Single Incision Laparoscopic Cholecystectomy in a Community Setting: Is Operator Experience Important?

M Bassante, MD, D McDonald, MD, R Hall, MD, C Moss, MD, M Kadowaki, MD, W Browder, MD

East Tennessee Department of Surgery

Abstract

BACKGROUND:
Single-incision laparoscopic cholecystectomy (SILC) is an alternative to standard laparoscopic cholecystectomy. Until recently, it has been confined primarily to high volume centers; however, with the rise of newer techniques and advances in technology it is becoming a more common practice in the community setting. In this study we review our experience with this technique in the setting of 108 consecutive patients to assess the importance of operator experience.

METHODS:
This is a review of 108 consecutive single incision laparoscopic cholecystectomies performed by a single surgeon. Multiple parameters were analyzed including: age, sex and ethnicity, ASA score, Body Mass Index, operating time, need for additional trochars, conversion to open cholecystectomy, length of hospital stay (LOS) and post-operative complications. The initial 50 cases (group 1) were compared to the subsequent 58 SILC cases (group 2) with regard to the above parameters.

RESULTS:
Demographics of the two groups were similar with respect to ethnicity (100% Caucasian in both groups), age (49.94±16.8 years vs. 51.46±17.37 years; p=0.645), gender (36% male vs. 45% male; p=0.433), BMI (33.56±10.99 kg/m2 vs. 30.16±5.9 kg/m2; p=0.208), ASA class (2.34±0.65 vs. 2.37±0.64; p=0.717), LOS (0.78±1.97 vs. 0.44±1.07; p=0.394). Operative time in group 1 was longer (68.58±25.6 minutes vs. 46.5±25.3 minutes; P<0.05). Additional port placement was required more often in group 1 (52% vs. 15%, p<0.05). There was only one conversion to open cholecystectomy from either group, and the number of complications was similar between groups (10% vs. 8.4%; p=1.00).

CONCLUSIONS:
After reviewing our experience with SILC, it appears that this technique is a reasonable alternative to traditional laparoscopic cholecystectomy. However, like most operative procedures, there does appear to be a learning curve, which was reflected in the decreased operative time and decreased need for additional port placement in the second group.


Session: Poster Presentation

Program Number: P547

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