Journal of Minimally Invasive Surgical Sciences. 2013 November 2(3):e11465. Published online 2013 October 8. Case Report Single Incision Lift Laparoscopic Surgeries [Sills]: Taking Modern Surgery to the Poor Gnanaraj Jesudian 1,* 1 Karunya Community Hospital, Karunya University, Coimbatore, India *Corresponding author: Gnanaraj Jesudian, Karunya Community Hospital, Karunya University, Coimbatore, India. Tel/Fax: +91-9500127271, E-mail: jgnanaraj@gmail.com. Received: April 9, 2013; Revised: July 31, 2013; Accepted: September 3, 2013 Laparoscopic surgery is now an integral part of the operative repertoire. Single-incision laparoscopic surgery (SILS) is a new technique developed for performing operations without a visible scar. Pneumoperitoneum, as a necessary precondition of laparoscopic procedures, represents the restriction of the surgeon's freedom of movement and can lead to rare but typical complications. The Single Incision Lift Laparoscopic surgery is advantageous. We presented our experience of 194 surgeries carries out this method since March 2012. This procedure is ideal in rural areas because it is cheap, safe and simple. Keywords: Appendectomy; Laparoscopy; Abdominal Wall Implication for health policy/practice/research/medical education: The regular Single incision laparoscopic Appendectomy is considered as an advanced difficult procedure with a recommendation that only few trained persons do it. However the procedure of Lift laparoscopic surgery makes it easy so that most of the surgeons can learn and many rural patients can benefit. Copyright © 2013, Minimally Invasive Surgery Research Center and Mediterranean & Middle Eastern Endoscopic Surgery Association. Published by DOCS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1. Introduction Today, laparoscopic surgery is an integral part of the operative repertoire. It has broadened gynecological and general surgery by continuously providing new indica- tion areas. Laparoscopy is regarded as the major trend of the century and a revolution in surgical technology. Single-incision laparoscopic surgery (SILS) is a new tech- nique developed for performing operations without a visible scar and has become an area of active research and interest within general surgeons’ community. SILS may further reduce the trauma of surgery leading to reduced port site complications and postoperative pain. Despite many advantages of minimally invasive surgeries like less pain, short hospital stay, less blood loss, etc., the lapa- roscopic surgeries are not popular in rural areas because of its high cost. In recent times, however, the problems as- sociated with laparoscopic surgeries with gas have been the subject of discussions and this leads to the develop- ment of Gas less laparoscopic surgeries. We described our experience with Single Incision gasless Lift Laparo- scopic surgeries that has the advantages of laparoscopy and open surgeries and does away with the drawbacks of laparoscopic surgeries. We presented the feasibility of the procedures in rural areas. 2. Case Report From March 2012 onwards until August 2013, 194 surgi- cal procedures were carried out in seven mission hospitals in South and Northeast India and in one Medical College. Table 1 gives the list of surgeries carried out. The Lift appa- ratus is fixed to the operating table. Shoulder braces are used to prevent the patient from sliding back. The inci- sion then holds the lower end of the umbilicus with two towel clips and cuts through the lower half of the umbi- licus. The incision is widened using the finger after enter- ing the abdominal cavity to comfortably insert the index finger. The abdominal portion of the Lift apparatus is in- serted and initially the finger is used to make sure that no bowel or omentum is caught between the Lift apparatus and the anterior abdominal wall. The abdominal wall is then lifted under vision. The Lift apparatus is designed so that it lifts the abdominal wall primarily lifting the um- bilicus to about 10 centimeters and lifts the recti muscles and does not extend beyond it so that there is no injury. There is sufficient space to operate and most of those who see just the television picture cannot believe that gas is not used for the surgery [especially during the two live surgi- cal workshops that were held]. The umbilical hole made easily the index finger of the surgeon accommodated and is about three cm in diameter. Combinations of open and laparoscopic instruments were used for the surgery. Since there is no gas, larger instruments could be passed one at a time conveniently. The technique was mostly useful for surgeries like Appendectomy and evaluation of infertility. Laparoscopy assisted vaginal hysterectomy, ovarian cys- tectomies needs a little more time for learning. Other sur- geries require longer learning curves. The exposure is not