Single-incision laparoscopic surgery (SILS) is an advanced form of minimally invasive or keyhole surgery that allows a gynaecological procedure to be performed through a single small incision, usually made within or around the belly button.
Traditional laparoscopic surgery generally uses several small incisions across the abdomen. With SILS, the aim is to perform the operation through one access point, potentially reducing the number of visible scars.
Mr Jafaru Abu was one of the first surgeons in the UK to perform this type of minimally invasive, single-incision surgery for selected gynaecology patients.
Although SILS can offer an excellent cosmetic result, it is not suitable for everyone or for every operation. The safest and most appropriate surgical approach will always depend on your individual circumstances, the condition being treated and the complexity of the procedure.
What is single-incision laparoscopic surgery?
Single-incision laparoscopic surgery is a form of keyhole surgery where the surgeon operates through one small incision rather than several separate abdominal incisions.
A laparoscope, a narrow telescope with a camera and light, is inserted through the incision. The camera provides a magnified view of the organs and structures inside the abdomen and pelvis, allowing the surgeon to carry out the procedure using specially designed instruments.
The incision is commonly positioned in the belly button. Because the natural contours of the umbilicus can conceal the wound, the resulting scar may be very difficult to see once healed.
SILS is also referred to as:
- Single-port laparoscopy
- Single-site laparoscopy
- Laparoendoscopic single-site surgery (LESS)
- Single-incision laparoscopic surgery
How is SILS different from traditional keyhole surgery?
Both techniques are forms of minimally invasive surgery and use a camera to allow the surgeon to operate inside the abdomen or pelvis.
The main difference is the number and position of the incisions.
Traditional laparoscopy usually involves several small incisions. One is used for the camera and additional incisions are used to introduce surgical instruments.
Single-incision laparoscopy uses one main access point, generally at the umbilicus, through which the camera and specialised instruments are introduced.
This means there may be fewer visible scars on the abdomen.
However, operating through a single access point can be technically more demanding because the instruments and camera are working through the same area. This requires advanced laparoscopic skills and appropriate equipment.
What gynaecological procedures can be performed using SILS?
Single-incision surgery can be considered for selected gynaecological procedures.
Depending on your diagnosis and individual circumstances, this may include procedures such as:
- Removal of ovarian cysts
- Treatment of endometriosis
- Removal of adhesions
- Selected hysterectomies
- Treatment of some benign ovarian conditions
- Selected other laparoscopic gynaecological procedures
The technique is not appropriate for every operation. Some procedures are technically more complex and may be safer using conventional multi-port laparoscopy or open surgery.
Your consultant will recommend the approach that provides the best balance between effective treatment and safety.
Can SILS be used for gynaecological cancer?
In selected circumstances, minimally invasive surgery can be used to treat or stage gynaecological cancers.
However, cancer surgery requires particularly careful consideration of the type, stage, size and location of the cancer.
Some cancers and more complex procedures are better performed using conventional multi-port laparoscopy, robotic surgery or an open approach. The existing Gynae Solution guidance correctly highlights that some cancer procedures are better undertaken using traditional multi-port laparoscopic access.
The priority is always complete and safe cancer treatment rather than achieving the smallest possible scar.
If SILS is not considered appropriate for your cancer, your consultant will explain why and discuss the alternative approach with you.
What are the potential benefits of SILS?
The principal attraction of single-incision surgery is the potential for a very discreet cosmetic result.
Potential benefits can include:
A single abdominal incision
Instead of several small incisions across the abdomen, the operation is performed through one main access point.
A discreet scar
When the incision is placed within the belly button, the resulting scar can be hidden within the natural folds of the umbilicus.
Potentially less visible scarring
Reducing the number of abdominal incisions can provide a cosmetic advantage for some patients.
Minimally invasive surgery
SILS retains the advantages associated with laparoscopic surgery, including small incisions and, where appropriate, faster recovery compared with open abdominal surgery.
