J Korean Surg Soc.  2011 Jan;80(1):43-50. 10.4174/jkss.2011.80.1.43.

Clinical Analysis of Single-Port Laparoscopic Cholecystectomies: Early Experience

• Song SC
• Ho CY
• Kim MJ
• Kim WS
• You DD
• Choi DW
• Choi SH
• Heo JS

• KMID: 2096618
• DOI: http://doi.org/10.4174/jkss.2011.80.1.43

Abstract

PURPOSE
Single-port laparoscopic cholecystectomy (SPLC) is a technique under development in the field of minimally-invasive surgery. We have considered the feasibility of SPLC based on the advantages or restrictions compared with multi-port procedures.
METHODS
Two hundred seventeen patients with benign gallbladder disease who underwent SPLC or multi-port laparoscopic cholecystectomy (MPLC) during the most recent 10 months were retrospectively reviewed.
RESULTS
Patients were divided into two or three groups based on the operative period and disease. The mean age and ASA scale were different between the three groups. The intra-operative bile leakage and post-operative hospital stay were significantly less in the SPLC group; however, the blood loss and operative time was greater in the SPLC group. When patients with empyema of the gallbladder were excluded and all patients were reassigned into two groups based on the operative method, the incidence of bile leakage and post-operative hospital stay were similar between the two groups. The mean blood loss and operative time were higher in the patients who underwent SPLC. The mean numeric rating scale (NRS) and requirement for opioid analgesics were similar in the two groups.
CONCLUSION
With the exception of increased intra-operative hemorrhage and a longer operative time, the risks associated with SPLC were not greater than MPLC. With adequate analgesics, advances in laparoscopic instruments, and surgical experience, SPLC is expected to gain acceptance amongst physicians.

Keyword

Laparoscopic cholecystectomy; Single-incision; One-port surgery; Minimally-invasive surgery

MeSH Terms

Analgesics
Analgesics, Opioid
Bile
Cholecystectomy, Laparoscopic
Empyema
Gallbladder
Gallbladder Diseases
Hemorrhage
Humans
Incidence
Length of Stay
Operative Time
Retrospective Studies
Analgesics
Analgesics, Opioid

Figure

• 

  Fig. 1. (A) Hand-made single-port laparoscopic system. (B) Laparoscopic instruments and wound retractor equipped in the umbilical port.

Reference

References

1. Curcillo PG 2nd, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, et al. Single-port-access (SPA(TM)) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc. 2010. (in press).

2. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 1999; 9:361–4.

3. Roberts KE, Solomon D, Duffy AJ, Bell RL. Single-incision laparoscopic cholecystectomy: a surgeon's initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg. 2010; 14:506–10.

4. Hong TH, You YK, Lee KH. Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc. 2009; 23:1393–7.

5. Rao PP, Bhagwat SM, Rane A. The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB (Oxford). 2008; 10:336–40.

6. Ponsky TA, Diluciano J, Chwals W, Parry R, Boulanger S. Early experience with single-port laparoscopic surgery in children. J Laparoendosc Adv Surg Tech A. 2009; 19:551–3.

7. Gumbs AA, Milone L, Sinha P, Bessler M. Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg. 2009; 13:533–4.

8. Bucher P, Pugin F, Buchs N, Ostermann S, Charara F, Morel P. Single port access laparoscopic cholecystectomy (with video). World J Surg. 2009; 33:1015–9.

9. Abe N, Takeuchi H, Ueki H, Yanagida O, Masaki T, Mori T, et al. Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery. J Hepatobiliary Pancreat Surg. 2009; 16:633–8.

10. Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E. Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg. 2009; 13:159–62.

11. Hirano Y, Watanabe T, Uchida T, Yoshida S, Tawaraya K, Kato H, et al. Single-incision laparoscopic cholecystectomy: single institution experience and literature review. World J Gastroenterol. 2010; 16:270–4.

12. Chow A, Purkayastha S, Paraskeva P. Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov. 2009; 16:211–7.

13. Kravetz AJ, Iddings D, Basson MD, Kia MA. The learning curve with single-port cholecystectomy. JSLS. 2009; 13:332–6.

14. Erbella J Jr, Bunch GM. Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc. 2010. (in press).

15. Connor S. Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg. 2009; 33:1020–1.

16. Langwieler TE, Nimmesgern T, Back M. Single-port access in laparoscopic cholecystectomy. Surg Endosc. 2009; 23:1138–41.

17. Ponsky TA. Single port laparoscopic cholecystectomy in adults and children: tools and techniques. J Am Coll Surg. 2009; 209:e1–6.

18. Mutter D, Leroy J, Cahill R, Marescaux J. A simple technical option for single-port cholecystectomy. Surg Innov. 2008; 15:332–3.

19. Romanelli JR, Mark L, Omotosho PA. Single port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov. 2008; 15:223–8.

20. Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc. 2009; 23:1660–6.

21. Paulson J, Mellinger J, Baguley W. The use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients. Am Surg. 2003; 69:275–8. discussion. 8–9.

22. Jeon KM, Cho HC, Lee OB, Choi YB. The effect of intraperitoneal and intra-incisional application of bupivacaine on pain after laparoscopic cholecystectomy. J Korean Soc Endosc Laparosc Surg. 2008; 11:35–9.