Single Incision Laparoscopic Cholecystectomy, Initial Evaluation of a Large Series of Patients

Introduction: Single Incision Laparoscopic Cholecystectomy (SILC) has been found to be feasible and safe. We have pioneered and mastered a two trocar SILC technique at UT Southwestern. Here we present our initial data using this technique on fifty patients.

Methods: Following an institutional review board, patients with symptomatic gallbladder disease were recruited from January until October of 2008. During this time, 50 patients underwent SILC through a 1.5 – 2 cm umbilical incision with a two- port (5mm) technique (Dexide, Covidien). For all but one patient a 30 degree angled scope from Storz was used. The gallbladder was retracted with 2-3 interrupted sutures placed in the gallbladder fundus, body and Hartmann’s pouch. These sutures were either internally fixated or placed through the abdominal wall to obtain a critical view of Calot’s triangle structures. Lap chole was then performed by standard technique with a single 5mm articulating dissector (Covidien) and/or conventional laparoscopic instruments. The cystic duct and artery were divided with a 5mm clip applier. Cholecystectomy was completed with electrocautery and the specimen retrieved through the umbilical incision.

Results: 41 Females (82%) and 9 males (18%) underwent SILC. The average age was 36 years (21-66), mean body mass index was 28 kg/m2 (17.4-41). 47% of patients had previous abdominal surgery. The mean operative time was 73 minutes (35-120), mean estimated blood loss was 32cc (10-125), and 8% of patients had an intraoperative cholangiogram. There were no conversions of SILC technique. 10 % of patients had SILC due to problems including acute cholecystitis and or gallstone pancreatitis.

Conclusion: SILC with a two 5mm port technique is safe, feasible and quite reproducible clinically. Operating times are reasonable and can be lessen with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. SILC is becoming the standard of care for most of our patients with gallbladder disease. Clinical trials are still warranted before is adopted universally.

Session: Podium Presentation

Program Number: S024