Single-incision Laparoscopic Cholecystectomy Technique Research Articles

Single-Incision Laparoscopic Cholecystectomy Using a Set of Novel Needle Instruments.

Although the technique of single-incision laparoscopic cholecystectomy (SILC) has improved remarkably, problems such as limited exposure and instrument collision persist. We describe a new SILC technique that uses a set of specially-designed needle instruments. Fifty-six patients with benign gallbladder disease underwent SILC using the newly-designed needle assembly instruments (NAIs). The NAIs comprise an needle assembly exposing hook for operative field exposure and an needle assembly electrocoagulation hook for dissection. During the operation, the NAIs were assembled and disassembled before and after gallbladder removal within the abdominal cavity. The operative efficacy and postoperative complications of this procedure were evaluated. SILC was completed successfully in 52 cases, and four cases (7.14%) required an additional trocar. There were no conversions to open surgery. The mean operative time was 48.2 ± 21.8min, and the mean operative bleeding volume was 10.5 ± 12.5mL. Minor postoperative complications occurred in 3 cases, including 2 cases of localized fluid accumulation in the abdominal cavity and 1 case of pulmonary infection, and all of them recovered after conservative treatment. There was no occurrence of bile leak, abdominal bleeding, bile duct injury and incisional hernia. The medical cost of each case was saved by approximately $200. The abdominal scars produced by the needle instruments were negligible. NAIs can make SILC safer, more convenient, and less expensive.

Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor.

A recent meta-analysis and systematic review suggested that single-incision laparoscopic cholecystectomy (SILC) had a higher procedure failure rate with more blood loss and that it required a longer surgical time than conventional laparoscopic cholecystectomy. Herein, we introduce our experience with the needlescopic grasper-assisted and bendable retractor-assisted SILC technique and evaluate its safety and sustainability. The present retrospective cohort study included 407 Japanese patients who underwent needlescopic grasper-assisted and bendable retractor-assisted SILC between January 2012 and April 2017 at our institution. In the present study, all patients successfully underwent needlescopic grasper-assisted and bendable retractor-assisted SILC without conversion to open surgery. Regarding surgical outcomes, mean surgical time was 58.2±23.2 minutes, and additional ports were required in 9 patients (2.2%). Postoperative morbidity developed in only 6 patients (1.4%). The surgical approaches defined herein were safe and sustainable with favorable surgical outcomes. Compared with conventional SILC, needlescopic grasper-assisted and bendable retractor-assisted SILC might become a mainstream procedure for minimally invasive surgery from the viewpoint of surgical difficulty.

The effect of single incision laparoscopic cholecystectomy on systemic oxidative stress: a prospective clinical trial.

PurposeSingle incision laparoscopic cholecystectomy (SILC) has become a more frequently performed method for benign gallbladder diseases all over the world. The effects of SILC technique on oxidative stress have not been well documented. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy techniques on systemic oxidative stress by using ischemia modified albumin (IMA).MethodsIn total, 70 patients who had been diagnosed with benign gallbladder pathology were enrolled for this prospective study. Twenty-one patients underwent SILC and 49 patients underwent laparoscopic cholecystectomy (LC). All operations were performed under a standard anesthesia protocol. Serum IMA levels were analysed before operation, 45 minutes and 24 hours after operation.ResultsDemographics and preoperative characteristics of the patients were similiar in each group. The mean duration of operation was 37.5 ± 12.5 and 44.6 ± 14.3 minutes in LC and SILC group, respectively. In both groups, there was no statistically significant difference in hospital stay, operative time, or conversion to open surgery. Operative technique did not effect the 45th minute and 24th hour IMA levels. However, prolonged operative time (>30 minutes) caused an early increase in the level of IMA. Twenty-fourth hour IMA levels were not different.ConclusionSILC is an effective and safe surgical prosedure for benign gallbladder diseases. Independent of the surgical technique for cholecystectomy, the prolonged operative time could increase the tissue ischemia.

Single-incision laparoscopic cholecystectomy: a novice technique

Background: Laparoscopic Cholecystectomy has been recognized since 1992 as the gold standard procedure for gallbladder surgery. Single-incision laparoscopic cholecystectomy (SILC) is a relatively new technique that has attracted the attention of all the laparoscopic surgeons worldwide. Methods: The author shares his small experience of single-incision laparoscopic cholecystectomy in 80 cases as a step toward less invasive surgical procedures. The procedure was done with the conventional instruments used for laparoscopic cholecystectomy. A single intraumbilical 15-20 mm incision was given. Two ports, one 10mm and the other 5mm are introduced through the incision with a fascial bridge between them (one for 5 mm 30 laparoscope and other for 10mm right angled dissector). Two sutures placed through abdominal wall retracted the gall bladder. After Calot’s triangle dissection, cystic duct and artery were clipped and divided. Cholecystectomy was completed with electrocautery and the gall bladder was retrieved through umbilical incision. Results: The author performed SILC in 80 patients between January 2010 and December 2012 and completed it successfully. The procedures were performed for elective indications only. One additional 5-mm port had to be placed in two patients. One patient with acute cholecystitis required conversion to four-port cholecystectomy. Almost 50% patients who had elective SILC could be discharged the day after surgery. There were no postoperative or wound-related complications and all the patients were very pleased with the cosmetic outcome. Conclusions: As per the available literature, the SILC technique is safe, feasible and reproducible. The learning curve can be steepened with experience and better results can be obtained.

