Supra-Pubic Single Incision Cholecystectomy

Abstract

IntroductionSurgery is moving towards less invasive and cosmetically superior approaches such as single incision laparoscopy (SIL). While trans-umbilical SIL is gaining popularity, incisions may lead to post-operative deformations of the umbilicus and the possibility of an increased rate of incisional hernias. Access within the pubic hairline allows preservation of the umbilicus and results in a scar which is concealed within the pubic hair.MethodsSupra-pubic single incision cholecystectomy was performed in a 30-year-old patient with symptomatic gallstones. A 2.5-cm transverse incision was placed within the pubic hairline and a subcutaneous tunnel was formed. Three 5-mm ports were introduced into the tunnel and perforated the anterior rectus sheath superior to the skin incision. The surgical procedure was then undertaken with conventional laparoscopic instrumentation. The adjacent 5-mm incisions were merged for gallbladder removal. The entry site was closed under direct vision.ResultsThe above procedure was technically feasible and without complication. Operative time was 45 min, and the patient was discharged 5 h post-operatively.ConclusionsSupra-pubic single incision laparoscopic cholecystectomy may offer a more cosmetically appealing result than standard umbilical access. The operation can be performed by surgeons skilled in single incision techniques with good result.Electronic supplementary materialThe online version of this article (doi:10.1007/s11605-009-1079-0) contains supplementary material, which is available to authorized users.

Traditional Versus Single-site Placement of Adjustable Gastric Banding: A Comparative Study and Cost Analysis

“…While new devices, with opposite hand dissection, have been proposed to achieve a better triangulation, surgeons typically do not prefer to use their non-dominant hand for dissection. Moreover, loss of the first assistant to help with exposure is a major drawback, as is the fact that the surgeon is forced to work in a parallel axis with constrained visibility [33].…”

Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study

“…At the same time, a single-incision technique was developed. This technique uses only one access point, mainly transumbilical or even suprapubic [1]. Some authors consider that the singleincision technique should be classified as part of NOS techniques, although the anatomical role of the umbilicus as a natural orifice remains controversial, and we think it should not be considered as such.…”

“…More than 150 publications in the last 5 years have dealt with transvaginal cholecystectomy, mainly performed as part of a hybrid technique (namely, with an additional route of transabdominal laparoscopic access) as well as with single-incision cholecystectomies [1,3,4,[9][10][11][12][13][14][15][16][17][18].…”

“…The first prospective randomised study of single-port cholecystectomy in 40 patients was published this year, but it was only double armed [17]. Most of the published data are feasibility studies, retrospective data analyses, 'how we do it' manuscripts or limited two-armed prospective data collections [1,3,4,7,9,10,[12][13][14][15][16][18][19][20]. Up to now, no prospective three-armed study comparing 'conventional' laparoscopic, single-incision and transvaginal cholecystectomy has been published.…”

Single-incision Robotic Cholecystectomy: Initial Experience and Results

“…Continued efforts to further reduce the invasiveness of this procedure have resulted in the development of singleincision laparoscopic cholecystectomy (SILC). [1][2][3] Navarra performed the first single-incision laparoscopic cholecystectomy procedure through the trans-umbilical approach in 1997. In recent years, literature related to this technology has accelerated to accumulate.…”