Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):344-352. 10.14701/ahbps.2019.23.4.344.

Solo single incision laparoscopic cholecystectomy using the parallel method; Surgical technique reducing a steep learning curve

Affiliations
  • 1Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. choiyoungrok@gmail.com
  • 2Department of Surgery, Chung-Ang University, College of Medicine, Chung-Ang University Hospital, Seoul, Korea.

Abstract

BACKGROUNDS/AIMS
To describe the techniques, short-term outcomes, and learning curve of solo single-incision laparoscopic cholecystectomy (Solo-SILC) using a laparoscopic scope holder.
METHODS
A total of 591 patients who underwent Solo-SILC from July 2014 to December 2016 performed by four experienced hepatobiliary surgeons were retrospectively assessed. Solo-SILC was performed using the parallel method using a scope holder. The moving average method was used to investigate the learning curve in terms of operative time.
RESULTS
In total, 590 Solo-SILC procedures were performed. Very few procedures were converted to multi-port laparoscopic cholecystectomy. There was one case of bile duct injury. The mean operative time (59.93±25.77 min) was shorter than that in other studies of SILC. Three postoperative complications, delaying bile leakage, occurred in the patients treated by one surgeon. These cases were resolved by ultrasound-guided puncture and drainage. The learning curve for surgeons A, B, and C was overcome after 14, 12, and 12 cases. Surgeon D, who had the most experience with SILC, had no obvious learning curve.
CONCLUSIONS
Hepatobiliary surgeons experienced in LC can perform Solo-SILC almost immediately. Solo-SILC using the parallel technique represents a more stable option and is a promising treatment for gallbladder disease.

Keyword

Cholecystectomy; Laparoscopy; Minimally invasive surgical procedures; Learning curve

MeSH Terms

Bile
Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic*
Gallbladder Diseases
Humans
Laparoscopy
Learning Curve*
Learning*
Methods*
Minimally Invasive Surgical Procedures
Operative Time
Paracentesis
Postoperative Complications
Retrospective Studies
Surgeons

Figure

  • Fig. 1 Solo-SILC technical procedure. (A) Single incision laparoscopic cholecystectomy (SILC), composed of operator and camera operator (scopist). (B) Solo single incision laparoscopic cholecystectomy (Solo-SILC), surgeon alone manipulates all instruments including the camera. (C) Laparoscopic scope holder (Laparostat™, CIVCO medical Solutions, IA, USA) is located in the level of lowest margin of left rib. (D) Glove port (Nelis, Bucheon-si, Gyeonggi-do, Korea) and instrument location; the body of the camera is kept low and the head is kept high, and each instrument is placed on both side of the camera. (E) Instrument movement; sideways vs. push & pull method.

  • Fig. 2 Learning curve of each surgeon. Learning curve for each surgeon A after 14 cases (learning period: 64.85±6.72 min; experienced period: 62.73±19.31 min; p=0.04). For the surgeon B, the operative time stabilized after 12 cases (learning period: 62.51±20.86 min; experienced period: 60.89±23.33 min; p=0.04) while surgeon C stabilized after 12 cases of Solo-SILC (learning period: 102.75±29.50 mins; experienced period: 84.38±21.51 mins; p=0.013). Surgeon D did not show a learning curve.


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