Clinical Analysis of Single-Port Laparoscopic Cholecystectomies: Early Experience

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. (J Korean Surg Soc 2011;80:43-50)

A Comparative Clinical Evaluation of Laparoscopic Cholecystectomy With Single and Multiport Access

“…Gall bladder perforation and bile spillage has also been reported by Song SC, Ho CY, Kim MJ, et al (2011). [9] They reported bile leakage in 6.2% cases in multiport group and 3.7% cases in single incision laparoscopic cholecystectomy group.…”

“…Whereas study conducted by Song SC, Ho CY, Kim MJ, et al (2011) [9] showed that mean operating time was found less using articulating instruments with flexible laparoscope which helped in reducing the learning curve. According to them long operating time was also due to severe inflammation of gall bladder as also been observed in two of our cases of empyema gall bladder.…”

“…3]. Similar 2 mm diameter mini-laparoscopic grasper was used by Song SC, Ho CY, Kim MJ, et al (2011) [9] in their 5 patients of single incision laparoscopic cholecystectomy, inserted through right sub-costal margin or through the inferior portion of umbilicus for retraction of gall bladder in order to ensure safe single incision laparoscopic cholecystectomy.…”

Our Experience With Single-Incision Laparoscopic Cholecystectomy

“…It has also been performed with multiple individual trocars through separate incisions within the umbilicus. We performed SPLC using X-cone single port access system, whereas there are authors who have used different types of access ports in their studies like Triport, [3,4] R-Port, [5] Glove port, [6,7] , Covideon. [8] The mean operating time in our study, which was taken from initial incision to closure of wound was 87.…”

The real-world application of single incision laparoscopic cholecystectomy

“…Two 2 mm trocars were inserted in the right subcostal area and at the anterior axillary line. The surgical technique was then identical to SILC, and has been described previously [5].…”