Laparoscopic surgery is commonly associated with shorter recovery than open surgery because the abdominal wounds are smaller.
However, it is important to understand that the evidence does not demonstrate that single-incision surgery is automatically superior to conventional laparoscopy in every respect. Research comparing the two approaches has found broadly comparable safety and effectiveness, with the clearest potential advantage being cosmetic.
Is single-incision surgery less painful?
One of the potential advantages of having only one incision is that there may be less discomfort associated with abdominal wounds.
However, postoperative pain depends on the type and extent of surgery rather than simply the number of incisions.
For example, a more complex procedure performed through a single incision may still involve significant internal surgery and therefore require appropriate pain relief.
Studies of gynaecological SILS have not consistently demonstrated a major pain advantage over conventional laparoscopy. The principal benefit should therefore not be presented as guaranteed reduced pain, but as the possibility of less visible scarring alongside the benefits of minimally invasive surgery.
Who may be suitable for SILS?
Whether you are suitable for single-incision surgery will be assessed during your consultation.
Your surgeon may consider:
- The condition being treated
- The type and complexity of the planned operation
- The size of any ovarian cyst, fibroid or other mass
- The presence of adhesions from previous surgery
- Your previous surgical history
- Your body habitus and abdominal anatomy
- The position of the organs or disease being treated
- Whether cancer is suspected or confirmed
- Whether there is a need to remove tissue safely and intact
- Your general health and suitability for anaesthesia
There is no single factor that determines suitability.
Someone who is suitable for SILS for one procedure may require conventional laparoscopy or open surgery for another.
What happens during single-incision laparoscopic surgery?
SILS is generally performed under a general anaesthetic.
Once you are asleep, a small incision is made, usually in or around the belly button.
The abdomen is gently inflated with carbon dioxide gas. This creates space for the surgeon to see and operate safely.
A specialised single-port device may then be positioned within the incision. The laparoscope and surgical instruments are passed through this access point.
The surgeon performs the planned procedure while viewing the internal anatomy on a high-definition monitor.
Once the operation is complete, the instruments and port are removed and the incision is closed.
The exact details depend on the procedure being performed.
What if the surgeon needs additional instruments?
Although the intention may be to complete the operation through a single incision, your safety always comes first.
Sometimes additional laparoscopic instruments or another small incision may be required to complete the procedure safely.
This can happen because of:
- Unexpected bleeding
- Adhesions
- Difficult anatomy
- A larger or more complex mass than expected
- Difficulty accessing an area safely
- The need for additional instruments
- Findings during surgery that were not apparent beforehand
Needing an additional port does not mean that the operation has failed. It means the surgeon has adapted the approach to complete the procedure safely.
Could SILS be converted to open surgery?
In some circumstances, it may be necessary to change from keyhole surgery to an open operation.
This is uncommon but is an important possibility to discuss as part of your consent.
Conversion may be recommended if the surgeon believes an open operation is safer or provides better access to the area being treated.
Possible reasons include significant bleeding, extensive adhesions, unexpected findings, a large or complex mass, or concerns about cancer.
The decision is made in your best interests and is focused on achieving the safest and most effective outcome.
Is SILS suitable after previous abdominal surgery?
Previous abdominal or pelvic surgery does not automatically prevent you from having SILS.
However, previous operations can result in adhesions, bands of scar tissue that can develop between internal organs and tissues.
Extensive adhesions can make laparoscopic surgery more technically difficult and may increase the risk of injury to organs such as the bowel or bladder.
Your previous operations will therefore be considered when deciding which surgical approach is safest.
What are the risks of SILS?
Single-incision laparoscopic surgery carries the risks associated with both laparoscopy and the particular procedure being performed.
