The First Additional Port During Single-Incision Laparoscopic Cholecystectomy

Area of Science:

• Minimally Invasive Surgery
• Gastrointestinal Surgery
• Surgical Oncology

Background:

• Single-incision laparoscopic cholecystectomy (SILC) is gaining popularity for gallbladder removal.
• Acute cholecystitis presents challenges for SILC, sometimes necessitating additional port insertion.
• Optimal placement for additional ports in SILC for acute cholecystitis remains understudied.

Purpose of the Study:

• To evaluate the safety and efficacy of using the epigastric region for the first additional port during SILC in acute cholecystitis.
• To determine if this strategy facilitates completion of the surgery without conversion to open procedure.

Main Methods:

• A retrospective analysis of 113 patients undergoing SILC for acute cholecystitis.
• Additional port insertion was required in 52 patients.
• The first additional port was placed in the epigastric region, with a second in the right lateral subcostal area if needed. A drainage catheter was used via the epigastric port.

Main Results:

• No cases required conversion to open surgery.
• Mean operative time was 45.0 minutes for pure SILC and 83.3 minutes for the additional port group.
• Mean hospital stay was 3.7 days for pure SILC and 5.9 days for the additional port group.
• Six patients experienced bile leakage (5 intra-operative, 2 post-operative).
• Delayed surgery after symptom onset correlated with bile duct injury in patients needing additional ports.

Conclusions:

• The initial epigastric additional port placement is a safe and effective strategy for completing SILC in acute cholecystitis, avoiding open conversion.
• This approach is most suitable for selected patients presenting with a relatively short duration of symptoms.
• Careful patient selection is advised, considering symptom duration and potential risks like bile duct injury.