Single Port Laparoscopic Surgery One of the most interesting recent developments in laparoscopic abdominal surgery has been single site or single incision laparoscopic surgery.  A number of laparoscopic equipment companies are investing big research and development in this idea.  A number of different technologies and ideas are changing the conventional ideas of laparoscopic surgery.  The original motivation behind the idea of single port surgery was to improve the cosmetic results of laparoscopic surgery. Laparoscopic surgery to Single Incision Laparoscopic Surgery (SILS™ and others) Laparoscopic surgery has always been “minimally invasive”, performing complex intra-abdominal procedures via small incisions and the use of TV monitors and specialized internal cameras and specialized instruments.  The goal of single site or single port surgery is to put all of the incisions in one incision to minimize the number of scars.  These single ports are often located near the natural scar of the belly button (umbilicus).  A criticism of how some surgeons are performing "single site surgery" is that in order to accomplish Single Site Laparoscopic Surgery (SILS™ is a trademark of Covidien, single port) surgery, it is necessary to use a rather large port and (in our opinion) an unacceptable scar near the belly button. The reality of " single port" surgery is that is most often not "single site" the name suggests. It is not single port. Other tiny scars are usually necessary to accomplish things like retraction of the liver and other maneuvers (such as gallbladder retraction). That is a good thing because those scars are imperceptable. But it isn't really single site or single incision laparoscopic surgery (SILS™). As technology improves, true single site “multi-ports might be small enough to hide in belly button scars. Some of the most popular” ports are pictured below. There are many companies that make such ports, but they are also relatively large. Does it really go into a ¾ inch incision as they claim? (No.) Why is it difficult to find photographs of procedures on the internet of patients after these procedures (or why are they out of focus)? (the incision for this large port is larger than they claim).

SILS™ is a trademark of Covidien	Single Site Laparoscopy (SSL) Access System is a product of Ethicon
	Laparo-Endoscopic Single Site Surgery(LESS) is a product of Olympus

Increasing the cost of your gastric banding procedure

You might be interested to know that using “SILS™” or similar ports may substantially increase the costs of your gastric banding. The patient cost of the SILS™ port is more than $2300. The “Stealth” technique that we recommend uses conventional laparoscopic ports. Would you be surprised to find out that the companies that make these ports are driving the popularity of these devices?  What the companies do is to convince surgeons that they will get a marketing advantage by promoting their “SILS™” ports or similar ports as "Single Incision Laparoscopic Surgery".  The emphasis is through a single expensive port, not necessarily to optimize the cosmetic results. In our opinion, it is not about the ONE port, it is about the cosmetic results.

Stealth Laparoscopic Surgery      

We do better cosmetically with the Stealth  technique.  We can perform “virtually scarless” surgery for the gastric banding with conventional laparoscopic ports.  We can avoid the expense of these single site multi-ports (like SILS™).  We can do it as safely as the techniques for conventional multiple port laparoscopic gastric banding. In my opinion with the technology presently available, the limitation of the presently available ports is that the ports are still too big to accomplish a good cosmetic result at the belly button.  With "Stealth" we acknowlege that single port surgery is not actually a "single incision". We use the same techniques as other surgeons claiming to be doing surgery with one port and most surgeons would refer to our technique as "single site" or "Single Incision Laparoscopic Surgery". With“Stealth”   we simply can offer a better cosmetic result using some of the ideas of single port laparoscopic surgery without using the large expensive single ports presently available.

The “Stealth” concept is that the most important idea is not that it is one port.  The most important idea is to make the access scars as imperceptible as possible, “virtually scarless.”  “Stealth” surgery emphasizes hiding the scar in the belly button scar, and to use other sites of tiny access ports that are imperceptible when healed.  “Virtually Scarless” means that you can have a laparoscopic gastric banding surgery (or gallbladder or other laparoscopic surgery) and you literally may not be able to tell you had the procedure.

If you want the best cosmetic result from laparoscopic surgery:  Don’t get hung up on having a single port laparoscopic surgery, speak to us about the “Stealth” approach. 

The photographs above were taken of a patient 6 weeks after the Stealth Laparoscopic Banding technique.  The bandaid is from her first Gastric Band fill. We will try to update these as she loses her wieght.  Notice how a Stealth Laparoscopic Gastric Band can be performed with one small scar that hides in the belly button, tiny scars in the upper part of the abdomen which when healed is imperceptible, and some needle holes to retract the liver.

The whole idea is to improve the cosmetic results of Laparoscopic Surgery

Not every patient may be interested in the Stealth  Gastric Band or can take advantage of the technique.  If there are already scars on the abdomen, the Stealth  technique obviously is not going to make those abdominal scars go away.  We may be able to use some of the scars that you have from other procedures.  Patients with high body mass indexes, maybe 50 or more may be impossible to do with this idea.  However, the decision to use this technique is done on a case by case basis, so if you are interested, ask your surgeon.

You can have a Lap Band or a Realize band with Stealth

The term gastric banding is used on this page because you can have either brand of band with the Stealth technique.

Do you want to be discrete?  Do you want to “hide” the fact you had gastric banding?

One of the things to consider in regards to Stealth Laparoscopic Banding is that is makes the procedure very discrete.  If you do not want anyone know you have had a Gastric Banding, you may choose the Stealth technique.

Dr. Fermelia has worked with surgeons who developed the "Stealth" idea in gastric banding and has further developed the Stealth technique in an effort to offer our patients the very best.

If you have struggled making a decision on whether you want Gastric Banding, we hope that Stealth makes the difference for you.