Single-Incision Laparoscopic Surgery (SILS): Scarless Gallbladder Removal

Single-Incision Laparoscopic Surgery (SILS) for Gallstones: A Complete Guide

Single-Incision Laparoscopic Surgery (SILS), also called SILS cholecystectomy or scarless gallbladder surgery, is an advanced minimally invasive technique that removes the gallbladder through a single small incision hidden inside the navel. The result is a virtually scar-free outcome — the incision is concealed within the natural folds of the navel and is barely visible once healed.

What Is SILS Cholecystectomy?

In standard laparoscopic cholecystectomy, 3–4 small incisions (5–10 mm) are made in the abdomen. In SILS, all instruments — the camera and two working instruments — are inserted through a single 2–3 cm incision inside the navel. The gallbladder is removed through this same incision.

The key difference: Instead of 3–4 separate port sites, SILS uses a single multi-channel port (SILS port) inserted through the navel. This port has multiple channels for the camera and instruments.

Who Is a Good Candidate for SILS?

SILS is suitable for:

• Patients with uncomplicated gallstone disease (biliary colic, chronic cholecystitis)
• Patients with a BMI <35
• Patients without previous upper abdominal surgery
• Patients who prioritise cosmetic outcome (minimal scarring)
• Patients without acute cholecystitis or CBD stones

SILS may not be suitable for:

• Acute cholecystitis with severe inflammation
• Obesity (BMI >35)
• Previous multiple abdominal surgeries (adhesions)
• Suspected CBD stones (ERCP is needed first)
• Patients with complex anatomy

Advantages of SILS

1. Superior cosmetic outcome

The single incision is hidden inside the navel. Once healed (3–6 months), it is virtually invisible. This is the primary advantage of SILS over standard laparoscopic surgery.

2. Reduced post-operative pain

Some studies suggest slightly less post-operative pain with SILS compared to standard laparoscopic surgery, as there are fewer port sites.

3. Equivalent safety and outcomes

In experienced hands, SILS has equivalent safety, complication rates, and recovery times compared to standard laparoscopic cholecystectomy.

4. Psychological benefit

Many patients report greater satisfaction with their body image after SILS due to the absence of visible scars.

The SILS Procedure: Step by Step

1. General anaesthesia is induced

2. A 2–3 cm incision is made inside the navel

3. The SILS port (multi-channel port) is inserted through this incision

4. The abdomen is inflated with carbon dioxide gas

5. The camera and two working instruments are inserted through the SILS port

6. The gallbladder is identified and dissected using the same technique as standard laparoscopic surgery

7. The cystic duct and cystic artery are clipped and divided

8. The gallbladder is removed through the navel incision

9. The SILS port is removed and the navel incision is closed with absorbable sutures

Duration: 45–90 minutes (slightly longer than standard laparoscopic surgery due to the technical challenges of operating through a single port).

Recovery After SILS

Recovery after SILS is similar to standard laparoscopic cholecystectomy:

• Hospital stay: 1 night
• Return to desk work: 5–7 days
• Return to manual work: 2–3 weeks
• Full recovery: 4–6 weeks
• Driving: After 1 week (once off strong pain medication)

SILS vs. Standard Laparoscopic Cholecystectomy: A Comparison

| Feature | SILS | Standard Laparoscopic |

|---------|------|----------------------|

| Number of incisions | 1 (navel) | 3–4 |

| Scarring | Virtually none | 3–4 small marks |

| Operating time | 45–90 min | 30–60 min |

| Technical difficulty | Higher | Standard |

| Hospital stay | 1 night | 1 night |

| Recovery time | 5–7 days | 5–7 days |

| Pain | Slightly less | Minimal |

| Cost | ₹55,000–₹95,000 | ₹60,000–₹1,00,000 |

| Suitable for complex cases | Less suitable | More suitable |

Is SILS Right for You?

SILS is an excellent option for patients who:

• Have uncomplicated gallstone disease
• Are of normal or slightly above-normal weight
• Have no previous abdominal surgery
• Prioritise cosmetic outcome

For patients with acute cholecystitis, obesity, or complex anatomy, standard laparoscopic cholecystectomy is safer and equally effective.

Dr. Adarsh M Patil will assess your suitability for SILS at your consultation and recommend the most appropriate approach for your specific situation.

Book a consultation: Call +91 80889 54804 or WhatsApp +91 99724 46882. Apollo Clinic, 1st Floor, 100 Feet Rd, Indiranagar, Bengaluru 560008.

*Medically reviewed by Dr. Adarsh M Patil, MBBS, MS (General Surgery), Fellowship in Advanced Laparoscopy & Bariatric Surgery (Belgium). Consultant General & Laparoscopic Surgeon, Apollo Clinic Indiranagar, Bangalore.*