Single-incision Laparoscopic Cholecystectomy Procedure Research Articles

The Predictive Factors Associated with Longer Operative Time in Single-Incision Laparoscopic Cholecystectomy

Objective: The difficult laparoscopic cholecystectomy (LC) is defined as the presence of one of the followingconditions including prolonged operative time, conversion to open cholecystectomy or significant blood loss. Atpresent, there is no evidence of predictive factors related to longer operative time in single-incision laparoscopiccholecystectomy (SILC). The aim of this study is to determine predictive factors associated with longer operativetime in SILC procedure.Materials and Methods: A retrospective study was conducted of patients with benign gallbladder disease whounderwent SILC in Thammasat University Hospital between October 2014 and December 2020. Patients’ recordswere reviewed. Primary outcomes were preoperative predictive factors associated with DSLC. Secondary outcomeswere perioperative and 3-month postoperative adverse outcomes.Results: 592 SILC procedures were categorized as 80 DSLC and 512 non-difficult SILC (NDSLC). The median(interquartile range) of operative time in all SILC procedure is 48 (38, 62) minutes. The threshold of operative timeof difficult SILC was 72 minutes. The multivariate analysis indicated 5 significant predictive factors. Obesity (bodymass index > 25 kg/m2)) and abdominal pain reflected the difficulty of SILC procedures (p = 0.041 and p = 0.009).Calcified gallbladder showed the highest RR of 14.08 (p = 0.011). Contracted gallbladder and chronic cholecystitiswere also predictive factors with RR of 13.79 and 3.64, respectively (p < 0.001 and p = 0.007).Conclusion: Obesity, abdominal pain, chronic cholecystitis, contracted gallbladder and calcified gallbladder werepreoperative predictive factors. Surgeons should perform the SILC procedure carefully when predictive factors areidentified.

Retrospective Non-Inferiority Analysis of Comparative of Performance on Single Incision Laparoscopic Cholecystectomy (SILC) between Using a Conventional Equipment and a Commercially Available Equipment

Background: Single incision laparoscopic cholecystectomy (SILC) is a modern technique for cholecystectomy via a single transumbilical incision. Original surgical equipment including an articulated minimally invasive surgical instrument was necessary for SILC procedures. However, the articulated long length with flexible rotatable tip instrument is expensive and could not be reimbursed by the Thai National Health Insurance. The present study used conventional laparoscopic equipment that is a non-articulated, shorter, and rigid tip to perform SILC. Objective: To compare the effectiveness between conventional and original equipment for the SILC procedure by evaluating the difficulty of SILC indicated by the length of operative time. Materials and Methods: The patients that underwent SILC in Thammasat University Hospital between October 2014 and December 2020 were reviewed from the electronic medical database. The primary outcome was the difficulty of the SILC procedure, determined from the operative time, to evaluate the performance of the SILC procedure between using the conventional or the original equipment in a non-inferiority trial. The secondary outcome was intraoperative and post-operative complications. Results: The eligibility criteria included 592 SILC procedure that was categorized as conventional equipment group with 351 (59.29%) patients and original equipment group with 241 (40.71%) patients. The multivariate analysis reported the number of difficult SILC procedures was less frequent in SILC using conventional equipment when compared with original equipment, significantly with 37 (10.54%) versus 43 (17.84%) relative risk (RR) (1.75, 95% CI 1.081 to 2.822, p=0.023). The intraoperative bile leakage, cystic artery injury, wound infection and 3-months follow-up of incisional hernia were not different in SILC procedures using eithers equipment. Conclusion: The application of conventional equipment that is used in multiple-port LC procedure to perform in SILC procedure was safe and not related to difficulty of SILC. This can reduce the cost of surgery, especially for articulated instrument that cannot be reimbursed from the National Health Insurance in Thailand. Keywords: Laparoscopic cholecystectomy; Single-incision laparoscopic cholecystectomy; Articulated minimally invasive surgical instrument; Difficult laparoscopic cholecystectomy.

Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial.

Background:Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time.Methods:This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate.Results:In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures.Conclusions:SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.

Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study

Purpose To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). Background Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. Methods Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. Results A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. Conclusions Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.

Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life?

