Introduction: The development of NOTES procedures and its clinical application has raised the possibility of modified laparoscopic approaches with less incisions for the performance of cholecystectomy. Our objective is to present our initial experience with an umbilical single incision laparoscopic (USIL) technique to perform cholecystectomy.
Methods: within a research protocol with IRB and approval of the Ethics Committee, 68 patients with symptomatic gallbladder stones were operated between July 2008 and July 2009 at the Department of General Surgery of the University of Buenos Aires at the “Dr. Carlos A. Bocalandro” Hospital. Fifty-three were female and average age was 34.5 (range: 25-47).
The patients fulfilled the following requirements: a) symptomatic gallbladder stones, b) absence of common bile obstruction, c) normal liver tests, d) body mass index below 25, e) ultrasound findings not relevant or indicative of acute cholecystitis or Mirizzi syndrome f) MMS of 14 or higher.
An umbilical single incision laparoscopic cholecystectomy was attempted with the placement of 3 5 mm trocars through the umbilical access and the standard fashion was the following: one for the laparoscope, the right one for a grasping forceps and the left one for dissection, electrocautery and clipping the cystic duct and artery. The gallbladder was removed through the incision, and sometimes we replaced one of the 5 mm trocars with a 10 mm to ease the manouvre.
Results: the procedure was completed as intended in the 68 patients (100%). In 2 of them, the additional placement of the trocars in a more lateral fashion was required to control bleeding of the surgical lodge. Intraoperative cholangiography (by puncture of the gallbladder) was performed in 35 patients (51%). The mean operative time was 38 minutes ± 11.5 minutes. No complications were achieved. Postoperative stay was limited to 12 -18 hours before discharge. Average length of the incision was 22 mm ± 3 mm. Mean time for return to work was 3 days ± 1days. Patient do not complain of excessive pain at the umbilical incision.
Conclusions: umbilical single incission laparoscopic (USIL) cholecyctomy represents an alternative minimal invasive option to laparoscopic, acuscopic and NOTES procedures. It is safe, with excellent outcomes and void of complications in our initial series of 68 patients.
Program Number: P402