Gallbladder-First Technique of Single Incision Laparoscopic Cholecystectomy (SILC): Prospective Study in 125 Cases

Vincenzo J GRECO, MD, Andrew A GUMBS, MD FACS, Ziad ELRASSI, MD, Abe L FINGERHUT, MD FACS, Elie K CHOUILLARD, MD. On behalf of the Intercontinental Society of Natural Orifice, Endoscopic, and Laparoscopic Surgery (i-NOELS), Poissy, FRANCE

Aim: Natural Orifice Translumenal Endoscopic Surgery (NOTES) is a major conceptual change in the field of modern surgery. However, corresponding technological refinements are yet to be available in order to fill the gap separating the nowadays laparoscopy from the NOTES of tomorrow. Meanwhile, “hybrid” NOTES techniques and single incision procedures have been increasingly reported. Single Incision Laparoscopic Cholecystectomy (SILC) has been on the most reported procedures using such novel techniques in humans. One of the main concerns with this operation is the theoretical risk of increased injuries of the common bile duct due to suboptimal exposure. In this study, we describe our technique of SILC emphasizing its rationale based on avoiding to injure the common bile duct.
Methods: Patients with cholelithiasis, excluding those with acute cholecystitis, peritonitis, major previous surgery, or major organ failure, underwent SILC. The procedure was performed using a single 15 to 20 mm-diameter umbilical incision with three 5 mm-diameter port sites. The dissection was started at the level of the gallbladder liver bed without any prior vascular or ductal identification. The artery and the duct were identified after complete freeing of the gallbladder. No systematic cholagiography was performed.
Results: Eighty six women and 39 men were included in the study. Mean age was 38 years (range, 18-78). The procedure was achieved in 111 patients (88.8 %) without additional ports. The mean operative time was 49 minutes (24-159). There was no mortality. The post-operative rate of complications was 4 % (4 complications, including one surgical site infection and two incisional hernias). No bile duct injury or hemorrhage occurred. The median length of hospital stay was 2 days (1-14).
Conclusion: Our technique of SILC is safe and feasible in selected patients with cholelithiasis.