Single-incision laparoscopic cholecystectomy using reusable conventional instruments

Abstract

Introduction Laparoscopic cholecystectomy is considered the gold standard for the treatment of symptomatic cholelithiasis. Single-incision laparoscopic surgery refers to the operative technique in which a surgical procedure is carried out through one incision. Patients and methods Prospectively randomly selected 30 patients with chronic calcular cholecystitis or gall bladder polyps for whom single-incision laparoscopic cholecystectomy (SILC) was performed between January 2011 and July 2013 were recruited to evaluate the feasibility of the procedure using conventional reusable cannulas and straight instruments with no more cost than that used in conventional four-port laparoscopic cholecystectomy. The Marionette technique at the three-point suspension of the gall bladder was used. Results The operative time ranged from 35 to 110 min, with a mean of 53.3 min. No patient required conversion to open surgery. One patient only required the addition of one more port. Two patients required the placement of a drain. In terms of postoperative complications, no patient developed bile leakage, postoperative bleeding, postoperative jaundice, or incisional hernias. Conclusion SILC was a technically more challenging but safe procedure compared with conventional laparoscopic cholecystectomy because of the close proximity of the working instruments with limited triangulation; limited range of motion of the laparoscope and instruments, and decreased number of ports all contributed toward increased difficulty. The Marionette technique in three points was a very important step in the procedure. The operating time is long initially, but it reduces as surgeons become more experienced.