Single Port Laparoscopic Cholecystectomy with the Triport: Initial Experience

Introduction: As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single incision have begun to gain traction. The TriPort system (Advanced Surgical Concepts, Wicklow, Ireland) is a single port device which allows the surgeon to perform laparoscopic surgery through a single periumbilical incision. We are attempting to ascertain if the TriPort system is a safe and reliable minimally invasive technique for laparoscopic cholecystectomy.

Methods: From March, 2008 to September, 2008, single port laparoscopic cholecystectomy was attempted in six patients and was successful in five. Data collected included demographics, operative time, complications, and reasons for conversion to standard laparoscopic surgery.

Results: The operation was completed successfully on four females and one male average age 36 (27-45). Average BMI was 34.2 (28.8-41.9), including a patient status-post laparoscopic Roux-en-Y gastric bypass. Average operative time was 70.8 minutes (51-90). There were no complications. One case required conversion to a standard four-port laparoscopic cholecystectomy, because the required traction stitch from a low-lying costal margin to the gallbladder did not provide enough traction. In addition, the distance from the port access site at the umbilicus to the gallbladder was too great to accommodate the roticulating instrument length.

Discussion: Results from our series shows the TriPort system to be a promising technique for single port laparoscopic cholecystectomy. A variety of patient demographics appear to be suited to this approach. There were no adverse outcomes in our series. In one patient, we were unable to adequately retract the gallbladder, and the instruments were not long enough to safely reach the gallbladder. In this case we successfully converted the operation to a standard four-port laparoscopic cholecystectomy. Average operative time in this series compares favorably with that of the standard four-port operation. The feasibility of single-port laparoscopic cholecystectomy is now established. However, routine application of this novel technique requires an evaluation of its safety and cost-effectiveness in larger studies. In addition, its superiority over standard laparoscopic cholecystectomy in terms of post-operative pain, cosmesis, and overall patient satisfaction requires further study. Refinements in instrumentation will further enable this novel minimally invasive approach.

Session: Podium Presentation

Program Number: S064