Single Port Access Laparoscopic Cholecystectomy (with video)

Abstract

Background Single port access (SPA) surgery is a rapidly evolving field due to the complexity of NOTES (natural orifice translumenal endoscopic surgery). SPA combines the cosmetic advantage of NOTES and possibility to perform surgical procedure with standard laparoscopic instruments. We report a technique of umbilical SPA cholecystectomy using standard laparoscopic instruments and complying with conventional surgical principle and technique of minimally invasive cholecystectomy. Methods Preliminary, prospective experience of SPA cholecystectomy in 11 patients (median age, 46 (range, 27-63) years) scheduled for cholecystectomy was evaluated. Diagnoses for cholecystectomy were: symptomatic gallbladder lithiasis (n = 7), previous acute cholecystitis (n = 3), and biliary pancreatitis (n = 1). Results SPA cholecystectomy was feasible in all patients (median body mass index, 24 (range, 20-34) kg/m 2 ) who were scheduled for preliminary experience using conventional laparoscopic instruments. Median operative time was 52 (range, 40-77) minutes. Intraoperative cholangiography was performed in all patients, except one, and was considered normal. No peroperative or postoperative complications were recorded. Median hospital stay was less than 24 h.Conclusions SPA cholecystectomy is feasible and seems to be safe when performed by experienced laparoscopic surgeons using standard laparoscopic instrumentation. SPA cholecystectomy may be safer than the NOTES approach at this time. It has to be determined whether this approach would benefit patients, other than cosmesis, compared with standard laparoscopic cholecystectomy.

Extraumbilical Single-Incision Laparoscopic Cholecystectomy with Standard Laparoscopic Instruments

“…The extraumbilical single-incision technique minimizes the clashing of instruments and gives us opportunity for using 10-mm hand devices such as clip applicator. In all transumbilical techniques, surgeons deal with clashing of the instruments and with limitation of freedom of movements, all of which increase the complexity of the operation (15,29,30). These technical difficulties also lead to consumption of more gas, energy, and time.…”

“…These technical difficulties also lead to consumption of more gas, energy, and time. They usually require the use of one or two more trocars or transparietal suspension stitches for exposure of the Callot's triangle (29,30). Clashing usually prevents using even two instruments, and some additional trocars are needed.…”

Clinical Analysis of Single-Port Laparoscopic Cholecystectomies: Early Experience

“…(11)(12)(13)(14) SPLC is regarded to be feasible and safe when performed by experienced laparoscopic surgeons. (8) It has been questioned whether or not SPLC is associated with significant improvement in post-operative pain, (15) SPLC were divided into two separate groups, group 2 and group 3, respectively. There were 6 patients who had combined procedures with MPLC (Table 1), and they were excluded from our study.…”

Transumbilical single-incision laparoscopic hysterectomy for large uterus: feasibility of the technique

“…In 1998, a single-incision laparoscopic appendectomy [9] was described, in which the appendix was laparoscopically mobilized and the appendectomy was extracorporeally performed through a single umbilical incision. Soon, other basic and advanced procedures were reported, such as hysterectomy, nephrectomy, pyeloplasty, cholecystectomy, and right hemicolectomy [10][11][12][13][14].…”