Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach?

Background: Laparoscopic cholecystectomy (LC) has evolved to be as gold standard treatment for gall bladder disease and is the most common laparoscopic procedure performed worldwide. In recent times, the innovative techniques of Natural orifice Transluminal Endoscopic Surgery (NOTES) and Single Incision Laparoscopic Surgery (SILS) have been applied as a step forward towards scar less surgery with added benefits of less pain and less analgesic requirement, shorter hospital stay, quick return to work.Methods: A retrospective study of 50 patients admitted with gall bladder disease through outdoor for laparoscopic cholecystectomy from November 2018 to January 2019 in Maharishi Markandeshwar Institute of Medical Sciences and Research Mullana (AMBALA) were randomized into two groups of 25 each for Single Incision Laparoscopic Cholecystectomy (SILC) and standard laparoscopic cholecystectomy (LC) comparing the operative time, outcome and complications.Results: 50 patients admitted to MMIMSR Mullana from November 2018 to January 2019 with gall bladder disease were divided into two groups of 25 each who underwent three port SILC and four port laparoscopic cholecystectomy (4PLC). The average intra-operative time in SILC (80.56 mins) was significantly more than standard laparoscopic cholecystectomy. The average length of stay in the hospital for SILC was 1.8 days (1-3 days), was significantly less than in standard four port laparoscopic cholecystectomy. Incidence of Intraoperative complications were more in SILC than standard LC.Conclusions: SILC as the newer novel technique had better outcomes in terms of cosmesis, early discharge, shorter stay at hospital.

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Single-Incision Laparoscopic Cholecystectomy: A Combined Analysis of Resident and Attending Learning Curves at a Single Institution

The American Surgeon ◽

10.1177/000313481207800148 ◽

2012 ◽

Vol 78 (1) ◽

pp. 119-124

Author(s):

Mark Joseph ◽

Michael Phillips ◽

Christopher C. Rupp

Keyword(s):

Laparoscopic Cholecystectomy ◽

Learning Curve ◽

Single Incision ◽

Learning Curves ◽

Patient Specific ◽

Short Learning Curve ◽

Significant Difference ◽

Surgeon Experience ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts ( P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC) along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.

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The Pilot Study of Single Incision Laparoscopic Cholecystectomy (SILC) with Standard Laparoscopic Cholecystectomy in Western UP

International Journal of Contemporary Surgery ◽

10.5958/2321-1024.2016.00010.6 ◽

2016 ◽

Vol 4 (1) ◽

pp. 41

Author(s):

Sohan Pal Singh ◽

Akhil Kumar Gupta ◽

Naveen Agarwal ◽

Pulkit Gupta

Keyword(s):

Laparoscopic Cholecystectomy ◽

Pilot Study ◽

Single Incision ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

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Initial Experience with Single-Incision Laparoscopic Cholecystectomy

The American Surgeon ◽

10.1177/000313481007600723 ◽

2010 ◽

Vol 76 (7) ◽

pp. 703-707 ◽

Cited By ~ 1

Author(s):

Aaron Carr ◽

Avinash Bhavaraju ◽

John Goza ◽

Russell Wilson

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Incision ◽

Open Cholecystectomy ◽

Biliary Colic ◽

Initial Experience ◽

Low Profile ◽

Female Predominance ◽

Conversion To Open Cholecystectomy ◽

Standard Laparoscopic Cholecystectomy ◽

Single Incision Laparoscopic Cholecystectomy

Single-incision laparoscopic surgical procedures are being developed with the goal of improving cosmesis, reducing postoperative pain, and increasing patient satisfaction. We performed this study to evaluate our initial experience with single-incision laparoscopic cholecystectomy. We used an infraumbilical incision with two upper low-profile 5-mm ports and one lower standard 5-mm port and either a standard 30° Storz laparoscope or an Olympus deflectable tip laparoscope. All patients were followed postoperatively to evaluate the feasibility and outcomes of the procedure. A total of 60 gallbladders were successfully removed by this method (95.2% success rate). Three cases were converted to standard laparoscopic cholecystectomy (4.8% conversion rate) with no conversion to open cholecystectomy. There were no major complications (bile duct injury, liver injury, bowel injury, biliary leak). Median operative time was 51 ± 21 minutes. Diagnoses included cholelithiasis (55%), biliary dyskinesia (32%), biliary colic (13%), and one case of gangrenous cholecystitis. Median patient age was 47 years with a strong female predominance (87%). Our initial experience demonstrates that single-incision laparoscopic cholecystectomy is effective and safe. We are confident that single-incision laparoscopic cholecystectomy is a viable alternative to standard laparoscopic cholecystectomy.

