HYPOTHESIS: Laparoscopic surgery has decreased trauma and improved results of surgery and single incision laparoscopic surgery (SILS) should be a further step in this direction. Minimizing the number and size of ports was an attempt to improve postoperative pain control, rapid return to activity, patient satisfaction, and cosmetic result. The umbilicus is a scar could be considered one of natural orifices of the human body. Healing of the re-opening of umbilicus gives no more scar and the operations via this natural hole would be considered a natural orifice surgery. We have carried out 36 laparoscopic cholecystectomies with transumbilical (TU) approach, using standard laparoscopic instruments. To do SILS, there is no need for special instruments. METHODS: 36 female patients underwent LC using SILS technique from January to December 2008. Only elective patients were enrolled in this series. None of them has the history of acute cholecystitis and they have BMI lesser than 35. Patients underwent LC with three ports: three 5-mm ports or one 10-mm port and two 5-mm ports. Trocars of 5 mm were introduced parallel to another with a bridge of fascia between them. With 5-mm grasper, from the left side port, the gallbladder was pulled up and the triangle of Callot was dissected free, cystic duct and artery clipped, cut, and the gallbladder was subsequently resected, taken out through the umbilicus and the umbilicus reconstructed. There were no conversions to an open procedure, no fourth trocars added, and no complications. The postoperative course was uneventful.
RESULTS: 36 female patients, mean age 36 years (range: 31–49), with cholelithiasis confirmed by ultrasonography with no suspicion of inflammation were included in this preliminary study. Mean operative time was 70 minutes (range: 65–85) with no conversions. The postoperative course was uneventful. The patients had no postoperative pain and no scars, and were discharged on the second postoperative day.
CONCLUSION: Looking to reduce operative trauma and improve the cosmetic result following LC, a SILS operative technique has been developed. Results of the operative procedure in a selected group of patients were encouraging. The umbilicus can be developed as a natural port for performing various operative procedures.
Program Number: P480