Abstract
Purpose: Since the early 1990s, laparoscopic cholecystectomy has become the gold standard for cholecystectomy. Single-incision laparoscopic surgery (SILS) is a rapidly evolving field as a bridge between traditional laparoscopic surgery and natural orifice transluminal endoscopic. The results are presented here of a single surgeon’s initial experience with single-incision laparoscopic cholecystectomy with conventional laparoscopic instruments through his first 11 cases. Materials and Methods: A single curved intra-umbilical 25-mm incision was made by pulling out the umbilicus. A 12-mm trocar was placed through an open approach, and the abdominal cavity was explored with a 10-mm laparoscope. One 10-mm and one 5-mm port were inserted laterally from the laparoscope port. Dissection was performed using a dissector, which was not articulated. The gallbladder was investigated with an Endograsper, which was not articulated either. The hilum was dissected, and the cystic duct and artery were clipped and divided. Results: The patients are comprised of 9 females and 2 males with a mean age of 43.3 years and mean body mass index (BMI) of 27.6 kg/m2. Open cholecystectomy was not required. The mean operative time was 69.9 min. Length of stay was only one day. All procedures were completed successfully without any perioperative or postoperative complications. In all cases, there was no need to extend the skin incision. Postoperative follow-up did not reveal any umbilical wound complications. The cosmetic results were scored as excellent by all patients. Conclusion: These results suggest that single-incision laparoscopic cholecystectomy is feasible, safe and effective and a promising alternative method to four-port and SILS-port laparoscopic cholecystectomy and as scarless abdominal surgery for the treatment of some patients with gallbladder disease with standard laparoscopic instruments.
Highlights
The first laparoscopic cholecystectomy was performed by Erich Mühe in the County Hospital of Böblingen, Germany, on September 12th, 1985
Mühe described designing and constructing his own laparoscope, called the Galloscope, and utilizing it before the era of video assistance. His technique, especially maintaining pneumoperitoneum proved to be so cumbersome that after performing the first six true laparoscopic cholecystectomies he abandoned the optically guided transumbilical approach under pneumoperitoneum for a single 3-cm subcostal incision approach where the gallbladder was removed under direct visualization [1] [2]
The abdominal cavity was explored with a 10-mm laparoscope, a 5-mm and a 10-mm port were placed through the same umbilical incision but through separate fascial incisions
Summary
The first laparoscopic cholecystectomy was performed by Erich Mühe in the County Hospital of Böblingen, Germany, on September 12th, 1985. Mühe described designing and constructing his own laparoscope, called the Galloscope, and utilizing it before the era of video assistance His technique, especially maintaining pneumoperitoneum proved to be so cumbersome that after performing the first six true laparoscopic cholecystectomies he abandoned the optically guided transumbilical approach under pneumoperitoneum for a single 3-cm subcostal incision approach where the gallbladder was removed under direct visualization [1] [2]. In the following 23 years, Mühe have witnessed many competitive approaches to minimize the invasiveness of laparoscopic cholecystectomies with surgeons developing new instruments and techniques to decrease postoperative pain and improve cosmesis [3] [4]. A technique involving several transumbilical-placed ports for single-incision laparoscopic surgery was newly developed, and SILS cholecystectomy by means of the ASC Triport (Advanced Surgical Concepts, Wicklow, Ireland) had been described successively [18]-[20]. No extracorporeal stay sutures were used to achieve cephalad retraction of the gallbladder fundus
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