Single-incision Laparoscopic Cholecystectomy Using a Surgical Glove Port

Naoki Ishida, MD, Tomoaki Okada, MD, Yoshitomo Ueno, MD, Kei Tamura, MD, Tetsuya Mizumoto, MD, Michiko Yamashita, MD, Masaru Matsumura, MD, Yoshinori Imai, MD, Taro Nakamura, MD, Hidenori Kiyochi, MD, Kenzo Okada, MD, Toshihiko Sakao, MD, Shinsuke Kajiwara, MD. Uwajima City Hospital, Uwajima, Ehime, Japan

Introduction: Single-incision laparoscopic cholecystectomy (SILC) is expected to produce better cosmetic results and shorten the recovery period for patients. However, SILC is associated with difficulties in performing the procedure and decreased safety compared to conventional methods. SILC using a surgical glove port was adopted in selected cases, and the initial results were evaluated.
Methods: The SILC with the surgical glove port method was performed as follows: A 3.0 cm skin incision was made in the umbilicus. A mini sized LAP PROTECTOR was placed through the umbilical wound. Subsequently, a non-powdered surgical glove (5.5 inches) was put on the LAP PROTECTOR through which two 5 mm slim trocars and one 3 mm trocar were inserted via the finger tips. Furthermore, one 3 mm trocar was punctured at the epigastrium. An additional 3 mm trocar was placed under the right costal arch for the first 8 cases.
Results: A total of 30 cholecystectomies were performed using this method from December 2009 to May 2011 in our institute. All cases had cholelithiasis. Fourteen patients were male and 16 were female. Their mean age was 54.8 years, with a range from 31 to 83 years. The average length of the operation was 96.0 minutes, ranging from 48 to 166 minutes. Four cases were complicated by chronic cholecystitis. Among, these four cases, three cases were converted to three port laparoscopic cholecystectomy and one case required laparotomy due to hemorrage from the gallbladder bed. The mean duration of the postoperative hospital stay was 4.3 days.
Discussion: The cosmetic results and duration of postoperative hospital stay were satisfactory. However, the average length of the operation for SILC was much longer than that of our conventional laparoscopic cholecystectomy. This method was a feasible technique for cholecystectomy that was associated with good cosmetic results and less invasiveness. Further efforts should therefore be made to improve this surgical technique.

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