Clinical outcomes of single incision laparoscopic cholecystectomy using standard laparoscopic instrumentation.

Erin Moran-Atkin, MD, Nathan Richards, MD, Richard Amdur, PhD, Fred Brody, MD, MBA

Department of Surgery, The George Washington University Medical Center, Washington DC

Background
Recent publications document variable outcomes comparing laparoscopic and single incision cholecystectomies. This study compares a large group of single incision laparoscopic cholecystectomy (SILC) patients versus a traditional laparoscopic four-port group(4PLC). The clinical outcomes as well as narcotic usage were analyzed in this study.

Methods
A consecutive series of 211 patients underwent SILC from August 2008 to September 2012. All cholecystectomies were attempted through a single incision on an intent-to-treat basis. The SILC group entailed standard laparoscopic instrumentation with three 5mm ports. A commercial platform was not used. Patient demographics including height, weight, body mass index (BMI), pathologic diagnosis, ASA classification, operative time, complications, conversion, narcotic use, and length of stay(LOS) were recorded. Data for a matched cohort of patients(n=44) undergoing a traditional 4PLC were used for comparison. Data were compared using a t-test and multivariate analysis with a p<0.05 for statistical significance.

Results
There were no differences in demographics between the two groups. SILC was completed successfully in 73.3% of patients with a colangiogram in 90.5% of patients. The converted-SILC(C-SILC) group vs successfully completed SILC(S-SILC) group weighed significantly more (93.7+/-22.2Kg vs. 81.1+/-18.3Kg, p<0.0001) and had a significantly higher BMI (33.0+/-8.1 vs 29.4+/-6.6, p<0.001). Mean operative times were longer for the S-SILC vs. C-SILC (93.9+/-40.7min vs 75.1+/-18.8min, p<0.0001). Similarly S-SILC operative times were longer than 4PLC group (p<0.006). LOS for S-SILC was significantly shorter vs C-SILC and 4PLC (1.0+/-0.3days vs. 1.7+/-2.0days and 1.4+/-1.3days, p<0.001). Postoperative narcotic use was significantly lower in the S-SILC group compared to the C-SILC and 4PLC group (p<0.05). There was one incisional hernia in the S-SILC group. Male gender, higher ASA and hepatomegaly were associated with conversion to a C-SILC (p<0.006) on multivariate analysis.

Conclusions
The data suggests that morbidly obese individuals, especially men, may require conversion to a four-port cholecystectomy. However a S-SILC is associated with a shorter LOS and fewer narcotics postoperatively. The decrease in postoperative narcotics may reflect a smaller fascial incision at the umbilicus using standard laparoscopic ports versus the incision for a commercial platform. Finally, a commercial platform is not a requirement for a S-SILC.

Session: Poster Presentation

Program Number: P535