Times of India
08 June 2011
By Sumitra Deb Roy
Mumbai, India

A seven-year-old girl suffering from bouts of vomiting after every meal has finally found relief in what doctors are calling a "pathbreaking" surgery.

The reason behind her condition was a gall bladder stone that doctors at PD Hinduja Hospital recently removed through a single hole in the umbilicus.

Panvel resident S Ghosh said his daughter Nandita experienced pain for the first time when she was three years old. But doctors took a while to diagnose the problem as cholelithiaisis–or gall bladder stone–among children is believed to be an uncommon condition affecting one in a few thousands.

After four years, as the girl’s condition became a cause for concern, Ghosh approached several doctors who told him that the only option was to surgically remove the 6-mm stone.

The surgery suggested to him was a standard laparoscopic one, where four cuts have to be made in the abdomen. "We were worried about the scars, but then cosmetic considerations cannot be the priority," said Ghosh, a state employee. Just then, the family learnt about the single incision technique for cholecystectomy, or removal of stones.

Ghosh was explained by doctors at Hinduja Hospital that this relatively new technique–Single Incision Laparoscopic Surgery (SILS) –could mean his daughter growing up with no scars on her abdomen.

Paediatric and laparoscopic surgeon Dr Rasik Shah, who performed the surgery on Nandita, said: "In this technique, we only made a single small cut in the umbilicus measuring 1.5 cm. The telescope and another instrument were placed in the abdomen using the same incision and the surgery was performed," he said.

Shah said Nandita is one of the few children in the country to have undergone the surgery using this technique. "Surgery through the belly button is gaining popularity in the country but it needs expertise," he said.

Shah explained that the psychological advantages for a patient are several as he/ she leads 60-70 years of life without any scars.

"We have also noticed that the pain is much less and so is the blood loss during the procedure," Shah said. Nandita went home the next day and will go to school soon.

Research papers across the globe have touted single incision as a technology with clear benefits over standard laparoscopy. The benefits range from reduced post-operative pain and better cosmesis to shorter hospital stay and faster recovery. Also, doctors believe the morbidity associated with laparoscopic surgeries could be further minimized using the single incision technique.

However, a senior laparoscopic surgeon from JJ Hospital said few paediatricians in India were conducting single incision laparoscopic surgeries. "It requires great skill. Also, the technique requires to be documented more to recommend larger use."

Belly Button Surgery

• Stones in the gall bladder (cholelithiaisis) is an uncommon condition among children though very common in adults
• In Single Incision Laparoscopic Surgery (SILS)–or belly button surgery–a single cut of 1.5 cm is made at the umbilicus
• A telescope and another surgical device is placed in the abdomen and the entire surgery is carried out
• The child gets to lead the rest of his/her life without any visible scar on the abdomen
• The USP of the surgery is that the child gets to go home in a day or two
• The use of SILS in adults is considered common but not so among children
• Doctors in India are slowly beginning to use SILS technology to treat children
• Studies show SILS is as effective as standard laparoscopic surgery
• Low rate of blood loss and less postoperative complications–compared to standard laparoscopic surgery–are some of the benefits of SILS
• Doctors say more studies need to be conducted on the benefits of SILS and there is a scope for a lot of development in this regard in India