Single-incision laparoscopic surgery (SILS): Current practice-based concerns

Surgery is a word married to precision, yet the practice of surgery remains an anathema to perfectionist. Pursuit of precision is benchmarked on various indices. 'Patient-reported outcomes' have become an acceptable metrics given the substantial progress on the clinical outcome measures. Surgery being a hybrid of science and arts, gives space for creativity culminating into innovations. Laparoscopic surgery has become the most recent licence for surgical innovations. Single-incision laparoscopic surgery (SILS) is an offspring of such innovating zeal. However, it is being viewed as if the surgeon is firing from the patient's shoulder. Enthused with the success of laparoscopic surgery without any randomized studies, the proponents of SILS display no need for such studies for justifying SILS. Concerns about SILS emanate from the possibility of harm to patient negating the tenet of 'Primum non nocere'. Surgeons have been known to be vindictive to their peers, hence the most honest criticism of SILS is fraught with contempt. Much of the support for scientific progress till the evidence emerges is at best seen as philosophical. We know that philosophical ideas become scientific facts once we understand them, as was said by Plato. In this backdrop of surgical vindictiveness versus 'science yet un-understood' any surgical innovation needs a philosophically scientific debate. We should not stifle the non-conformist with a noose of randomized controlled trial (RCT) just to inflate our ego and satiate our envy. Modern science has seen the validation of paradoxical theories. Matter and antimatter is an obvious existential paradox. Professor F.A. Wilczek of the Massachusetts Institute of Technology (MIT) won a Nobel Prize in 2004 for describing a force stronger than gravitational force, a force which grows with the distance between two particles. Scientific technological evolution is yet primitive. We are yet not half as close to the efficiency of locomotion and communication in fellow planet-dwellers such as insects, birds, fish, dolphin, penguins, etc., with the best of technological revolution in aerodynamics and energy-guided systems. Given this technological handicap, the future technologies may make SILS less philosophical and more scientific. Till that time we needed a review of current literature and this article aims to do that.