Masafumi Ohira, MD1, Kazuaki Shibuya, MD1, Kazuhiro Uemura, MD1, Hiroaki Takahashi, MD1, Naotake Honma, MD2, Yoshihiko Osaka, MD2, Yoshio Ito, MD1. 1Department of Surgery, National Hospital Organization Hokkaido Medical Center, 2Department of Thoracic Surgery, National Hospital Organization Hokkaido Medical Center
Background: Single-incision laparoscopic cholecystectomy (SILC) has gained popularity recently thanks to improvements in laparoscopic instruments and techniques. However, it is more challenging than conventional (multi-port) laparoscopic cholecystectomy because of instrument collisions and limited workspace. The procedural difficulty may increase when the port-to-target distance is long. We aimed to assess the correlation between port-to-target distance and procedural difficulty and determine the predictability of difficult cases in single-incision laparoscopic cholecystectomy (SILC).
Methods: In 36 consecutive patients who underwent SILC at our hospital, the intraoperative umbilicus-to-Calot’s triangle distance (UCD) was measured, and, in addition, the UCD was estimated from preoperative computed tomography (UCD-CT). The correlation between the UCD and the operative time and the predictability of the actual UCD from UCD-CT were analyzed. Operative time was calculated as pneumoperitoneum time to eliminate the effect of trocar placement and wound closure. The usefulness of UCD-CT as a predictive factor for difficult cases was assessed by receiver operating characteristic (ROC) curve analysis.
Results: Thirty-four patients successfully underwent SILC. Two patients required conversion to open cholecystectomy for severe inflammation and adhesion, and they were excluded from further analysis. There were positive correlations between the UCD and pneumoperitoneum time (rs=0.682, P<0.0001) and between the UCD-CT and UCD (rs=0.802, P<0.0001). The area under the ROC curve of UCD-CT for detecting prolonged operative duration cases (pneumoperitoneum time >60 min) was 0.875 (95% confidence interval, 0.75–1); the sensitivity and specificity sum was maximum at a UCD-CT of 219 mm.
Conclusions: A longer UCD is correlated with longer operative time, and it is possible to estimate actual UCD from preoperative computed tomography. The UCD-CT may be a good predictive factor for difficult SILC cases. If the UCD-CT is ≥220 mm, shortening of the umbilical incision and use of an additional trocar may help decrease invasiveness and improve surgical maneuverability.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77347
Program Number: P104
Presentation Session: Poster (Non CME)
Presentation Type: Poster
