Comparison of Advantages and Disadvantages between SILS and NOTES

Abstract

Minimal access surgery is the gold standard for several abdominopelvic procedures in the present era. The prime advantage with minimal access surgery is the minimal surgical trauma in comparison to the conventional surgery. The other advantages of laparoscopy like less operative time, less pain, early recovery and return to work and above all better cosmetics have been well proven."Change is constant in life," SILS and NOTES are the two newly emerging novel techniques in laparoscopy. SILS is a new advancement in laparoscopy, where the whole surgery is conducted through a single umbilical incision whereas NOTES is totally incisionless. In real sense, the incision in NOTES is not externally visible because of the natural orifices like oral cavity, vagina, urethra and anus that are used as entry sites. SILS have the advantages of better cosmetics, less blood loss, faster recovery, less complications, early return to work, versatility, better patient acceptance and easy tissue retrieval, etc. The critics are high cost, need of high expertise and more chances of port site hernia and infection. Similarly, NOTES has its edges over traditional laparoscopy surgery with the advantages of highest cosmetic value (no visible scar), less pain, requirement of less immunosuppressant and less anesthesia, faster recovery, and no external wound complications (hernia, hematoma and abscess). But it has also its own critics like questionable safety, unproven data about complications, requirement of high expertise, low patient acceptance, requirement of advanced endoscopic instruments, difficulty in closing internal wounds, intraperitoneal infection, gastrointestinal fistula and high cost. Poor acceptance is a major concern for NOTES.Aims: To explore the positive and negative aspects of above two procedures in order to find out the better option. ABSTRACT SINGLE INCISION LAPAROSCOPIC SURGERY (SILS)

A research review on clinical needs, technical requirements, and normativity in the design of surgical robots

“…From Table it is possible to extract the most urgent clinical needs that should be met in order to achieve greater acceptance and market penetration of surgical robots. These clinical needs are: Cost reduction . To gain acceptance, new robotic systems must demonstrate relative competitiveness versus a conventional alternative and achieve a favourable ratio of cost–benefit.…”

Magnetic Surgical Instruments for Robotic Abdominal Surgery

“…Endoscopic-like surgical instruments are used to manoeuvre into the abdomen through an incision made in the stomach wall, uterus or colon to access the abdomen. Due to the cumbersome of procedural setup and manipulation with current available surgical instruments [28], [29] as well as the lack of cases to evaluate the possibility of infection [30], [31], NOTES remains largely experimental.…”

An investigation for public acceptance of laparoendoscopic single-site surgery

“… 6 , 7 Owing to the development of instruments and surgical technique, LESS is getting more clinical applications than NOTES. 8 Unfortunately, there is no particular study investigating public perception for LESS and the possibly increasing unfavorable outcomes as a direct result of the surgery, such as complications, postoperative pain, cosmesis, hospital stay and cost. Thus, the aim of this study was to investigate the public perception of LESS and their tolerance of LESS for potential increasing risks, especially in the above-mentioned aspects, compared with CLS.…”