Hon Phin Wong, MD, Hurng-Sheng Wu, MD, Dev-Aur Chou, MD, Shih-Wei Huang, MD
Show Chwan Memorial Hospital
OBJECTIVE: Cholecystectomy lends itself well to a single-incision laparoscopic surgery (SILS) approach. SILS is a virtually “scarless” technique; the single port is hidden in the umbilicus. As these procedures have become more widely adapted, it is important to determine the approximate learning curve to decrease two surgical endpoints: time to completion of the procedure; and, decreased incidence of conversion.
METHODS: We retropectively reviewed our series of 136 cholecystectomies using the SILS approach between Feb 2009 to Nov 2012. The access was made by a standard wound protector and a size 7 glove through the unbilicus. A series of little accesses were then made on the tips of the glove-fingers and the trocars were fitted into it and fixed by surgical knotting. We usually use two 5mm and a 10mm ports: 5mm ports for hand instruments and 10mm ports for the laparoscope, while clip applicator was introduced via the 4th finger access without trocar. Pneumoperitoneum was induces through the 10mm port during the operation
RESULTS: Of the 119 patients, average length of time for cases was 1 hour 28 minutes with a range between 35 minutes and 215 minutes. The average length of time for the first 25 cases was 99 minutes. When compared with cases in the 2nd, 3rd and 4th quintiles, the average length of time were 101 minutes, 87 minutes and 77 minutes; while the percentage of operation that can be completed within 90 minutes were 40%, 64% and 80%, respectively. Conversion was accomplished through the addition of a 5-mm port elsewhere on the abdominal cavity, with the rate of 9.2%. The postoperative course was uneventful in all patients.
CONCLUSIONS: The learning curve for successful consistent completion of SILS cholecystectomy cases appears to be after 50 cases. Conversion can be done by advancing an additional port on the abdomen without open surgery.
Session: Poster Presentation
Program Number: ETP042