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Triple Umbilical Incision for Videlaparoscopic Cholecystectomy

10.53902/sioaj.2020.01.000501 ◽

2020 ◽

Vol 1 (1) ◽

Author(s):

Héctor Rolando Herrera Cabral

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Single Incision ◽

Single Port ◽

Cystic Artery ◽

Advanced Training ◽

Surgical Time ◽

Umbilical Incision ◽

Intraabdominal Bleeding ◽

Initial Results

Introduction: The laparoscopic surgery is done by using a single port. You place a device through a single incision between 18mm to 50mm and 3-4 trocars can be used. Our work consists of making 3 little incisions to put the three trocars which measure 5 mm and use conventional instruments that measure 36 cm of length of laparoscopic surgery within the internal limits of the umbilicus. Objective: Describe the surgery technique and evaluate the initial results of a laparoscopic cholecystectomy option through three intraumbilical incisions. Methods: It is a retrospective, descriptive, multicentre and observational study. Since June 2014 to August 2019, 20 patients, 17 females and 3 males, were operated using this method from the age ranges of 16 to 65 years old. The average surgical time was 65 minutes. Results: In all cases the procedures were concluded by the intraumbilical approach. One of the cases had to be re-operated due to intraabdominal bleeding from the posterior branch of the cystic artery. Conclusions: The technique is reproducible; the usual triangulation of the ports is not available. Therefore, fort this technique the surgeon needs to have experience and have had advanced training in laparoscopic surgery. The cases must be selective.

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Coagulation and Fibrinolysis Activation After Single-Incision Versus Standard Laparoscopic Cholecystectomy

Surgical Innovation ◽

10.1177/1553350613484591 ◽

2013 ◽

Vol 21 (1) ◽

pp. 22-31 ◽

Cited By ~ 4

Author(s):

Petros Zezos ◽

Anna Christoforidou ◽

Georgios Kouklakis ◽

Christos Tsalikidis ◽

Constantinos Dimakis ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Incision ◽

Standard Laparoscopic Cholecystectomy ◽

Coagulation And Fibrinolysis

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Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports

Case Reports in Surgery ◽

10.1155/2014/164342 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Shamir O. Cawich ◽

Dexter Thomas ◽

Dale Hassranah ◽

Vijay Naraynsingh

Keyword(s):

Laparoscopic Cholecystectomy ◽

Single Incision ◽

Fascial Closure ◽

Umbilical Incision ◽

Conventional Laparoscopic ◽

Conventional Instruments ◽

Feasible Option ◽

Single Incision Laparoscopic Cholecystectomy ◽

The Caribbean ◽

Puncture Technique

Introduction.Single incision laparoscopic cholecystectomy (SILC) has become accepted as an alternative to conventional multiport cholecystectomy. However, SILC is still limited in applicability in low resource centres due to the expense associated with specialized access platforms, curved instruments, and flexible scopes.Presentation of Case.We present three cases where a modified SILC technique was used with conventional instruments and no working ports. The evolution of this technique is described.Discussion.In order to contain cost, we used conventional instruments and three transfascial ports placed in an umbilical incision, but we noted significant instrument clashes that originated at the port platforms. Therefore, we modified our technique by omitting ports for the working instruments. The technique allowed us to exchange instruments as necessary, maximized ergonomics, and prevented collisions from the bulky port platforms. Finally, the puncture left by the instrument alone did not require fascial closure at the termination of the procedure.Conclusion.The direct transfascial puncture using conventional laparoscopic instruments without working ports is a feasible option that minimizes cost and increases ergonomics.

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Single access laparoscopic cholecystectomy: technique without the need for special materials and with better ergonomics

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015005012 ◽

2015 ◽

Vol 42 (5) ◽

pp. 337-340 ◽

Cited By ~ 1

Author(s):

Marco Aurélio Lameirão Pinto ◽

Raphael Fernando Costa Gomes de Andrade ◽

Luiz Gustavo de Oliveira e Silva ◽

Marco Aurélio de Lacerda Pinto ◽

Roberto Jamil Muharre ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Surgical Technique ◽

Single Incision ◽

Specimen Extraction ◽

Suture Ligation ◽

Single Access ◽

Umbilical Incision ◽

Surgical Ergonomics ◽

Straight Needle

The authors describe a surgical technique which allows, without increasing costs, to perform laparoscopic cholecystectomy with a single incision, without using specific materials and with better surgical ergonomics. The technique consists of a longitudinal umbilical incision, navel detachment, use of a permanent 10mm trocar and two clamps directly and bilaterally through the aponeurosis without the use of 5mm trocars, transcutaneous gallbladder repair with straight needle cotton suture, ligation with unabsorbable suture and umbilical incision for the specimen extraction. The presented technique enables the procedure with conventional and permanent materials, improving surgical ergonomics, with safety and aesthetic advantages.

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