Potential risks include:
- Bleeding
- Infection
- Blood clots
- Anaesthetic complications
- Injury to the bowel, bladder, ureters, blood vessels or other organs
- Internal bleeding
- Formation of adhesions
- Wound infection
- Delayed wound healing
- Scar problems
- Incisional hernia
- Need for additional laparoscopic ports
- Conversion to open surgery
- The possibility that the planned procedure cannot safely be completed
There are also specific technical considerations associated with operating through a single access point, which is why experience in advanced laparoscopic surgery is important.
Your individual risks will be discussed before surgery.
Can a single incision cause a hernia?
Any incision through the abdominal wall carries a risk of an incisional hernia.
Because SILS generally uses a larger single incision at the umbilicus than some of the individual ports used during conventional laparoscopy, careful closure of the abdominal wall is important.
Incisional hernia following gynaecological single-incision surgery appears to be uncommon, but it remains a recognised potential complication.
What is recovery like?
Recovery depends primarily on the operation you have rather than simply the type of incision.
Because SILS is a minimally invasive approach, recovery can be relatively quick compared with an equivalent open procedure.
You may experience:
- Abdominal discomfort
- Tiredness
- Bruising around the incision
- Temporary bloating
- Shoulder-tip discomfort caused by the carbon dioxide gas used during laparoscopy
- Mild pulling or tenderness around the belly button
You will normally be encouraged to get up and move around as soon as it is safe to do so.
Your consultant will advise you about returning to driving, work, exercise and other normal activities.
What will the scar look like?
The incision is usually made within or immediately around the belly button.
As it heals, the scar may become difficult to see because it sits within the natural contours of the umbilicus.
However, individual healing varies and no surgical technique can guarantee a completely invisible scar.
Factors including your skin type, healing response, the size of the incision and whether complications occur can affect the final appearance.
Is SILS really “scarless”?
The term “scarless surgery” is sometimes used to describe single-incision surgery because the incision can be concealed within the belly button.
Strictly speaking, SILS is not completely scarless. There is still an incision and therefore a scar forms as the wound heals.
A more accurate description is potentially scar-minimising or discreetly scarred surgery.
The cosmetic result is one of the principal reasons some patients choose or are offered this approach.
Why does surgical experience matter?
Single-incision laparoscopic surgery can be technically more demanding than conventional laparoscopy because the camera and instruments enter through the same access point.
This can restrict the surgeon's working angles and requires careful instrument control.
For this reason, SILS should be performed by a surgeon with appropriate advanced laparoscopic experience and training.
Mr Jafaru Abu was one of the first surgeons in the UK to perform single-incision laparoscopic surgery for selected gynaecology patients. His specialist interest in minimally invasive surgery allows him to assess whether a single-incision approach is appropriate for your particular procedure.
Choosing the right surgical approach
Although a single small incision can be appealing, the smallest scar is not necessarily the best operation for every patient.
Your surgeon will consider all available approaches, including:
- Single-incision laparoscopy
- Conventional multi-port laparoscopy
- Robotic-assisted surgery where appropriate
- Vaginal surgery for selected procedures
- Open abdominal surgery
The recommended approach will depend on what needs to be achieved surgically.
Our priority is to provide effective treatment while minimising unnecessary surgical trauma wherever this can be done safely.
Book a consultation
If you have been advised that you need gynaecological surgery and would like to know whether a single-incision laparoscopic approach could be suitable for you, a specialist consultation can help you understand your options.
At Gynae Solution, we will explain the proposed procedure in plain language, including the potential benefits, limitations and alternatives, so that you can make an informed decision about your care.
The aim is not simply to offer the smallest possible scar, but to provide the safest and most appropriate treatment for you.
Patient leaflets
Written for patients, relatives and hospital personnel, to read before your operation and to keep afterwards.
Common questions
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Daily appointments are available at The Park Hospital. Call the secretary on 0115 966 2049, or send an enquiry below and we will reply within 24 hours on business days.
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Referrals from GPs are welcome, and you can also enquire directly. If you are using private medical insurance, check with your insurer whether a referral is required for your policy. See GP referrals and fees and insurance.
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