• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Single Incision Laparoscopic Cholecystectomy with Routine Cholangiogram: Report of 30 Cases

Introduction: One concern with the single incision technique for cholecystectomy is that inferior retraction and triangulation could cause injuries of the common bile duct. One method of minimizing the chance for a missed CBD injury is to employ routine cholangiography. There are no reports in the literature of routine cholangiograms being performed with SILS cholecystectomy. We present our results from thirty cases in which routine cholangiogram was attempted.
Methods: Operative records and follow-up data from 30 patients undergoing SILS cholecystectomy were retrospectively reviewed. The SILS port (Covidien, Norwalk, CT) was utilized along with roticulating instruments. Percutaneous sutures were placed through the gallbladder for retraction. In some cases, additional retraction was needed and one or two 2mm graspers were inserted in the right subcostal space. Cholangiogram was attempted in all patients utilizing an Olsen clamp introduced through the SILS port. Operative data reviewed were: Patient demographics, BMI, indication for surgery, operative time, need for conversion or placement of additional ports, whether or not the cholangiogram was successful, time to perform the cholangiogram, and results of the cholangiogram. Follow up data reviewed were: length of stay, time interval to follow-up, length of narcotic use, days to return to normal activity, wound evaluation (healed, infection, hernia).
Results:
Patient demographics: 23 female, 7 male. Average patient age 50 years, average BMI 31.
Indication for surgery: Biliary colic with gallstones (26/30), biliary dyskinesia (1), acute cholecystitis (2), gallstone pancreatitis (1).
Operative data: Average operative time was 94 minutes (range 70 to 170 minutes). Cholangiogram was successful in 28/30 patients. Both unsuccessful cholangiograms were attributed to inability to cannulate the small cystic duct. Two cholangiograms demonstrated choledocholithiasis. In one of these patients the duct was cleared with transcystic passage of a Fogarty catheter; the other patient required ERCP. Average time to perform the cholangiogram was 15 minutes (only recorded in 8 cases). Accessory graspers (2 mm graspers) were used in 10/30 cases. Conversion to traditional laparoscopic cholecystectomy was required in 1/30 cases. No conversions to open procedure.
Follow up: Most patients were discharged the day of surgery (28/30). All were seen 2 weeks postoperatively. Average length of narcotic use was 3.7 days and average return to normal activity was 3.5 days. All wounds were well healed with no seromas, hematomas, or hernias. Two patients had erythema surrounding the incision which was treated with antibiotics.
Conclusion: As experience grows with SILS cholecystectomy, it will be important to monitor the safety of this operation compared with traditional techniques. Most importantly, the avoidance of any common bile duct injury is paramount. The ability to perform cholangiogram, whether routinely or selectively, is a critical skill in avoiding or recognizing CBD injuries and must be available. We have found that cholangiogram during SILS is technically feasible with minimal added time. The use of small 2 mm graspers as an adjunct to the usual graspers and retraction sutures greatly enhanced our ability to complete the operation safely in a number of cases without a significant scar.


Session: Poster

Program Number: P401

View Poster

425

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons