Single-port access cholecystectomy. A comparative study of 150 patients with the gold standard

Jesus Garijo, MD, Martin Gascon, MD. Hospital de Torrejon, Madrid, Spain.

Single Port Access (SPA) surgery, also known as Single Incision Laparoscopic Surgery (SILS) or One Port Umbilical Surgery (OPUS), amongst others, is an advanced, minimally invasive surgical procedure in which the surgeon operates exclusively through a single access port. Since the whole procedure is performed typically through the umbilicus, it does not leave any visible scar, unlike traditional laparoscopic surgery. Patients should benefit from less post-operative pain, less blood loss, faster recovery time, fewer complications and better cosmetic results.
We present preliminary results of our experience in single-port access cholecystectomy compared with a simultaneous series of conventional laparoscopic cholecystectomy performed during the same period of time.

We communicate a retrospective analysis of collected data from 150 patients subjected to SPA (SPAC) or multiport laparoscopic cholecystectomy (LC) during 2008 and 2012. Selection criteria included absense of previous cholecystitis and/ or cholelythiasis that required hospital treatment, no previous supramesocolic surgeries and BMI< 35 kgr/m².
Three conventional trocars were utilized in the LC group. SPAC were performed with an R-Port™ (Advanced Surgical Concepts; Whilock, Brey, Ireland). The R-Port™ consists of an external disc which has three valves with a gel interface, which fits onto a double-layered plastic cylinder that serves as the common channel or a single port. The plastic cylinder, when deployed, is held in place by an inner ring very much like a miniature hand port. Three separate valves allow insertion of one 12 mm and two 5 mm or three 5 mm instruments at the same time. A 5 mm 30 degree videolaparoscope was used, combined with 5 mm conventional laparoscopic instruments in both groups.

150 LC and 150 SPAC surgeries were performed. In the SPAC group mean age was 34´8 (range 21- 53), mean weight was 65´1 kg (range 49- 110) mean BMI 24´8 (range 18´7-39´6), mean operative time 58´2 , mean hospital stay 25´2 hours and 4 complications were reported. In the LC group, mean age was 48´9 (range 19-76), mean weight 78´4 (range 55- 102), BMI 29´8 (23´1- 40), mean operative time 67´4 (range 28- 125), mean hospital stay 45´5 (range 22- 98) and 3 complications were described. SPAC comprised younger patients with minor BMI values. Complications rates and operative time did not differ significantly between groups. SPAC was associated with reduced postoperative hospital stay (p< 0´05).

Data obtained present selection bias, which we consider still necessary to evaluate SPA technique. Despite, results show the benefits of SPAC in terms of hospital stay. Compared to LC, SPAC showed no disadvantage concerning risk profiles and operative times.
We consider SPA cholecystectomies safe and feasible. Cosmetic results are better than in conventional multi-port laparoscopic technique. Wether this approach turns to be superior to conventional laparoscopy remains subject to more substantial research.


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