Cholecystectomy conducted with single-port incisionless-intracorporeal conventional equipment-endoscopic surgery

As the interest in minimal invasive surgery has turned to single-site access surgery, single-incision laparoscopic surgery (SILS) is becoming popular. Recently limited numbers of pediatric SILS series have been published. SILS needs nonconventional three-lumen ports and articulated working instruments. However, it is possible to perform single-port laparoscopic cholecystectomy using a single conventional port and conventional working instruments. We herein present our preliminary experience with cholecystectomy conducted with single-port incisionless-intracorporeal conventional equipment-endoscopic surgery.

During December 2009-October 2012, 27 patients (12 boys, 15 girls) underwent single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy. A 10-mm 0° scope with a parallel eye piece and an integrated 6-mm working channel is inserted through an 11-mm "conventional umbilical port." Conventional working instruments were introduced through the integrated working channel. The fundus of the gallbladder is hung with a transabdominal sling suture. The infundibulum is retracted laterally to expose the triangle of Calot with a second transabdominal sling suture. Then the cystic duct and the artery are dissected and clipped separately. The gallbladder is dissected from the liver bed with monopolar cautery and extracted through the umbilicus.

The patients were 5-17 years of age (mean, 10.7±4.6 years). Cholecystectomy was performed through a single port in 23 patients. A second port insertion was necessary in 4 patients. No preoperative or postoperative complications were encountered. Mean operating time was 74.3±13 minutes.

Single-port incisionless-intracorporeal conventional equipment-endoscopic cholecystectomy is feasible in pediatric patients with reasonable operating times. It is a safe, cheap, and highly minimal invasive procedure with excellent cosmetic results.