‘lesssons ‘ Learned: Single Centre Experience of Single Port Cholecystectomy

Introduction: Single Port Surgery has been described and published by various authors. A recent consensus meeting and white paper from the Cleveland Clinic gave the acronym LESSS (Laparo- Endoscopic Single Site Surgery) for all such procedures. We present the largest series of single port cholecystectomies to date using the R Port (Tri port). The paper gives the evolution of single port surgery in our hands. Materials and Methods: From May 2007 to date a total of 42 patients were subjected to LESSS for symptomatic Cholelithiaisis. The initial problems we faced were the chopsticks effect of all three instruments entering through the same site, the light cable clashing with the instruments and the inability to place a 10 mm clip applier. All these were surmounted using modified instruments and special equipment. Results. In the initial cases, one patient required a 5mm port and one 5 mm port was used for two patients for CBD exploration. One other patient needed a 2mm grasper for suturing. Single port surgery was successfully accomplished in 38 / 42 (90%) of the patients. Of these, in 10 patients, a port closure needle was used to retract the gall bladder. In 28 patients (66%) no extra needle or any kind of instrumentation was used. We realized that using a sandbag under the right scapula, lifted the gall bladder sufficiently into the field of view to obviate the need for a Similarly, increasing the umbilical port incision from 17 mm in our early cases, to 25 mm in our later cases, gave us the increased play between the instruments, needed for free movement to finish the procedure without extra instrumentation. Conclusion: The operative time showed a significant decline later. Decreased pain, decreased need for analgesics and improved cosmesis were the benefits of the procedure.

Session: Poster of Distinction

Program Number: P015

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