Dr. S Sevellaraja FRCOG
Consultant Obstetrician and GynaecologistMahkota Medical Centre, Melaka, Malaysia. 

Performing single incision Laparoscopic surgery in often hampered by the need of specialized instruments. Some advocate the use of “endoeye” laparoscope by Olympus while others advocate the use of the 50 cm 5 mm telecopes. Morever there are many commercially prepared devices that makes single incision laparoscopic surgery expensive. Single incision laparoscopic surgery can be performed using normal instruments available in most operating theaters. To perform this 3 port technique, the instruments required are: a 5 mm 30 degrees telescope or a 10mm 30 degrees telescope, one 10 mm trocar, two 5 mm trocars, bipolars, graspers, scissors that are usually used during conventional laparoscopic surgery. An incision measuring 2.5 cm is made vertically through the umbilicus. The skin of the umbilicus is detached from its attachment centrally. A space is created around the incision above the rectus sheath. A Verres needle is used to insufflate the abdomen and a 5mm or 10mm trocar with a rubber band attached to it is inserted at the centre of the incision. The pelvis is visualized. Two other 5mm trocars are placed beneath the skin as lateral as possible. The surgery is then performed using conventional instruments. The use of vessel sealing devices such a Ligasure, Enseal or Bicision can make coagulation and cutting easy. On completion of the surgery, the umbilicus is reconstructed. Using this technique, 160 cases have been performed from Feb 2011 till December 2014. The cases ranged from laparoscopic tubal ligation, laparoscopic salpingectomy for ectopic pregnancy, total laparoscopic hysterectomy and laparoscopic myomectomy. Conclusion: Single incision laparoscopic surgery can be performed without any extra cost or instrumentation in most hospitals using this simple 3 port technique.