Ann Surg Treat Res.  2016 Nov;91(5):233-238. 10.4174/astr.2016.91.5.233.

Single center experiences of needle-scopic grasper assisted single incision laparoscopic cholecystectomy for gallbladder benign disease: comparison with conventional 3-port laparoscopic cholecystectomy

• Kim TS
• Kim KH
• An CH
• Kim JS

• KMID: 2356373
• DOI: http://doi.org/10.4174/astr.2016.91.5.233

Abstract

PURPOSE
Single incision laparoscopic cholecystectomy (SILC) has some technical problems. Our group has performed needlescopic grasper assisted SILC (nSILC) to overcome these problems. In this study, we introduce our technique and evaluate the safety and feasibility of this technique compared with the conventional laparoscopic cholecystectomy (CLC).
METHODS
The medical records of 485 patients who received nSILC and CLC were reviewed retrospectively. Surgical outcomes including operative time, hospital stay, postoperative pain and perioperative complication were compared between the 2 techniques.
RESULTS
Although wound complications were developed more frequently in nSILC group, there was no significant difference between groups in other surgical outcomes. In subgroup analysis, surgical outcomes of nSILC were similar with those of CLC not only in easy group but also in difficult group.
CONCLUSION
It seems that nSILC is safe and feasible not only in selected patients but also in difficult cases such as acute cholecystitis.

Keyword

Minimal invasive surgical procedures; Cholecystectomy; Laparoscopy

MeSH Terms

Cholecystectomy
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute
Gallbladder*
Humans
Laparoscopy
Length of Stay
Medical Records
Operative Time
Pain, Postoperative
Retrospective Studies
Wounds and Injuries

Figure

• 

  Fig. 1 External view of needlescopic grasper assisted single incision laparoscopic cholecystectomy procedure. Needlescopic grasper (black arrow) was used for traction through direct puncture on right upper abdomen. Snake liver retractor (white arrow) was used for cephalad traction of liver to obtain better visualization.

• 

  Fig. 2 Intra-abdominal view of needlescopic grasper (black arrow) assisted single incision laparoscopic cholecystectomy using snake liver retractor (white arrow). Clear visualization can be obtained by lateral and cephalad traction.

Reference

1. Solomon D, Bell RL, Duffy AJ, Roberts KE. Single-port cholecystectomy: small scar, short learning curve. Surg Endosc. 2010; 24:2954–2957.

2. Pan MX, Jiang ZS, Cheng Y, Xu XP, Zhang Z, Qin JS, et al. Single-incision vs three-port laparoscopic cholecystectomy: prospective randomized study. World J Gastroenterol. 2013; 19:394–398.

3. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg. 1997; 84:695.

4. Wagner MJ, Kern H, Hapfelmeier A, Mehler J, Schoenberg MH. Single-port cholecystectomy versus multi-port cholecystectomy: a prospective cohort study with 222 patients. World J Surg. 2013; 37:991–998.

5. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010; 211:132–138.

6. Avgerinos C, Kelgiorgi D, Touloumis Z, Baltatzi L, Dervenis C. One thousand laparoscopic cholecystectomies in a single surgical unit using the "critical view of safety" technique. J Gastrointest Surg. 2009; 13:498–503.

7. Heistermann HP, Tobusch A, Palmes D. Prevention of bile duct injuries after laparoscopic cholecystectomy. "The critical view of safety". Zentralbl Chir. 2006; 131:460–465.

8. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995; 180:101–125.

9. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20:35–46.

10. Kim MJ, Kim TS, Kim KH, An CH, Kim JS. Safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic cholecystectomy in patients with acute cholecystitis: comparison with three-port laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2014; 24:523–527.

11. Barband A, Fakhree MB, Kakaei F, Daryani A. Single-incision laparoscopic cholecystectomy using glove port in comparison with standard laparoscopic cholecystectomy SILC using glove port. Surg Laparosc Endosc Percutan Tech. 2012; 22:17–20.

12. Cheon SU, Moon JI, Choi IS. Risk factors for prolonged operative time in single-incision laparoscopic cholecystectomy. Ann Surg Treat Res. 2015; 89:247–253.

13. Srikanth G, Shetty N, Babu P. A technique for gall bladder fundal traction in single-incision laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2011; 21:e239–e241.

14. Horisberger K, Grossen E, Schöb O. How to meet the challenge of flexible exposure of the Calot triangle in SILS cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2012; 22:e63–e65.

15. Canes D, Desai MM, Aron M, Haber GP, Goel RK, Stein RJ, et al. Transumbilical single-port surgery: evolution and current status. Eur Urol. 2008; 54:1020–1029.

16. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A. 1999; 9:361–364.

17. Raman JD, Scott DJ, Cadeddu JA. Role of magnetic anchors during laparoendoscopic single site surgery and NOTES. J Endourol. 2009; 23:781–786.