SMILE technique for pilonidal sinus destruction with a radial laser probe—a video vignette

Abstract

AIM\nThe ideal treatment for pilonidal sinus disease is still not established. It is generally agreed that the treatment of choice for pilonidal disease should be characterized by a short time to healing with a low recurrence rate, a short hospital stay, easy postoperative care, minimal pain and a short time off work. In 2017 Densilly introduced sinus laser-assisted closure (SiLaC) - a new treatment option for pilonidal sinus disease by using a radial laser probe (1).\n\n\nMETHODS\nWe present the Sinus pilonidalis Minimally Invasive Laser Excision (SMILE) procedure which consists of combining pit picking and radial laser ablation techniques. We believe that this technique can decrease the recurrence rate. We use this technique in acute and chronic conditions. The video presents the SMILE technique for pilonidal disease. The procedure can be performed using Swing diode laser of 1470 nm 12W or Thulium diode laser TWIST 1940nm wavelength 10W energy. The procedure is performed under general anesthesia (laryngeal mask airway) or spinal anesthesia. We firstly use a probe to check for tract direction and length. We then excise all sinuses. We use 400J of energy per tract of 15 cm length. The patient is discharged the same day, 2-3 hours after the operation and is advised not to sit till the next day. The wound heals completely in about twelve days.\n\n\nCONCLUSION\nThe technique is safe, simple, short and well tolerated by patients as it is almost painless, requires little postoperative care and has good cosmetic results.