Single Incision laparoscopic cholecystectomy without any special port or roticulating laparoscopic instruments – Are We Kidding ?

Nitin Jha, MBBS, MS, FIAGES, FAIS¹, Sanjay Chaurey, MBBS, MS, FIAGES². ¹FORTIS & PSRI HOSPITAL , DELHI-NCR, ²PSRI HOSPITAL ,DELHI

INTRODUCTION: Laparoscopic cholecystectomy has undergone enormous changes after advent of SILS .There are numerous studies showing equal risks and better cosmetic outcomes with SILS .The main drawback with SILS is the high costs associated with special ports and the special instruments .Since last 2 years we have been doing modified SILS with one 10 mm standard trocar and one 5 mm standard trocar with  almost invisible scar.

METHOD: We have performed  55 cases of modified SILS using our technique. One  10 mm port is placed in lower aspect of the umbilicus at 6 o clock position  and gall bladder is assessed for suitability for SILS and  then another 5 mm port is placed at 3 o’clock position through a separate incision..  A minilap grasper (Mini-Lap Technologies)is inserted at the right subcostal region. Rest of the steps are same as for any standard lap cholecystectomy. Careful and skillful manipulation of the minilap grasper helps in ant. and posterior dissection of callots triangle , all the while maintaining the triangle of instrumentation (which is not achievable in SILS port techniques) . For clipping the CA & CD we use 5 mm scope thru the 5 mm port and  standard clip applicator through the 10 mm port. Gall bladder is extracted  through the 10 mm port . 10 mm port fascia is closed .skin is closed with glue or subcuticular stiches.The patient is discharged by evening or next morning.

RESULT: 54 cases were completed by the above described modified SILS. One case had to be converted to standard 4 port technique due  to the confusing ductal anatomy . 40  females and 15 males underwent  surgery. Mean age was 36 years (range, 10-77). There was no mortality.  No bile duct injury or hemorrhage occurred. The median length of hospital stay was 1.1  days (1/2.2 days). The mean operative time was 45 min (30  to 95 mins). There was no case of any port site hernia. 1 patient  developed 10 mm port site infection which responded to dressing  and antibiotics.

CONCLUSION: We  have found this modified technique of SILS to be extremely useful  in giving  the benefits of SILS to the patient and at the same time keeping the cost to almost same as for any standard laparoscopic cholecystectomy without compromising the principles of safe surgery.