only eliminates visible scars, but also considerably reduces the pain associated with multiple access ports. The single site technique is also applicable for other types of operations, such as those related to the gallbladder, appendix, and hernias.
Single site surgery through the umbilicus carries the same risks as any other operation, including infections and bleeding, as well as hernias, which are a common risk in any laparoscopy.
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