Single-Incision Laparoscopic Cholecystectomy in Children Using Standard Straight Instruments: A Surgeon's Early Experience

Abstract

With the evolution of surgical techniques and instrumentation, surgeons have adapted methods to provide safe and effective therapy through less invasive operations. Conventional laparoscopy utilizes several small incisions in well-separated areas of the body, but more recently, surgeons have been performing minimally invasive procedures through a single incision. Specially designed ports and instruments have been employed to offset the disadvantage of losing the ability to have instruments separated in space while working through a single incision. We have reviewed our initial experience with single-incision laparoscopic cholecystectomy (SILC) in children using conventional straight laparoscopic instruments compared with those who underwent standard laparoscopic cholecystectomy (SLC). During the study period, a retrospective chart review was performed on 54 consecutive children who underwent laparoscopic cholecystectomy. Twenty-seven patients who underwent SILC (1 patient had splenectomy with cholecystectomy) were compared with 27 patients who underwent SLC by a single pediatric surgeon. Outcomes measured included successful completion rate, operative time, length of hospital stay, blood loss, and postoperative complications. Fifty-four cholecystectomies were performed laparoscopically with no conversions to open. In the SILC group, 24 of 27 (89%) were successfully completed. Two patients required one additional trocar/incision (laparoscopic splenectomy with cholecystectomy) and another two additional trocars/incisions to complete the procedure. Operative time was longer in the SILC group than in the SLC group (116 versus 61 minutes; P value <.0001). Two umbilical wound infections occurred in the SILC group (7.4%) and 1 patient in the SLC group developed postoperative choledocholithiasis. In our experience, SILC in children using standard straight laparoscopic instruments is a safe and effective alternative to conventional four-incision laparoscopic cholecystectomy. This technique, although safe, may lead to longer operative times since there is a loss of instrument triangulation provided with SLC or use of articulating instruments.