BackgroundLaparoscopic cholecystectomy is the standard treatment for gallbladder diseases. In recent times, single-incision laparoscopic cholecystectomy(SILC) has developed as a less invasive alternative technique to conventional laparoscopy. In the literature, many studies have compared SILC and conventional laparoscopic cholecystectomy (CLC) procedures but a limited number of studies have compared the two techniques with regard to quality of life (QOL). The choice of surgical procedure was effected by QOL of the patients. The effects of SILC on QOL remain unclear. In this study, we aimed to compare the effects of conventional laparoscopic cholecystectomy (CLC) and single-incision laparoscopic cholecystectomy (SILC) procedures on the clinical outcomes and quality of life of patients by short-term follow-up evaluation.Material and methodsIn this study, 142 patients who underwent cholecystectomy operations with either technique underwent SILC and CLC were evaluated. The quality of life index in the patients was measured with short form 36 (SF 36) test.ResultsThe results of mean operative time, length of stay and complication rate for SILC and CLC were similar. The postoperative health-related quality of life (HRQOL) scores were not significantly different between the SILC and CLC patients but only physical functioning score were higher in SILC patients.ConclusionsSILC is a safe and effective alternative to CLC. To detect the effects of SILC on HRQOL, we need long-term prospective comparative studies.

Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial

Background: Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. Methods: In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. Results: There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m²) was the only significant influential factor for operating time over 100 min (p = 0.031). Conclusion: NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.

Single incision laparoscopic cholecystectomy: Less scar, less pain.

CONTEXT AND AIMS:Our study aims to evaluate the post-operative pain and cosmesis of single-incision laparoscopic cholecystectomy (SILC) in comparison with the standard, 3-port laparoscopic cholecystectomy (SLC) with respect to the length of incision, cosmetic scores, post-operative pain scores and duration of hospital stay.SETTINGS AND DESIGN:This comparative randomised study was conducted in a tertiary care centre teaching hospital between September 2012 and 2014. One hundred and fifty consecutive patients, who qualified as per inclusion criteria, were included in the study.SUBJECTS AND METHODS:Seventy-five patients were included in the SLC arm and 75 in the SILC arm. SILC procedure was carried out as transumbilical multiport technique and SLC as 3-port technique utilizing - 5, 5, 10 mm ports.STATISTICAL ANALYSIS USED:The data for the primary observations (post-operative pain scores, cosmetic score and incision length) and secondary observation (post-operative hospital stay) were noted. Weighted mean difference was used for calculation of quantitative variables, and odds ratios were used for pooling qualitative variables.RESULTS:Pain scores at 4 and 24 h were significantly better for SILC arm than SLC arm (at 4 h - 4.84 ± 0.95 vs. 6.17 ± 0.98, P < 0.05 and at 24 h - 3.84 ± 0.96 vs. 5.17 ± 0.09, P < 0.05). Length of incision was significantly smaller (SILC - 2.631 ± 0.44 cm vs. SLC - 5.11 ± 0.44 cm), P < 0.05 and cosmetic score was significantly better in SILC arm (6.25 ± 1.24) than SLC arm (4.71 ± 1.04), P < 0.05. Difference between the hospital stay is insignificant for two arms SILC (2.12 ± 0.34) and SLC (2.13 ± 0.35), P > 0.05.DISCUSSION:Significant difference was found in duration and intensity of pain between two procedures at 4 and 24 h. Cosmesis was significantly better in SILC than SLC group, the sample size in our study was small to arrive at a definite conclusion. The procedure can be selectively and judiciously performed by surgeons trained in regular laparoscopic surgery. Furthermore, the threshold for conversion should be low in learning phase. Widespread application must await Level 1 evidence from prospective trials.

Preoperative factors predicting the need for additional ports during single‐incision laparoscopic cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity as a minimally invasive technique that provides some benefits in terms of improved cosmesis. However, the insertion of an additional port is required in a subset of cases. We retrospectively analyzed 308 SILC procedures in patients with benign gallbladder diseases, except acute cholecystitis, to identify preoperative factors predicting the need for an additional port. SILC was completed with a single incision in 272 patients (88%); the insertion of at least one additional port was required in 36 patients (12%). The additional port requirement was associated with a longer operative time (P < 0.0001), greater intraoperative blood loss (P < 0.0001), and longer postoperative hospital stay (P = 0.0002). Multivariate analysis revealed male gender (odds ratio: 2.57, P = 0.0170), prior history of upper abdominal surgery (odds ratio: 5.53, P = 0.0132), and a higher preoperative white blood cell count (odds ratio: 3.62, P = 0.0244) to be independent factors associated with the requirement for an additional port. Our results suggest that gender, prior history of upper abdominal surgery, and white blood cell count can predict the likelihood of requiring an additional port in SILC.

Clinical value and pitfalls of fluorescent cholangiography during single-incision laparoscopic cholecystectomy.

