Evaluation of the role of single incision laparoscopic cholecystectomy (SILC) for the management of chronic calculous cholecystitis

Abstract

Background: Laparoscopic cholecystectomy has become the gold standard for cholecystectomy. Single-incision laparoscopic operations have recently emerged as a less invasive alternative to conventionallaparoscopy as the tendency of minimizing surgical trauma encourages the use of new approaches in laparoscopic surgery which has the potential of further reducing the trauma of surgical access. This may lead to reduced post operative pain and improved patient cosmesis. Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). The aim of this work was to evaluate the role of SILC for the management of chronic calculous cholecystitis as regards its feasibility and outcome. Patients and methods: Between January 2010 and January 2014, 120 patients were subjected to SILC. A single 2.5cm long semicircular supraumbilical skin incision was used. Pneumoperitoneum was established with the Veress access needle. Abdominal cavity was entered through three trocars: 10-mm trocar for camera and two 5-mm trocars, each placed 1-2cm laterally and cranially from the 10-mm trocar, with carefully placed sutures to puppeteer the gall bladder and thus aid retraction. Results: In this series, out of 120 patients, 90 patients (75%) were females, and the remaining 30 patients (25%) were males, with an average age of 32.8 years (range, 23-60 years), and 36 female patients had undergone previous lower abdominal surgery (Cesarean section or other gynecological procedures). Mean operative time was 58.6 min (range 40-120 min). Out of 120 patients, 106 patients (88.3%) successfully underwent SILC. In 10 patients (8.3%) an additional epigastric port was used, in 3 patients (2.5%) conversion to the traditional4-port laparoscopic technique was done, and conversion to open surgery was done in one patient. Conclusions: SILC using conventional laparoscopic instrumentation is an effective alternative to standard four-incision laparoscopic cholecystectomy in selected patients, it is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience.