The Midwest Surgical Association
Single-incision laparoscopic cholecystectomy (SILC): a refined technique

https://doi.org/10.1016/j.amjsurg.2009.08.037Get rights and content

Abstract

Background

Reports of decreasing the number of incisions in laparoscopic procedures began appearing in the 1990s. A recent spark in pursuing such an approach has been accelerated by natural-orifice transluminal endoscopic surgery.

Method

Several modifications in performing single-incision laparoscopic cholecystectomy (SILC) were introduced until it was possible to develop a simple and safe technique.

Results

SILC was completed in 61 of 71 operated patients. Fifty-five patients had SILC without cholangiography (average operative time, 49 minutes). Thirteen patients had SILC with cholangiography, 11 with negative results (average operative time, 67 minutes). Three patients needed additional trocars (bi-incision access surgery [BIAS]). None were converted to open procedures. Of the 69 patients with SILC or BIAS, 66 had same-day discharge, and 3 were discharged the following day.

Conclusion

SILC or BIAS is effective for gallbladder removal, with comparable lengths of stay, operative times, and safety as the traditional method, with better cosmetic results.

Section snippets

Methods

Seventy-one consecutive patients underwent attempted SILC between July 2008 and February 2009 by the senior author (A.H.). Initially, we used three 5-mm trocars in the umbilicus, with retractable curved dissectors. Several modifications were made to this new approach, until we reached our final refined technique using the same instruments as in traditional 4-trocar laparoscopic cholecystectomy. The only instruments added were a long Endo Close, an Endo Stitch, and a low-profile 5-mm trocar

Results

SILC was completed in 66 of 71 patients, with a success rate of 93% (Fig. 3). The average age was 45 years (range, 16–86 years), with 56 female and 15 male patients. All patients had body mass indexes <40 kg/m2.

Fifty-five patients had straightforward SILC without cholangiography, with an average operative time of 49 minutes (range, 20–115 minutes). Three patients (4%) needed additional trocars to be placed in the epigastric area to complete the procedure because of difficulty in the exposure

Comments

Decreasing the number of incisions in performing laparoscopic procedures has been the main goal in improving cosmetic results and decreasing operative trauma, port-site hernia, and infection, while maintaining patient safety. Cholecystectomy has been the target in these attempts as the gold standard of laparoscopic procedures. In 1996, Leung et al1 described a technique using 2 ports in removing the gallbladder. Navarra et al2 reported in 1997 on 30 patients who underwent one-wound laparoscopic

Conclusions

Our refined SILC technique can be applied to the laparoscopic removal of the gallbladder with safety and a short length of stay. It has added benefit to the traditional 4-trocar technique by its well-hidden umbilical incision. On occasion, an additional trocar may be needed in the epigastric area (BIAS technique) to complete the operation with the same outcome. This technique can be taught in a didactic way to both established surgeons as well as residents in training, while maintaining

References (15)

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