SINGLE PORT CHOLECYSTECTOMY: Standard Technique in 100 cases

INTRODUCTION: Single Port Surgery has demonstrated good surgical outcomes and a very good cosmetic results in patients submitted to cholecystectomy. For the past three years we have been  trying different acces ports, using flexible instruments available in our country, with help of the optics designed for this type of surgery. According to our experience, we selected the best acces port, the most effective instruments and optics for our practice and we report our technique and results.

 

MATERIAL and METHODS:: 100 patients were selected for Single Port Cholecystectomy (SPC) from 2010 to 2013. Including criteria were: Chronic calculous cholecystitis or gallbladder polyps,  BMI: 18.5 to 29, not previous upper abdominal surgery, ASA I-II, normal liver function test. Our standard technique was performed using a 15mm vertical incision at the patient navel, the acces port was the GelPOINT,  Endocamaleon Laparoscope  was used in all procedures as well as rigid instrumentation. We performed safe disection of the cystic duct and artery, placing doble clips in each, and retrograde cholecystectomy. Extraction of the gallbladder was done directly trough the port wich protected the wound from spillage. Closure of the wound with non-absorbable separate sutures at the fascia and absorbable subcuticular was performed in all cases

 

RESULTS: 85 females/15 males , age: 22 – 75 y/o. 95% were completed as SPC, 5% had a 2mm extra port to complete the safe disection placed at the right upper abdominal cuadrant. Operating  time: 35-90 min. Conversions to open surgery: 0. Morbidity: 5%, wound infections 0%, incisional hernia 0%, pain score during hospitalization : 3-5 (VAS), hospital stay: 24 hrs. Time to return to normal activities: 7days. Patient.  satisfaction with cosmesis at 1 month : 100 %.    

        

CONCLUSION: SPC is a safe technique with good surgical outcomes. Using the standard technique can be acomplished in the majority of patients. Combining the Gelpoint with Endocamaleon Laparoscope and the rigid curved instruments results in great tools for the single port surgey. We strongly recomend this tool box to avoid increasing the procedure cost.