Single-incision laparoscopic cholecystectomy: surgery without a visible scar

Abstract

Laparoscopic cholecystectomy has been recognized since 1992 as the gold standard procedure for gallbladder surgery. The authors propose a single-incision laparoscopic (SILS) cholecystectomy as a step toward less invasive surgical procedures. A single intraumbilical 12-mm incision is made, and the umbilicus is pulled out, exposing the fascia. Pneumoperitoneum is induced with the Versastep Veress access needle. A 5-mm trocar then is introduced, and the abdominal cavity is explored with a 5-mm 30 degrees optic. Second and third trocars are introduced respectively at the left and right sides, near the first trocar. Two sutures are used to suspend the gallbladder and to ensure optimal exposure of the Triangle of Calot. Dissection is performed as a normal retrograde cholecystectomy using an Endoshear roticulator in the left trocar and an Endograsp roticulator in the right hand. The cystic artery and cystic duct are clipped separately with a standard 5-mm clip applier and then excised. The gallbladder is removed through the umbilical incision. Of the 12 patients who underwent SILS cholecystectomy without major complications, 8 had previously undergone other laparoscopic surgeries. The body mass index (BMI) exceeded 35 in three cases. Operative time decreased and stabilized from the first 3-h SILS cholecystectomy to approximately 50 min after the first five cases. At this writing, the authors find SILS cholecystectomy to be feasible, safe, and effective.

The initial experience of dual port laparoscopy-assisted total gastrectomy as a reduced port surgery for total gastrectomy

“…The most important merit of RPS is cosmesis [3,4,6,9,11,13]. Therefore, this cosmetic merit must be retained as long as possible when performing RPS for total gastrectomy.…”

“…In recent years, reduced port surgery (RPS), including single port surgery (SPS), in which fewer ports are used than in conventional procedures, has become increasingly popular in various surgical fields [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. There have been reports describing the application of RPS to laparoscopic sleeve gastrectomy for morbid obesity or laparoscopic partial gastrectomy for gastrointestinal stromal tumors, and the use of RPS has recently also been reported in laparoscopy-assisted distal gastrectomy for gastric cancer [1,7,[15][16][17].…”

Comparison of Cosmetic Outcome Between Single-Incision Laparoscopic Cholecystectomy and Conventional Laparoscopic Cholecystectomy in Rural Indian Population: A Randomized Clinical Trial

“…SILC was first described in 1997 [6], but it remained reserved for selected patients owing to technical difficulties [7,8]. With the advent of more sophisticated instruments, many reports on SILC cholecystectomy have demonstrated its feasibility and wide acceptability [9][10][11].…”

Single-incision laparoscopic cholecystectomy: is it more than a challenge?

“…Despite obeying the rules of chest tube insertion, passing the suture in the pleural space may give rise to bleeding, pneumothorax, and/or lung injury, especially in a patient who is ventilated under positive pressure. The suspending suture, thus, should be better placed through the abdominal wall as suggested by Tacchino et al [2]. The potential complications that may follow are not acceptable for a standard laparoscopic cholecystectomy.…”