Single Port Access (spa) Cholecystectomies: Multi-institutional Report of the First 100 Cases

Since the inception of Single Port Access (SPA) surgery in April 2007, we have strived to develop a reproducible technique applicable to cholecystectomy. The ability of other surgeons in varying institutions to perform a new technique is an important step in determining its feasibility. In follow-up to the initial report of our training program presented at SAGES 2008, we report the first 100 cases performed in a multi-institutional and international review (SPA Consortium).
We have collected the data on the initial patients undergoing SPA cholecystectomies by 14 surgeons. A retrospective review of the initial cases performed by these surgeons included evaluation of operative time, blood loss, incision length, addition of trocars, performance of IOC, and length of stay. In addition, wound follow-up was included.
The technique utilized by each surgeon included placement of a clear central trocar (5mm) and two lateral low profile trocars (5mm) through a single incision within the umbilicus with soft tissue and skin flaps raised off the fascia laterally. An additional fourth small fascial defect within the same incision was used by some to facilitate fundal retraction. Positioning of the camera and other instruments within the trocars was surgeon preference.
To date, over 100 SPA cholecystectomies have been performed by this group. Diagnoses include both acute and chronic gallbladder disease. Demographics included 70% women and 30% male. Age ranged from 21 to 78. Mean operative time was 79 minutes, decreasing with experience. IOC increased operative time by a mean of 20 minutes. Both the 2 and 3 instrument technique have been employed. Up to one additional port site was added in 8 cases. EBL was minimal. LOS has been 1-2 days, with most patients being discharged same day. Complications include seromas and minor post operative wound infections.
These results are comparable to standard multiport Cholecystectomy, with the exception of operative time which is longer in the SPA group.
We have demonstrated that Single Port Access (SPA) surgery is an alternative to multiport laparoscopic cholecystectomy with less scars and better cosmesis. Further, the reproducibility by other surgeons in community hospitals, medical centers and university settings is shown.
The strength of a new procedure is its reproducibility, and the results of the first 100 cases of SPA cholecystectomies in this multi-institutional and international review are indicative of its technical feasibility and success

Session: Podium Presentation

Program Number: S023

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