Objective: As the paradigm of Single Incision Laparoscopic Surgery (SILS) and Natural Orifice Translumenal Endoscopic Surgery (NOTES) advances, novel techniques and equipment are necessary for its progress. There have been various techniques for SILS cholecystectomy. Specifically, there has been no description of a single fascial incision without the addition of other ports or instruments for retraction. Here we describe a single port surgery (SiPS) cholecystectomy.
Methods: We recruited 9 consecutive patients with symptomatic cholelithiasis or acute cholecystitis. Making a 2cm incision through the umbilicus, we introduced a GelPort™ system to create pneumoperitoneum. A combination of 2mm and 5mm graspers were introduced through the Gelport™ system. A 5mm or 10mm flexible-tip laparoscope was used for visualization. We used either traditional or Autonomy™ Laparo-Angle™ electrocautery for dissection of the cystic duct and artery. Both the cystic artery and duct were clipped with a 5mm clip applier and divided with scissors. The gallbladder was then removed from its fossa with electrocautery and brought out through the wound protector.
Results: This procedure was successfully performed in all 9 patients without additional ports. All but two patients were female with a mean age of 46.8 years. Mean operating time was 75.6 minutes. Mean estimated blood loss was 22 milliliters. There were no intra-operative or post-operative complications observed in any patient. Six patients were discharged on the day of surgery. All 9 patients subjectively reported minimal pain post-operatively although no standardized scoring system was used.
Conclusion: Our results demonstrated that SiPS cholecystectomy could be safely performed today with current instrumentation. We believe the single port allows greater freedom of hand movements and instrument options. Furthermore, this procedure serves to advance technique development of NOTES by more closely resembling the in-line visualization and working space. Further improvements in the instrumentation should improve the outcomes and adoption of this procedure.
Program Number: P387