Single incision laparoscopic surgery is a new advance wherein laparoscopic surgery is carried out through a single small incision hidden in the umbilicus. Advantages of this technique over standard laparoscopy are still under investigation. The objective of this study is to describe the short term outcomes of single port access(SPATM) cholecystectomy in a single community based institution.
Following an institutional review board, patients with symptomatic gallbladder disease were recruited from November 2008. During this time, 20 patients underwent SPATM.
As opposed conventional laparoscopic cholecystectomies using tree or four access ports, we perform SPATM cholecystectomy using a 5mm 30 degree angled laparoscope, endo instruments and 5mm endo-clips. A vertical incision is made at an everted umbilicus for an average length of 2.5cm. 3 trocars(5mm each) are inserted through this incision for the for the dissection. Skin and soft tissue flaps are raised off the fascia for a distance of 2cm in each direction.A clear 5mm trocars is centrally placed and two low profile 5mm trocars are then placed in a triangulated fashion.A fourth small fascial defect is made inferiorly to accommodate a rigid grasping instrument for retraction. This flap technique allows us to access up to 5cm of fascia below the skin to insert our trocars in a triangulated fashon, eliminating the fulcrum effect of a single fascial incision.
Usual steps of laparoscopic cholecystectomy are followed including obtaining critical view. Both the cystic duct and artery were clipped with a 5mm clip applier and divided with scissors. At the end of the procedure, one of the trocar is exchanged for a 12mm trocar through which an endocatch is introduced for removal of the gallbladder. The fascia is closed with absorbable sutures and umbilicus is reconstructed.
This procedure was successfully performed in all 20 patients without additional ports.
Mean operating time was 80 minutes. Mean estimated blood loss was 3 milliliters. Only complication was entry into the gallbladder during dissection from the liver bed in two patients.There were no post-operative complications observed in any patient.
SPATM appears to be a promising alternative to conventional laparoscopic cholecystectomy with acceptable morbidity and mortality. This operation could be safely performed today with current instrumentation.
Further improvements in the instrumentation should improve the outcomes and adoption of this procedure.
Program Number: P488