Initial experience of single incision laparoscopic cholecystectomy (with video)

Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and retrospectively reviewed our initial experience on SILC. To evaluate the feasibility and safety of the SILC using standard laparoscopic instruments and complying with the conventional surgical principle and technique of minimally invasive cholecystectomy.

From October 2008 to March 2009, 40 patients underwent SILC for the treatment of cholelithiasis at Taipei Medical University Hospital, Taipei, Taiwan. All these patients scheduled for an elective surgery underwent clinical evaluation and appropriate investigations. The exclusion criteria for SILC were acute cholecystitis, concomitant common bile duct stone, obstructive jaundice, previous upper abdominal surgery, and body mass index greater than 35 kg/m. The operation was completed laparoscopically through single 1.5 cm subumbilical incision, through which 3 separate fascitomies were made in triangular form and introduced three 5 mm trocars. A 5-mm 30-degree laparoscope was inserted through the trocar for visualization of the target area. A 5-mm clip was applied to ligate the cystic duct and artery through the others 2 ports alternatively after dissection. Finally, the gallbladder was taken out through the umbilicus and the fascial defect was closed with a direct suturing technique.

SILC was performed in 40 patients, 22 (55%) females and 18 (45%) males with a mean age of 46.9+/-10.9 years (range: 28 to 76 y), the mean operative time was 54+/-21.2 minutes (range: 30 to 125 min), and the mean hospital stay was 1.85+/-0.72 days (range: 1.0 to 2.5 d); the mean dosage of the meperidine hydrochloride (Pethidine) was 0.23+/-0.4 mg/kg, the mean pain intensity (Universal Pain Assessment Tool) is mild at 8 hours after surgery, and no pain at 24 hours, the conversion rate for additional incision was 5% (2 of 40).There was no perioperative and postoperative complication. There was no mortality in this study.

The results of our initial experience in SILC showed that it is technically feasible and safe. No additional incisions were used and virtually no scar remained. The established procedure shows that initially learning curve by experienced and well-trained team can be easily overcome by reduced operative duration, postoperative complications, and conversion rate.