Transumbilical single incision laparoscopic cholecystectomy with conventional instruments: A continuing study

The feasibility of the single incision, multiport transumbilical approach(SILC) for the treatment of symptomatic gallbladder calculus disease has been established.

The study examines both short and long term morbidity of the SILC approach.

All the 1338 patients were operated by the same surgeon through a transversely placed umbilical incision in the upper third of the umbilicus. Three conventional ports,10,5 and 5 mm were introduced through the same skin incision but through separate transfascial punctures. The instruments were those used for standard laparoscopic cholecystectomy(SLC).Patients with acute cholecystitis and calculous pancreatitis were included,while those with choledocholithiasis were excluded. Results were compared with those of SLC.

Forty patients had difficult gall bladders, 214 had acute cholecystitis, and 16 had calculous pancreatitis. The mean operating time was 24.7 mins as compared to 18.4 mins in SLC. Intracorporeal knotting was required in four patients. Conversion to SLC was required in 12 patients. Morrisons pouch drain was left in 3 patients. Injectable analgesics were required in 85% vs 90% (SILC vs SLC) on day 1 and 25% vs 45% on day 2 and infection was seen in 6(0. 45%) patients. Port site hernia was seen in 2 patients. The data was compared with that of SLC and significance calculated by the student 't' test. A p value less than 0.05 was considered as significant.

Trans umbilical SILC gives comparable results to SLC, and is a superior alternative when cosmesis and postoperative pain are considered, but the operative time is significantly more.