Single-incision laparoscopy: a review of the indications, techniques and results after more than 700 procedures

Single-incision laparoscopy (SIL) gained in popularity in the last 5-7 years, as a new philosophy has emerged to reduce the invasiveness of minimally invasive surgery. Various abdominal procedures using fewer and smaller trocars in order to obtain pure SIL have been described. To overcome some known problems of SIL, such as establishing the conventional multiport laparoscopic working triangulation, the non-ergonomic positioning of the surgeon, and the increased cost of each procedure, a particular SIL technique has been developed. The technique involves reusable trocars along with specially designed DAPRI curved reusable instruments introduced through the same incision but laterally to the optical system. Hence, the main principle of conventional multiport laparoscopy--working in an appropriate triangulation while maintaining the scope in the center--is respected. The final scar is 15 mm and the cost of the procedure remains unchanged because reusable materials are used. All the abdominal procedures, including upper and lower gastrointestinal, colorectal, hepatobiliopancreatic, solid organs, gynecologic and abdominal wall hernia repair, are here reported, as are the indications for and the results after 740 procedures. In conclusion, SIL has to be considered as one of the most attractive techniques of the new minimally invasive era.