Single Incision Laparoscopic Surgery for the difficult cholecystectomy

Hirotaka Sasada, MD, Fuminori Wakayama, MD, Kohji Nagao, MD, Tadashi Iwabuchi, MD, Nobuo Yagihashi, MD, Shunnichi Takaya, MD. Seihoku Central Hospital.

Backgound: Single Incision Laparoscopic Surgery (SILS) is currently popular because it is less invasive. In many cases, SILS is performed for easy cholecystectomy. Here, we report SILS that was performed for all patients with difficult cholecystectomy except patients with poor general health.

Methods: Single Incision Laparoscopic Cholecystectomy was performed on 181 patients from May 28th 2009. [Remark 1] We analyzed the data that included the surgery duration, rate of using additional port, and DIC-CT or MRCP .

Results: The surgery duration was <120 min for 117 cases, 120–179 min for 41 cases, and >180 min for 22 cases. We classified the 22 cases that required >180 min as difficult cholecystectomy. Among these, 7 cases were cholecystolithiasis and 15 cases were acute cholecystitis. The reason for comparatively long surgery duration was inflammation in 15 cases and joint surgery in 4 cases. Additional port was used in 19 cases in which 12 cases were difficult cholecystectomy.
In contrast, DIC-CT or MRCP did not detect cystic duct in 31 cases, and 9 of the 22 cases were difficult cholecystectomy.

Conclusions: In SILS for difficult cholecystectomy, care should be taken for cases with acute cholecystitis, cases in which DIC-CT or MRCP does not detect cystic duct, and cases in which the probability of using additional port is high.

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