No scar surgery?

When I first heard about single incision laparoscopic surgery (SILS) for gallbladder removal, I was quite skeptical. I really had a difficult time understanding what the benefit is over traditional laparoscopic cholecystectomy. I have always been an advocate of smaller scars whenever possible. From the medical standpoint, anytime we have smaller incisions, we reduce the incidence of hernia formation following abdominal access. From the human/vanity/cosmesis side of things, who would want a big, ugly scar if the same surgery could be completed equally without any visible scars?

Let's consider the progression of cholecystectomy. Tradionally, the gallbladder was removed via a large incision (5-10 inches) below the ribcage on the right side. Currently, the standard approach is to remove the gallbladder via laparoscopic cholecystectomy. This involves 4 small incisions from 1/4 to 1/2 inch each. Open cholecystectomy is reserved for cases in which the gallbladder cannot be removed via the laparoscopic approach and accounts for less than 5% of gallbladder surgery today. Few surgeons have adopted the "mini lap chole" which is accomplished by 3 small incisions- 2 which are 1/4 inch and one which is 1/8 inch. I am one such surgeon, and whenever it is technically safe and feasible, I use the mini lap chole approach. Ultimately, when the incisions are healed, they are tiny yet still visible.

Over the last 2 years, surgeons have improvised a way to remove the gallbladder through a single incision made right through the middle of the umbilicus. Ultimately, when the belly button is closed and the incision heals, there is no visible scar. I was definitely a skeptic at first. In order for me to consider this approach, the surgery had to be equally safe as traditional laparoscopic cholecystectomy. This was the number one priority. Next, it had to be similar in cost to traditional lap chole- no additional instrumentation special tools should be required. Finally, the length of time to complete the surgery has to be similar as well. So when I saw someone complete a single incision laparoscopic cholecystectomy that met all of these criteria, I was sold. If you would like to see for yourself, check out the video on YouTube by Alberto Iglesias, MD, surgeon at the University of Miami.

So now any patient who has not had any abdominal surgery and wants to have the possibility of no scars after gallbladder removal is given this opportunity. So far, the results have been amazing. My patients- mostly young female- are so happy to have a relatively painless surgery and no scars to show for it. It sure beats the alternative of going to the surgeon across town who makes four big holes for the traditional lap chole then staples them all shut at the end (doubling the visible scarring)! I would personally opt for the no scar approach.