A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture

Many surgeons face difficulties during single-incision laparoscopic cholecystectomy (SILC) surgery and are forced to use an additional port. We compared the results of a technique that we developed with SILC. Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multi-channel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analog scale scores, need for analgesia in the postoperative period, and rate of changing to another technique due to inadequacy of the surgical technique. MCAP is as safe as SILC for cholecystectomy and is easier for the surgeon to perform.

Single-incision Versus Conventional Laparoscopic Cholecystectomy in Patients With Uncomplicated Gallbladder Disease

Laparoscopic cholecystectomy is the gold standard treatment for cholecystectomy. Recently, single-incision laparoscopic cholecystectomy (SILC) has been suggested as an alternative technique. Six databases were searched and reference lists of retrieved articles were checked to identify eligible studies. Data from randomized clinical trials related to the safety and effectiveness of SILC versus conventional laparoscopic cholecystectomy (CLC) were extracted by 2 independent reviewers. Odds ratio and mean differences were calculated with 95% confidence intervals based on intention-to-treat analyses whenever possible. Fifteen studies with 1113 patients met the eligibility criteria. Methodologic quality was unclear in most trails. Operating time was significantly longer in the single-incision laparoscopic surgery group compared with the CLC group (P<0.00001). Cosmesis was improved in single-incision laparoscopic patients at 1 month (P<0.00001). The pooled mean difference in pain scores at 24 hours was -0.75 in favor of the SILC technique (P=0.04). There was no significant difference in the conversion rates, adverse events, analgesia requirements, or the length of hospital stay between the 2 groups. The current evidence shows that patients with uncomplicated cholelithiasis or polypoid lesions of the gallbladder who prefer a better cosmetic outcome, SILC offers a safe alternative to CLC. Further high-powered randomized trials are need to determine whether SILC truly offer any advantages, especially be focused on failure of technique, adverse events, cosmesis, and quality of life.

Analysis of perioperative factors and cost comparison of single-incision and traditional multi-incision laparoscopic cholecystectomy

Recent technological advances in single-incision platforms have allowed many general surgeons to add single-incision laparoscopic cholecystectomy (SILC) to their armamentarium. However, adopting new surgical technologies comes at a cost to the patient and the surgeon. This study compared retrospective case-matched SILC and traditional multi-incision laparoscopic cholecystectomy (MILC) to evaluate the effects of SILC on perioperative outcomes and patient cost. The study compared 50 patients who underwent SILC with a case-matched population of individuals who underwent traditional MILC. The SILC technique was performed using one of three commercially available single-incision platforms currently used for single-incision laparoscopic surgery (SILS) cholecystectomies. All the SILS platforms were placed in a 2-cm supraumbilical incision. All statistical analyses were performed using Microsoft Excel 2008 for Macintosh, with statistical significance determined by a p value of 0.05 or less. The average operative time was 42 min for the SILC group and 45 min for the MILC group. The difference was not statistically significant. Similarly, the average estimated blood loss was 14 ml for the SILC group and 11 ml for the MILC group. Again, the difference was not statistically significant. Moreover, the body mass index (BMI) did not differ statistically between the SILC group (28.4 kg/m(2)) and the MILC group (32.2 kg/m(2)). The average patient cost was $18,447 for SILC and $17,701 for MILC, yielding a cost difference of $746. This difference was not statistically significant. At the authors' institution, SILS cholecystectomy was performed with blood loss, operating room time, and cost equal to that for MILC. Further research is necessary to assess the economic feasibility of SILC and the trade-off of cost with the improved cosmesis, decreased pain, greater patient satisfaction, reduced postoperative analgesic requirement, and faster return to work to determine the overall value and superiority of SILC compared with MILC.

Original single-incision laparoscopic cholecystectomy for acute inflammation of the gallbladder

To investigate the safety and feasibility of our original single-incision laparoscopic cholecystectomy (SILC) for acute inflamed gallbladder (AIG). One hundred and ten consecutive patients underwent original SILC for gallbladder disease without any selection criteria and 15 and 11 of these were diagnosed with acute cholecystitis and acute gallstone cholangitis, respectively. A retrospective review was performed not only between SILC for AIG and non-AIG, but also between SILC for AIG and traditional laparoscopic cholecystectomy (TLC) for AIG in the same period. Comparison between SILC for AIG and non-AIG revealed that the operative time was longer in SILC for AIG (97.5 min vs 85.0 min, P = 0.03). The open conversion rate (2/26 vs 2/84, P = 0.24) and complication rate (1/26 vs 3/84, P = 1.00) showed no differences, but a need for additional trocars was more frequent in SILC for AIG (5/24 vs 3/82, P = 0.01). Comparison between SILC for AIG and TLC for AIG revealed no differences based on statistical analysis. Our original SILC technique was adequately safe and feasible for the treatment of acute cholecystitis and acute gallstone cholangitis.

Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?

Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world. One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC). Most reported techniques utilize special purpose-made access port and articulating instruments, rendering the procedure costly and difficult to learn. This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port. It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.

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.