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Single-incision laparoscopic cholecystectomy for biliary dyskinesia in children: a simple, safe, and inexpensive
Michael J Leinwand1, Mohamed H Elgamal
1Department of Pediatric Surgery, Bronson Children’s Hospital, Kalamazoo, Michigan 49007, USA. leinwanm@bronsonhg.org
Insights
Single-incision laparoscopic cholecystectomy (SILC) is a safe and cost-effective method for treating pediatric biliary dyskinesia. This minimally invasive technique reduces operative time with surgeon experience and lowers disposable equipment costs compared to traditional methods.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Biliary dyskinesia is a functional gallbladder disorder causing abdominal pain in children.
- Traditional laparoscopic cholecystectomy involves multiple incisions.
- Single-incision laparoscopic cholecystectomy (SILC) offers a potentially less invasive alternative.
Purpose of the Study:
- To evaluate the safety and feasibility of a low-cost single-incision laparoscopic cholecystectomy (SILC) technique in pediatric patients diagnosed with biliary dyskinesia.
- To assess the economic benefits of SILC by comparing disposable equipment costs with standard laparoscopic procedures.
Main Methods:
- Eighteen children with biliary dyskinesia underwent SILC using a 2-cm transumbilical incision with two 5-mm trocars and a specialized grasper.
- Low-profile trocars and a bariatric laparoscope minimized instrument collisions.
- An internally anchored device suspended the gallbladder, eliminating the need for an additional trocar.
Main Results:
- Sixteen of eighteen patients (88.9%) successfully underwent true SILC, with two requiring conversion to a standard laparoscopic procedure.
- Mean operative time decreased significantly with surgeon experience, from 94 minutes for the first six patients to 68 minutes for the last six (P=.02).
- SILC resulted in a 28.4% cost saving ($205.05) on disposable equipment compared to the four-port laparoscopic approach, with no reported complications.
Conclusions:
- Single-incision laparoscopic cholecystectomy (SILC) is a safe and feasible surgical option for pediatric patients with biliary dyskinesia.
- The technique demonstrates a learning curve effect, with operative times decreasing as surgeon experience increases.
- SILC offers significant cost savings due to reduced disposable equipment needs compared to conventional laparoscopic surgery.
Purpose:
To evaluate a low-cost technique for single-incision laparoscopic cholecystectomy (SILC) in children with biliary dyskinesia.
Patients And Methods:
Eighteen children with biliary dyskinesia underwent SILC between March and September 2010. Two 5-mm trocars and a directly introduced grasper were inserted through a 2-cm vertical transumbilical incision. Instrument collisions were minimized by using low-profile trocars and a bariatric laparoscope with a right-angle light adaptor. An internally anchored retracting device suspended the gallbladder, obviating the need for an additional trocar. No other special equipment was used.
Results:
There were 15 girls and 3 boys with a mean age of 15.9 years (range, 9-18 years). Sixteen (88.9%) underwent true SILC. One patient was converted to a four-port laparoscopic procedure because of uncertainty of ductal anatomy. Another required a 5-mm subxiphoid port for liver retraction. Mean operative time was 82 minutes (range, 42-105 minutes): 94 minutes (range, 75-105 minutes) for the first 6 patients, 85 minutes (range, 60-102 minutes) for the second 6, and 68 minutes (range, 42-90 minutes) for the last 6. Operative times between the first and last groups were significantly different (P=.02). Sixteen patients were discharged home the following day and the remaining 2 on the second postoperative day. There were no complications. The hospital costs of the disposable equipment needed to perform SILC at our institution was $205.05 less than that needed for the four-port operation ($516.32 versus $721.37), a 28.4% savings.
Conclusions:
SILC is safe and feasible in children with biliary dyskinesia. The operative time decreased with experience. The disposable equipment needed was less expensive than that used for the standard laparoscopic technique.