Single Incision Laparoscopic Surgery (SILS) for Cholecystectomy using standard laparoscopic instrumentation: Advantages and benefits of a new surgical technique

Anibal J Rondan, MD, Gabriela E Centurion, MD, Natalia E Bongiovi, MD, Mariano Gimenez, MD, Alberto R Ferreres, MD, FACS

Hospital Asociado UBA Dr Carlos A Bocalandro

Single incision laparoscopic surgery (SILS) is an area of active research within general surgery. A number of advantages have been proposed including cosmesis, less incisional pain, and the ability to convert to standard multiport laparoscopic surgery if needed.
The primary disadvantages of SILS are the restricted degrees of freedom of movement, the number of ports that can be used, and the proximity of the instruments to each other during the operation all of which increase the complexity and technical challenges of the operation.

A number of methods have been described for port access to perform SILS, including multiple facial punctures through one skin incision, the use of additional transabdominal sutures to stabilize the target organ. We describe our method of establishing single-port access for SILS that has reduced some of the technical challenges in the performing SILS cholecystectomies. Our method involves the use of existing instrumentation. The objective of this study is to evaluate the safety and feasibility of the SILS cholecystectomy with conventional instrumentation as an standard technique with low costs.

Methods and Procedures:
Under the approval of the Ethics Committee, a retrospective review of SILS cholecystectomies was conducted at the Department of Surgery of the University of Buenos Aires. The procedure began with an incision in the umbilical region approximately 2 cms length, and then the abdominal cavity is insufflated using a Veress needle followed by a dissection of the surrounded subcutaneous tissue, 10mm trocar placement and two 5mm trocars, one flexible on the right and one rigid on the left (Mickey Mouse Technique), having the freedom to have the 10mm trocar either in the upper or lower vertex. After this, the scope is introduced through the 5mm trocar based on the better visualization and comfort with the external manipulation of the instruments. Pulling the gallbladder fundus with 3-0 nylon suture using a percutaneous straight needle and neck retraction with articulated grasping forceps, introduced by trocar flexible. Cholecystectomy similar to that made by conventional laparoscopy, with the search for the "critical view of safety" and performing cholangiography selectively. Using forceps 10 mm clipper reusable. Extraction with ad hoc clamp 10 mm trocar.

Two hundred-fifty cholecystectomies were performed between January 2009 and December 2011, the mean patient age was 35 years (range 20-56), and an average BMI of 24 (range 18-28). 242 (96.8 %) completed successfully with the proposed technique, the remaining cases were converted to laparoscopic approach due to adhesions. One case required a laparotomy through a previous kocher incision looking for bleeding of the liver. Systematic assessments prove adequate healing of the umbilical access with no local complications. Follow-up averaged 6 months (range 1-12).

This study demonstrates the feasibility, safety and reproducibility of an standardized technique for the performance of a single umbilical incision cholecystectomy. Our initial experience found that complications are similar to the previous reported in conventional cholecystectomy technique with 4 trocars.

Session: Poster Presentation

Program Number: P024

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