Laparoendoscopic Single Site Surgery can be Performed Completely With Standard Equipment

Abstract

To determine the feasibility of laparoendoscopic single site surgery (LESS) with nonarticulating instruments and conventional trocars. After Institutional Review Board approval, a prospective database was used to identify 30 patients who underwent LESS. All procedures were begun using three 5 mm trocars, nonarticulating instruments, and a 5 mm, 30-degree laparoscope. Twenty-six patients underwent LESS cholecystectomy. Four patients underwent LESS appendectomy; 2 for acute appendicitis and 2 for interval appendectomy. The mean patient age was 37.1 ± 14 years for the cholecystectomy group and 29.3 ± 2.2 years for the appendectomy group. Mean body mass index was 28.4 ± 7 kg/m2 for the cholecystectomy group and 25 ± 5.6 kg/m2 for the appendectomy group. Eight patients (31%) undergoing LESS cholecystectomy required an additional 5 mm port; 6 (26%) required 1 additional port for gallbladder retraction, 1 case (4%) required 2 additional ports to control cystic artery bleeding, and 1 case (4%) was converted to a traditional 4 trocar cholecystectomy because of chronic inflammation and multiple adhesions. None of the patients in the appendectomy group required an additional port. The mean operative time was 94 ± 19 minutes for cholecystectomy and 65 ± 19 minutes for appendectomy. Ninety-two percent (N=24) of patients in the laparoscopic cholecystectomy group were discharged within 24 hours. One patient underwent postoperative endoscopic retrograde cholangiopancreatography with bile duct stone removal and was discharged after 48 hours. One patient remained until postoperative day 2 for pain control. All patients in the LESS appendectomy group were discharged within 24 hours. There were no postoperative complications. Although operative time for LESS is increased compared with laparoscopic cholecystectomy and appendectomy, LESS can be performed safely. In our institutional experience, LESS was successfully performed using standard laparoscopic instruments, laparoscope, and trocars. Although longer follow-up is necessary, early data supports the feasibility and safety of LESS. A low threshold should exist for the addition of extra trocars, especially during a surgeon's early experience with LESS.