Ann Surg Treat Res.  2014 Apr;86(4):177-183. 10.4174/astr.2014.86.4.177.

Single incision laparoscopic cholecystectomy using Konyang Standard Method

• Son JI
• Choi IS
• Moon JI
• Ra YM
• Lee SE
• Choi WJ
• Yoon DS

• KMID: 2167123
• DOI: http://doi.org/10.4174/astr.2014.86.4.177

Abstract

PURPOSE
Single incision laparoscopic cholecystectomy (SILC) is a minimally invasive surgery that is growing rapidly among surgical procedures. However, there is no standard method for SILC. Therefore, we evaluated the adequacy and feasibility of SILC using Konyang Standard Method.
METHODS
We retrospectively reviewed our series of 307 SILCs performed between April 2010 and August 2012. Initially we excluded the patients who were more than 70 years old, had cardiologic or pulmonologic problems and complications of acute cholecystitis. After 50 cases, we did not apply the exclusion criteria. We performed SILC by Konyang Standard Method using three-trocar single port (hand-made) and long articulated instruments.
RESULTS
Three hundred and seven patients underwent SILC. Male were 131 patients and female were 176 patients. Mean age was 51.6 +/- 13.7 years old and mean body mass index was 24.8 +/- 3.6 kg/m2. Ninety-three patients had histories of previous abdominal operation. Patient's pathologies included: chronic cholecystitis (247 cases), acute cholecystitis (30 cases), gall bladder (GB) polyps (24 cases), and GB empyema (6 cases). Mean operating time was 53.1 +/- 25.4 minutes and mean hospital stay was 2.9 +/- 3.4 days. There were four cases of 3-4 ports conversion due to cystic artery bleeding. Complications occurred in 5 cases including wound infection (2 cases), bile duct injury (1 case), duodenal perforation (1 case), and umbilical hernia (1 case).
CONCLUSION
SILC using Konyang Standard Method is safe and feasible. Therefore, our standard procedure can be applied to almost all benign GB disease.

Keyword

Laparoscopic cholecystectomy; Konyang Standard Method

MeSH Terms

Aged
Arteries
Bile Ducts
Body Mass Index
Cholecystectomy, Laparoscopic*
Cholecystitis
Cholecystitis, Acute
Empyema
Female
Hemorrhage
Hernia, Umbilical
Humans
Length of Stay
Male
Pathology
Polyps
Retrospective Studies
Surgical Procedures, Minimally Invasive
Urinary Bladder
Wound Infection

Figure

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  Fig. 1 Hand-made port and the long articulated Endo-roticulator.

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  Fig. 2 Schematic diagram of single incision laparoscopic cholecystectomy.

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  Fig. 3 "Cephalic traction" on the fundus and "lateral traction" on the infundibulum of the gallbladder.

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  Fig. 4 Exposure of the Calot's Triangle. (A) Anterior dissection, (B) posterior dissection of peritoneum of cystic duct.

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  Fig. 5 Isolation and division of cystic duct and artery. (A) Isolation of the cystic duct and artery using 30°-50° angulated dissector, (B) division of the cystic duct and artery.

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  Fig. 6 Dissection of the gallbladder off the liver bed using suction-hook bovie divices.

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