Single incision laparoscopic cholecystectomy with conventional instruments and ports: Initial experience at tertiary care public sector Hospital.

Abdul Razaque Shaikh ,Ambreen Munir,Syed Asad Ali ,Arif V Shaikh

doi:10.12669/pjms.333.12930

Abstract

Objective:To find out safety and feasibility of single incision laparoscopic cholecystectomy (SLIC) using conventional instruments.Methods:This study was conducted at surgical department of LUMHS Jamshoro Pakistan from Jan: 2014 to Dec: 2015. All cases of symptomatic cholelithiasis that consented for laparoscopic surgery were included. The exclusion criteria were acute cholecystitis, acute gall stone pancreatitis, common bile duct stones and patients with co-morbid. A midline 3cm incision made supraumbilically and 10mm port placed. Two 5mm ports placed on either side of umbilicus slightly superior and laterally in or-der to triangulate. A 2/0 prolene suture placed through the infundibulum of the gall bladder to achieve retraction. The rest of the procedure is like standard 4 ports laparoscopic cholecystectomy.Results:Total no of cases were 50. The age ranged from 30-59 years (mean 35.20 years ±4.886.) There were 43(86%) females and 07(14%) males. The mean operating time was 80 minutes (range 50-120 ±16.020). Four (8%) cases were converted to standard four ports laparoscopic cholecystectomy due to bleeding and difficult dissection in Calot’s triangle. Minimal blood loss was observed during the procedure with no postoperative complications. The range of hospital stay was 1-2 days (mean 1.08 ±0.274).Conclusion:SILC is a safe and feasible procedure with conventional laparoscopic instruments without additional cost of single port and articulated instruments. The cosmetic results are excellent with minimal increase in the operating time.

Highlights

Minimal invasive surgical techniques have replaced open surgical procedures with the advantage that it has reduced the trauma of access
The efforts proved fruitful and single incision laparoscopic surgery (SILS) using single port articulated instrument came into practice.[5]
Patients were provided information sheet elaborating the rationale and detail of the procedure. They were informed about the possibility of more than one incision and conversion to open method as safety of the patient is of prime importance

Summary

Introduction

Minimal invasive surgical techniques have replaced open surgical procedures with the advantage that it has reduced the trauma of access. The reason is very simple; just to ligate the cystic artery and cystic duct; in open cholecystectomy wide skin incision is needed but all layers of the abdominal cavity have to be incised and trauma of access to the area of gall bladder is much more than the trauma of the required procedure. This is Single Incision Laparoscopic cholecystectomy with conventional instruments probable explanation of the world wide popularity of the laparoscopic cholecystectomy. The efforts proved fruitful and single incision laparoscopic surgery (SILS) using single port articulated instrument came into practice.[5]

Methods

Results

Conclusion