Noriaki Kameyama, MD, PhD, Yuki Mae, MD, Masashi Yahagi, MD, Kenta Inomata, MD, Tomoko Takesue, MD, Yoshinobu Akiyama, MD, PhD. KKR Tachikawa Hospital
Background: We introduced single port laparoscopic surgery at our hospitals in May 2009 and our experiences of single port laparoscopic surgery now number more than 1000 as of March 2018. Single port laparoscopic surgery has been gaining attention because of its effectiveness in reducing postoperative wound pain and superior cosmetic results with minimal scarring. In our hospitals, 80% of single port laparoscopic surgery cases were benign diseases such as cholecystectomy, appendectomy, and inguinal hernioplasty (TAPP and TEP). The most common procedure was cholecystectomy (43%).
We performed single port laparoscopic cholecystectomy via an 1.0 cm transumbilical incision (the minimum size for inserting the wound retractor) with the glove method. We examined the cost benefits of this method compared to other platforms for single port laparoscopic surgery and conventional laparoscopic cholecystectomy.
Methods: An 1.0cm incision was made at the bottom of the umbilicus. After small laparotomy, the Alexis wound retractor (size XXS) was inserted. After inserting the wound retractor, the surgical glove is attached and two low-profile laparoscopic 5mm ports are inserted through the holes of the surgical glove with cut fingertips. The original pre-bending forceps inserted directly through the hole of the cut fingertip. We usually use 5mm flexible laparoscopes by Olympus. The data from 484 cases of cholecystectomy performed by this technique were analyzed.
Results: A supplemental miniport or 5mm port including conversion to conventional laparoscopic cholecystectomy, was required for 6.4%, and the conversion to open surgery in only two cases (0.4%). The rate of complications is only 2.9% with only one case of incisional hernia. Our follow-up outcome is continued until one year after surgery.
Average hospital stay was 3.5 days, and operation time was 70 minutes overall. (63 minutes for expert surgeon) The average BMI in our patients was 24.6 Kg/m2.
The cost of our glove method was $140.40 compared to $224.50 for "EZ-access", the most popular platform for single port laparoscopic cholecystectomy in Japan and $163.60 for conventional laparoscopic cholecystectomy.
Conclusions: Single port laparoscopic cholecystectomy can be successfully performed via a minimal 1.0cm transumbilical incision with our glove method. Our method for single port cholecystectomy is not only minimally invasive but also relatively safe and has cost benefits.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93327
Program Number: P265
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster