Davinci Single Incision Cholecystectomy: A Successful Rural Based Practice Experience.

Sofiane El Djouzi, Sean McClamon. Poplar Regional Medical Center

Background: Da Vinci® single-incision cholecystectomy (DSIC) experienced originlly a good acceptance when the technique was introduced, but the approach has been labeled with limitations such as high rate of incisional hernia and wound complications. This study aimed at sharing our practice experince and updating the previousely published outcome parameters.

Method: Retrospective review of a prospectively collected data on da Vinci single incision cholecystectomies. The cases were performed at a rural facility by a fellowship MIS trained single surgeon. The three arm da Vinci® Si platform was used. The access was created through a 2 cm skin semi-circular umbilical incision and a 2 cm longitudinal fascial incision. A five-lumen soft single incision port was used for docking the flexible instruments. Using absorbable braided suture material, several figures of eight stitches were fashioned to close the fascia. Descriptive statistics were analyzed followed by  a five-question quality of life phone survey.

Results: A total of 109 cases were collected of which 69% were female. The age range was 17 to 84 years with a median BMI of 31 [15.5 – 54.7]. The patients ASA was II in 66% and higher in the rest of the sample. The median total OR time was 88 min [44 – 220 min] with EBL recorded as 100 cc in 4 patients and less than 25 cc in the rest. Two conversions to laparoscopic cholecystectomy and one to open surgery were reported. A total of 8 cases of liver cirrhosis were diagnosed with 97% of pathology reports unveiling a wide spectrum of chronic cholecystitis severity. The phone survey reached 61% responders with a postoperative follow-up ranging: [3-22 months]. Full satisfaction was collected in 92% of the patients. The wound complications were: 2 cases of wound infections with one requiring incision and drainage of MRSA abscess and one case of hematoma that necessitated hospital readmission. There were only 2 cases of documented incisional hernias with no additional cases revealed through the survey. 

Conclusion: In our experience, DCIS is widely accepted by patients with an excellent overall satisfaction and only 2.7% wound complications. The technique is safe in acute cholecystitis and feasible in super obese patients. The fascia closure technique is likely the key factor leading to the low incisional hernia rate of 2%. 

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