Optimal indication of single-incision laparoscopic cholecystectomy using Konyang Standard Method in benign gallbladder diseases

Abstract

Purpose:The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established. Methods:This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Difficult surgery (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were defined to comprehensively evaluate surgical difficulty and postoperative outcomes, respectively.Results: Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m 2 were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, p < 0.001) and PPO (5.0% vs. 15.9%, p = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC. Conclusion:SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea

“…The use of SILC in patients undergoing AC remains controversial. Recently, the authors analyzed 1,402 SILC procedures and reported that SILC is not recommended for patients with grade II/III AC according to the TG18 [ 15 ]. This study only included patients who underwent SILC.…”

Optimal indication for single-incision laparoscopic cholecystectomy in benign gallbladder diseases

“…This study [ 7 ] analyzed the outcomes of SILC performed on patients with benign gallbladder disease based on a retrospective analysis of single-center cases. To determine the optimal indication of SILC, this study analyzed various factors, including operation time, estimated blood loss, adjacent organ injury, postoperative complications, and length of hospital stay, focusing on difficult surgery and poor postoperative outcome.…”