SILS Cholecystectomy

Adrian M Maghiar, MD, PhD, George E Dejeu, MD, Pravish R Sookha, MD, PhD

Spitalul Pelican Oradea, Romania

Aim: Evaluating the difference between two SILS Cholecystectomy techniques in the experience of our clinic.
Methods: From August 2009 till September 2012 the surgical teams, taking in consideration ultrasonography measurement of the thickness of the gallbladder wall, previous surgery on superior abdominal wall, and the lack of signs of acute inflammation, proposed the single incision laparoscopic cholecystectomy to all patients that met all conditions.
Our technique involves a 2 cm transombilical incision, through which we introduce our first 10 mm trocar and perform a exploratory laparoscopy. If the case seems feasible for SILS cholecystectomy, we continue by placing a second 10 mm trocar just anterior and lateral to the first one.
We took into consideration 100 consecutive cases resolved by SILS Cholecystectomy through the puppeteer technique (group A) and 100 consecutive cases resolved by SILS Cholecystectomy using the Dapri forceps from Karl Storz and the Endograb (group B).
Results: We had 4 conversions from SILS to classic laparoscopic cholecystectomy. All of these cases were for bleeding difficult to control through the SILS technique, all in the first 100 cases resolved by the puppeteer technique. The mean operation duration was 42 minutes for the puppeteer technique and 33 for the technique using the Dapri forceps. We must admit that the first SILS Cholecystectomy using the Dapri forceps was after the first 90 cases resolved by the puppeteer technique. Most patients were female in both groups (79% in group A and 82% in group B). There was no statistically significant difference in pain score and cosmetic result (as judged by the patients) between the groups (pain score of 3.4 out of 10 for group A and 2.8 for group B; and cosmetic result score at one month postop of 9.2 out of 10 for group A and 9.5 for group B).
Conclusions: Single incision laparoscopic surgery is still a new concept, it is feasible, and will definitely be in great demand in the future. The puppeteer technique is a economic way of performing SILS cholecystectomy and can be performed in all surgery clinics that are performing laparoscopic procedures. The introduction of curved instruments, although more expensive, comes in the aid of both surgeons ergonomics and shortening the operating time without the sacrifice of patient safety. More studies are needed before one can draw a clear conclusion on weather one technique is better than the other.

Session: Poster Presentation

Program Number: P349