A Novel Method in Single Incision Laparoscopic Cholecystectomy without a Cameraman.

Ho-Seong Han, YoungRok Choi, Yoo-Seok Yoon, MD, PhD, Jae Young Cho, MD, PhD, Jae Yool Jang, Han Lim Choi, Jae Seong Jang, Seong Wook Kwon. Seoul National University, College of Medicine

Purpose: This study aimed to evaluate the implementation of solo surgery using a laparoscopic scope holder in the single incision laparoscopic cholecystectomy (SILC).

Method: With a glove port and a flexible high-definition scope, a SILC was performed through the trans-umbilical single incisional site with CO2 pneumoperitoneum with the pressure of 12 mmHg. Fifty nine cases of solo SILC using a scope holder (Solo-SILC) were compared with 15 cases of cameraman-assisted SILC (Ca-SILC) in the aspect of surgical outcomes.

Result: Two cases of chronic cholecystitis and 13 cases of GB stones in Ca-SILC, 20 cases of cholecystitis including acute- and chronic-cholecystitis, gangrenous cholecystitis, 38 cases of GB stones and 1 case of GB polyp in Solo-SILC were included. One case in Ca-SILC(A) and 3 in Solo-SILC were emergency cases. Their mean BMI and operation time were 23.0 ± 3.6 kg/m2 & 64.4 ± 16.6 min and 25.0 ± 3.8 kg/m2 & 58.3 ± 26.9 min in Ca-SILC and Solo-SILC respectively (P=0.077 and P=0.416). The estimated blood loss was scanty and there was no the additional assistant port in both groups. One case of intraoperative gallbladder perforation and bile leak were happened in Ca-SILC and 3 cases in Solo-SILC (P=0.167). Postoperative outcomes including surgical complications, diet restriction, diarrhea and hospital stay were not significantly different except shoulder pain (P=0.009).

Conclusions: Even with the limitations of the small series of patients, a Solo-SILC is feasible. To confirm the safety of solo-SILC, further studies with a large sample size are required.

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