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.