Single-access laparoscopic cholecystectomy with routine intraoperative cholangiogram

Abstract

Completion of intraoperative cholangiography is an important aspect of cholecystectomy in order to identify choledocholithiasis and verify anatomy. With the advent of single-access laparoscopy, standard operative principles should not be compromised. Cholangiography may provide a safer approach to cholecystectomy when adopting a new technique. We present our technique of single-incision cholecystectomy and routine cholangiography with a 95% success rate. The ability to perform single-incision intraoperative cholangiograms will allow a safe, more minimally invasive approach to cholecystectomy with suspected choledocholithiasis and obviate the need to convert to standard multiport laparoscopy for the sole reason of completing cholangiograms.

Single‐site robotic cholecystectomy: efficiency and cost analysis

“…However, we did not find this to be the case and only chose the laparoscopic approach for carefully selected patients, such as those without high‐acuity inpatient illnesses (acute cholecystitis, biliary pancreatitis or cholangitis) and for patients without an indication for intraoperative cholangiography (IOC). While difficult cases and IOC are feasible with SILC, and routine IOC can be performed by the advanced laparoscopic surgeon , these are the exception rather than the rule and we did not feel that the potential benefits outweighed the technical difficulties. Therefore, after 10 cases within a 13 month time period (ending in 2010), we made the decision to discontinue the use of the SILC approach.…”

Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate

“…15 Several of the studies included in our analysis note that the presence of acute cholecystitis was used as an exclusion factor in the determining whether to proceed with SILC versus SLC. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] Although the study investigators should be commended for limiting their application of SILC methods to disease processes without an acute inflammatory component, the result is that our aggregate database contains mostly cases at low risk for biliary injury, namely those performed in the best of circumstances (ie, minimal inflammation). Although no investigator has published results of SILC specifically performed for acute cholecystitis, the natural progression of a new surgical technique to broader indications as surgeons become facile with SILC would suggest that this will soon be evaluated.…”

Transumbilical single-incision laparoscopic cholecystectomy: long-term review from a single center

“…As reported, a larger transumbilical incision was more likely to increase the incidence of incisional hernias [16,[61][62][63]. The reported hernia rate ranged from 0.9 to 4.8 % for SILC, but higher incidence might be identified when performed through single-port product [2,3,26,29,38,44,45,64] than SILC through three traditional ports [40,[65][66][67]. As a matter of fact, the umbilical hernia rate was 0.2 % in our long-term review, which was much lower than current reported rates.…”