To clarify the clinical value and pitfalls of fluorescent cholangiography (FC) during single-incision laparoscopic cholecystectomy (SILC). Our SILC procedure utilized the SILS-Port with additional 5-mm forceps through an umbilical incision. A laparoscopic fluorescent imaging system developed by Karl Storz Endoskope was utilized for fluorescent cholangiography. We performed fluorescent cholangiography during SILC in 21 patients. All procedures were completed successfully without biliary injury. The detectability of the running course of the cystic duct, the confluence between the cystic duct and the common hepatic duct, and the common hepatic duct before the dissection in Calot's triangle was 47.6, 71.4, and 81.0%, respectively. The detectability of biliary structures was worse in 9 obese patients (body mass index≥25.0kg/m2) than in 12 non-obese patients. The mean operative time for the patients in whom fluorescent cholangiography could identify the running course of the cystic duct before dissection in Calot's triangle (68±16min) was shorter than that for the other patients (91±35min; p=0.037). Fluorescent cholangiography can prevent biliary injury during SILC and facilitate SILC. Obesity is the most important factor that can prevent identification of biliary structures under fluorescent cholangiography.

A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.

Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=<0.05). Furthermore, the patients of the SILC group had less post-operative pain, with lesser analgesic requirements (p=<0.05), shorter hospital stay and earlier return to normal activity. SILC is feasible and safe in trained hands. It did not compromise the procedural safety, or lead to any complication. The operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.

Risk factors for a prolonged operative time in a single‐incision laparoscopic cholecystectomy

BackgroundA prolonged operative time is associated with adverse post‐operative outcomes in laparoscopic surgery. Although a single‐incision laparoscopic cholecystectomy (SILC) requires a longer operative time as compared with a conventional laparoscopic cholecystectomy, risk factors for a prolonged operative time in SILC remain unknown. MethodsA total of 20 clinical variables were retrospectively reviewed to identify factors for a prolonged operative time (longer than 3 h) in a total of 220 consecutive patients undergoing SILC. ResultsThe median operative time was 145 min (range, 55–435) and a prolonged operative time was required in 62 patients (28%). Independent factors that predict a prolonged operative time as identified through multivariate analysis were body mass index (BMI) (P = 0.009), acute cholecystitis (P < 0.001) and operator (resident or staff surgeon) (P < 0.001). Furthermore, a prolonged operative time was significantly associated with an increased amount of intra‐operative blood loss (P < 0.001) and a prolonged stay after surgery (P < 0.001). ConclusionsThese findings suggest that a higher BMI, acute cholecystitis and a resident as an operator significantly increase the duration of SILC procedures.

Single-incision cholecystectomy: a comparative study of standard laparoscopic, robotic, and SPIDER platforms

Many series have shown the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC), but this technique still has limitations such as instrument collisions and lack of triangulation. Recently, two single-incision platforms, robotic and SPIDER, have attempted to ameliorate such problems. This study aimed to compare three different techniques of single-incision cholecystectomy: standard laparoscopic, robotic, and SPIDER approaches. The authors retrospectively collected data from their first 166 single-incision robotic cholecystectomies (SIRCs) and compared the findings with the data from their first 166 SILCs and the first 166 s-generation SPIDER procedures. All the SILCs were performed with three trocars placed in one umbilical incision and with gallbladder retraction using a Prolene stitch on the right upper quadrant. All the robotic cases were managed using the da Vinci Single-Site Surgical System, and all the SPIDER procedures were performed using the SPIDER Surgical System. The SILC, SIRC, and SPIDER groups consisted respectively of 129 (76.3%), 131 (78.9%), and 136 (81.9%) women with the respective mean ages of 44.5 ± 14.3, 51.6 ± 15.9, and 46.4 ± 15.2 years. The mean body mass indexes (BMIs) were respectively 29.1 ± 5.6, 29.4 ± 6.2, and 27.5 ± 4.8 kg/m(2), and the mean surgical times were 37.1 ± 13.3, 63.0 ± 25.2, and 52.8 ± 18.7 min. The total hospital stays were respectively 1.3 ± 5.3, 1.2 ± 2.2, and 1.5 ± 2.6 days, and complications were seen respectively in three SILC cases (1.8%), three SIRC cases (1.8%), and two SPIDER cases (1.2%). The results of this study demonstrate similar results among the three platforms for most of the parameters measured. The SILC procedure appears to be superior to SIRC and SPIDER in terms of surgical time, but selection bias could be the cause. The SILS, SIRC, and SPIDER procedures all are similar in terms of complication profile. It can be concluded that SILC, SIRC, and SPIDER all are feasible and safe alternatives when used for single-incision cholecystectomy.

