First Report of a New Access Site, Extraumbilical, for Single Port Laparoscopic Cholecystectomy; Three Trocars with Multipl Puncture Technique, a Pilot Study of 25 Cases

M. TAHIR ORUC, MD, M.UMIT UGURLU, MD, S.YIGIT YILDIZ, MD, ILKNUR ERGUNER, MD, ZEHRA BOYACIOGLU, MD, KURSAT CETIN, MD, ALI CIFTCI, MD. Kocaeli Derince Teaching and Research Hospital, Kocaeli, Turkey

Introduction: Single port laparoscopic cholecystectomy is a rapidly progressing field as it combines some advantages such as cosmesis and less incisional pain. But it has also some disadvantages such as limitation of movement and clashing of the hand instruments which increases the complexity and technical challenges of the operation. We herein describe a new access site for single port cholecystectomy that can reduce these problems.
Method: Twenty five patients underwent laparoscopic cholecystectomy with new method. Acute cases with empyema and patients with history of previous abdominal surgery were excluded. Single incision is established on the right upper quadrant, right laterosuperior of the umbilicus so that trocar sites and projection of the gallbladder on the abdominal wall should be on the same vertical line to minimize the angle between them to prevent to clash. Then three trocars are placed into the abdominal cavity. Once the laparoscope, grasper and dissector is in place, the overall procedures are similar to the standard laparoscopic cholecystectomy.
Results: Laparoscopic cholecystectomy with single port access using three trocars with this new method was succesfully completed in all 25 patients without conversion to open surgery. Additional skin incision and trocar access were required only in two patients. The mean operative time was 39.3 (range, 20-75) min. The mean body mass index was 27.2. Postoperative course was uneventful in all patients. The mean postoperative hospital stay was shorter than 24 hours and all patients were discharged at first day postoperatively. No postoperative complications including seroma, wound infection, trocar-site hernia has been observed at 3 months follow-up after surgery. Postoperative analgesic needs were lower than patients operated with standard laparoscpic cholecystectomy.
Conclusion: We described a new access site, extraumbilical, for single port laparoscopic cholecystectomy and reported our initial experience of single port laparoscopic cholecystectomy with extraumbilical, three trocars technique in 25 patients. This is the first report in the literature. According to our experince, many of the patients with gallstone disease are amenable to this approach. We believe that this type of port access overcomes the technical difficulties of performing SPLC and therefore this technique is a promising alternative method for the treatment of patients with symptomatic gallstone disease as a minimal invasive abdominal surgery.