The Midwest Surgical AssociationSingle-incision laparoscopic cholecystectomy (SILC): a refined technique
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
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Cited by (21)
Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study
2017, Surgery (United States)Citation Excerpt :Two controlled trials have reported port site hernias exclusively after SILC,29,30 but the small number of patients in those studies and the low incidence of this complication does not allow proper conclusion.15 There was no significant difference regarding the readmission rate in our study which was similar to those of Hawasli et al.31 The duration of hospitalization was measured as the time that the patient stayed in hospital after the operation.
Single-incision laparoscopic cholecystectomy (SILC) using harmonic scalpel
2012, Journal of Surgical ResearchCitation Excerpt :This step is the main difference from other techniques, and has not been described by any other author so far. The second modification, described previously by Hawasli et al. [17] was the use of the ordinary Veress needle as an efficient retractor to push the liver, gallbladder or duodenum for better exposure of the triangle of Calot to be similar to the traditional technique. The additional puncture hole that is used for the Veress needle can hardly be seen after healing, resulting in excellent cosmetic outcome (Fig. 6).
Single incision laparoscopic surgery (SILS) versus conventional laparoscopic technique for ileostomy: a retrospective cohort study
2022, Langenbeck's Archives of Surgery