A New Retraction Technique Improves the Safety of Single Incision Laparoscopic Cholecystectomy

Kee-Hwan Kim, MD, PhD, Chang-Hyeok An, MD, PhD, Jeong-Soo Kim, MD, PhD, Il-Young Park, MD, PhD, Dong-Gu Kim, MD, PhD, Sang-Kwon Lee, MD, PhD

Department of Surgery, Uijeongbu St. Mary??s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea

Purpose:
Laparoscopic cholecystectomy is the gold-standard procedure for gallbladder removal. The advantages of this procedure over the open approach include better cosmetic result, less postoperative pain, and shorter recovery time. Recently, in order to reduce operative trauma and improve cosmetic result following laparoscopic cholecystectomy, new operative techniques have been developed. Single-incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of traditional laparoscopy, But, Limited retraction has been an obstacle in the advancement of pure single incision cholecystectomy. Adequate retraction is necessary to perform a safe cholecystectomy. We reviewed the results of a single instituition with respect of single incision cholecystectomy with a single 2mm needlescopic instrument and snake retractor to aid in obtaining a critical view of safety to identify the ideal surgical strategy of single incision laparoscopic cholecystectomy in disease of biliary tree.

Materials & Methods: Between October 2010 and August 2012, 265 patients underwent single incision laparoscopic cholecystectomy with needle scopic infundibular retraction for gallbladder disease in single institute by one surgeon, Uijeongbu St. Mary’s hospital. 265patients with a mean age 49.6± 14.5 years (range 12 to 82) were identified. We used a hand-made Glove port or SILSTM (Covidien, Tyco health Medical) single-port device for operation. Single port device was placed through umbilicus. A(2mm) needlescopic retractor(Stryker, San Jose, CA) was placed in the right flank region directly through the abdominal wall for retraction of the gallbladder infundibulum in an anterior and cephalad direction. And snake retractor was used for liver retraction We grouped two group: group A(without flexible videoscope), group B (with flexible videoscope)

Results: Patient all had a pathologic diagnosis of acute and chronic cholecystitis. ASA class averaged 1.62 (range 1 to 2). Operative times(skin to skin) averaged 64.1± 49.6 minutes (range 25 to 313 minutes): in simple cholecystectomy averaged 46.4± 24.7 minutes and in difficult cholecystectomy 82.8± 58.9 minutes (range 28 to 313 minutes) Postoperative hospital stays averaged 2.6 days. There were three open conversion cases:one bile duct injury, one uncontrolled bleeding and one difficult dissection. No major morbidity and mortality cases. postoperative stay were similar in two group, the operative time was significantly shorter in group B and the incidences of overall postoperative complications and biliary complications were statistically and insignificantly lower in group B.

Conclusions: Single incision cholecystectomy with a single needlescopic instrument is safe for acute and chronic cholecystitis even in gallbladder empyema. Liver retraction using a snake retractor is very useful in easy and difficult gallbladder disease.

Session: Poster Presentation

Program Number: P558