4-channel single incision laparoscopic cholecystectomy using a snake retractor

In Seok Choi, PhD, Naksong Sung, MD, Wonjun Choi, MD, Ju Ik Moon, MD, Daesung Yoon, MD, Yumi Ra, MD. Department of Surgery, Konyang University Hospital, Daejeon, Korea.

Introduction: Single incision laparoscopic cholecystectomy (SILC) is rapidly popular. Common technique in SILC is a 3-channel method. However, there is a certain limitation for exposure of Calot’s triangle. Therefore, we report an adequacy and feasibility of 4-channel SILC using a snake retractor.

Material and methods: 480 SILC were performed between April 2010 and June 2013. 326 3-channel SILC had been performed from April 2010 to September 2012. After October 2012, we have added a snake retractor for liver retraction and modified to 4-channel SILC. 125 4-channel SILC have been performed.

Results: Previous upper GI operation history was higher in 4-channel SILC (2.1% vs. 8.0%, p=0.021), a mean BMI in either group was similar (25.7kg/m2 vs. 24.9kg/m2, p=0.592), a mean operating time was similar (53.0 minutes vs. 52.6 minutes, p=0.879), a rate of preoperative PTGBD treatment due to acute inflammation was higher in 4-channel SILC (9.2% vs. 20.1%, p<0.001), and a mean hospital stay was shorter in 4-channel SILC (3.0d vs. 2.4d, p=0.003). Ports addition were at 6 cases (1.8%) vs. 4 cases (2.6%) (p=0.733), because of cystic artery bleeding, or bile leakage from GB bed, but there were no open conversions. 6 complications (3 wound infections, 1 bile duct injury, 1 duodenal perforation, and 1 incisional hernia) were observed at 3-channel SILC, whereas 1 wound infection was observed at 4-channel SILC without significant difference. (p=0.773)

Conclusion: 4-channel SILC using the snake retractor is safe and feasible. Therefore, almost all benign diseases of gallbladder could be treated with 4-channel SILC.

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