Safety and Feasibility for Single-Incision Laparoscopic Cholecystectomy in Local Community Hospital

The aim of this study was to evaluate the safety and feasibility for single-incision laparoscopic cholecystectomy (SILC) by retrospective comparison with conventional laparoscopic cholecystectomy (CLC) in a local community hospital. SILC was introduced and performed in 57 patients for benign gallbladder diseases. Their clinical data were compared with those of 62 patients treated with CLC. They included patient demographic data and operative outcomes. SILC was attempted in 57 patients and 52 cases (91.2%) were successfully completed. There were no statistical differences between the 2 groups in terms of operative time, blood loss, and postoperative complications. The length of hospital stay in the SILC group was significantly shorter compared with CLC (P < 0.0001). SILC has been successfully introduced in a local community hospital. The safety and feasibility was also confirmed. The SILC procedure may become 1 standard option for the treatment of benign gallbladder diseases.

Effectiveness of a Surgical Glove Port with Homemade Trocars Made of Syringes for Single Incision Laparoscopic Cholecystectomy

Single incision laparoscopic cholecystectomy (SILC) has two serious problems; its feasibility and cost. We report our experience and benefits of our original SILC procedure using homemade trocars that can solve those problems. SILC was attempted for thirty-four patients at our hospital. The SILST" Port (Covidien, Inc) was used in 16 patients (SPgroup) and the original method using a surgical glove port with homemade trocars was performed in 18 patients (GP-HT group). A homemade trocar was made ofa 2.5mL and a 5mL syringe. We performed the retrospective comparison of the operative and postoperative results between those two groups. Thirty patients (14 in the SP group and 16 in the GP-HT group)successfully underwent SILC. No patient had a grade IIor more severe postoperative complication based on the Clavien-Dindo classification. Our original home made trocar was slim and compact enough to avoid clashes among surgical instruments and surgeon's hands. Operative time in the GP-HT group was significantly short-er than that in the SP group (p=0.0044). Although further prospective studies of larger series should be performed, this simple and cost-effective system can be one of the promising ways for SILC.

Learning Curve of Transumbilical Single Incision Laparoscopic Cholecystectomy (SILS): A Preliminary Study of 80 Selected Patients with Benign Gallbladder Diseases

Transumbilical single incision laparoscopic surgery (SILS) is a new laparoscopic procedure in which only one transumbilical incision is made, demonstrated as a scarless procedure. Here we report a single-center preliminary experience of transumbilical single incision laparoscopic cholecystectomy (SILC) in the treatment of benign gallbladder diseases, defining a single surgeon's learning curve. A total of 80 patients underwent SILC successfully by a single experienced laparoscopic surgeon. The operation was performed following the routine LC procedure. Then the perioperative demographics were recorded and the operative time was used to define the learning curve. The study group included 27 male and 53 female patients with gallstones (56 cases), cholesterol polyps (16 cases), an adenomatous polyp (3 cases), adenomyomatosis (1 case), or complex diseases (4 cases), and all consented to undergo SILC. No patient was converted to normal LC or open surgery. There were no perioperative port-related or surgical complications. The average operative time was 46.9 ± 14.6 min. The average postoperative hospital stay was 1.8 ± 1.3 days. The learning curve of the SILC procedures for this series of selected patients confirmed that SILC is a feasible, safe, and effective approach to the treatment of benign gallbladder diseases. For experienced laparoscopic surgeons, SILC is an easy and safe procedure. Patients benefit from milder pain, a lower incidence of port-related complications, better cosmesis, and fast recovery. The SILC procedure may become another option for the treatment of benign gallbladder diseases for selected patients.

A Specific Instrument to Facilitate Single-Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is a promising technique with regard to reducing postoperative pain, decreasing complications, and improving cosmesis. Many instruments have been invented to overcome the limitation brought about by the chopstick effect, most of which are inflexible. This results in a limitation when the operator wants to move the tip of the instrument to a certain angle. Recently, the authors used a new instrument, which has 2 simultaneously movable wrists, in 30 cases of SILC. From May 2010 to August 2010, 30 patients with symptomatic gallbladder disease underwent SILC through a 15- to 20-mm umbilical incision using a 3-trocar technique. A novel laparoscope instrument with adjustable and rotatable wrists (Liuyedao, Inc, Yuyao,China) was applied, combined with the use of harmonic scalpel. The mean operation time was 56.4 minutes (range = 26-170 minutes). The mean estimated blood loss was 16.6 mL (range = 5-60 mL). There were no conversions of the SILC technique. No drainage was placed, and no bleeding or bile leakage occurred. The mean hospital stay was 3 days (range = 1-5 days). The SILC technique with the novel instrument is safe, feasible, and effective. This new instrument facilitates the SILC procedure.