Comparative study of standard laparoscopic cholecystectomy and single incision laparoscopic cholecystectomy: outcome and complications

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.

Experience of 1 126 cases with routinely single incision laparoscopic cholecystectomy / 中华肝胆外科杂志

Objective To estimate the safety,feasibility and generalization of three point single-incision laparoscopic cholecystectomy (SILC).Methods The clinical data of 1 126 patients who underwent three-point SILC at the second department of Hepatobiliary Surgery of Zhu Jiang Hospital,Southern Medical University From January 1,2011 to December 30,2015 was analyzed retrospectively.The patient who were indicated for conventional laparoscopic cholecystectomy were included,but those suspected malignant diseases of gallbladder were excluded.Results Of the 1126 patients,the surgery was performed successfully in 923 patients,and 192 patients need extra ports due to the adhesion and difficulty of exposing the Calots triangle,and 11 were converted to open surgery due to severe adhesion,with the success rate being 81.9％.The operating time was (29.5 ± 12.2) min (from the entrance of laparoscope to the removing of gallbladder),the blood loss was (8.7 ± 7) ml,and the hospital stay time was (1.4 ± 0.7) d (after surgery).There were three cases of bile duct injury:two of them were bile leak of aberrant duct,one of them was bile leak of cystic duct damaged by heat.And there was one case of injury of duodenum,22 cases of umbilicus hematoma,13 cases of hematoma of thorax,and 2 cases of thoracic hemorrhage who required surgery.There were no hernia,aerothorax and so on.Conclusion Three point SILC is a technology that is safe,maneuverable and suitable for being carried out in clinical practice.

One-year experience with single incision laparoscopic cholecystectomy in a single center: without the use of inverse triangulation

PURPOSE: Single incision laparoscopic cholecystectomy (SILC) is generally performed with the use of inverse triangulation. In this study, we performed 3-channel or 4-channel SILC without the use of inverse triangulation. We evaluated the adequacy and feasibility of SILC using our surgical method. METHODS: We retrospectively reviewed our series of 309 SILCs performed between March 2014 and February 2015. RESULTS: Among 309 SILCs, male were 148 and female were 161 patients, mean age was 48.7 +/- 15.3 years old and mean body mass index was 24.8 +/- 3.8 kg/m2. Forty patients had previously undergone abdominal surgery including 6 cases of upper abdominal surgery. SILC after percutaneous transhepatic gallbladder (GB) drainage was completed in 8.7% of cases. There were 10 cases of emergency SILC. SILC was performed for noncomplicated GB including symptomatic GB stone and polyp in 66.7% of cases, acute cholecystitis in 33.3%. Overall, 96.8% of procedures were successfully completed without additional port. The reason for addition of an extra port or open conversion included technical difficulties due to severe adhesion and bleeding. The mean operating time was 60.7 +/- 22.3 minutes. The overall complication rate was 4.8%: 9 patients of wound seroma, 1 case of bile leakage from GB bed, 4 cases of intra-abdominal abscess or fluid collection, and 1 case of incisional hernia were developed. There was no case of common bile duct injury. CONCLUSION: Our surgical method of SILC without the use of inverse triangulation is safe, feasible and effective technique.

Single Fulcrum Laparoscopic Cholecystectomy in Situs Inversus Totalis

Single fulcrum laparoscopic cholecystectomy (SFLC) is a modified version of single incision laparoscopic cholecystectomy (SILC). In this article we report on the first experience of SFLC in a patient with situs inversus totalis (SIT). A 36-year-old female patient with SIT whose gallbladder was located on the left side was admitted to hospital due to a symptomatic gallbladder stone; 2 cm of transumbilical skin and subcutaneous fat layer were dissected and the fascia layer was left undissected to make two openings at the upper and lower part each, dividing where trocars were placed. Compared to conventional SFLC or SILC, the right hand, which is dominant for most people, performed the main operating movements, such as cutting and clipping, while the other hand was retracting the fundus of the gallbladder to show the Calot triangle. SFLC is a facilitating operation in that it does not require a specialized trocar or instruments, and is also convenient for a patient with SIT.

The Effectiveness of a Snake Liver Retractor during Needlescopic Grasper Assisted Sinlge-Incision Laparoscopic Cholecystectomy in the Aspect of Securing a Critical View of Safety

PURPOSE: Limited traction has been an obstacle in the advancement of single incision laparoscopic cholecystectomy (SILC). Adequate retraction is necessary for safe performance of a cholecystectomy. In this study, we introduce our method for securing CVS for prevention of bile duct injury during performance of SILC and evaluated the effectiveness of the snake liver retractor. METHODS: A total of 148 patients who underwent needlescopic assisted SILC (nSILC) from February 2011 to February 2012 at Uijeongbu St. Mary's Hospital, Uijeongbu, Korea were analyzed. Patients were categorized into two groups: G roup I consisted of patients who underwent nSILC without use of a snake liver retractor from February 2011 to October 2011 (n=51) and group II consisted of patients who underwent nSILC using a snake liver retractor from October 2011 to February 2012 (n=97). Patient characteristics and operative outcomes were compared between groups in order to evaluate the effectiveness of use of a snake liver retractor during performance of SILC. RESULTS: There were no differences in age, sex, BMI, and history of previous abdominal surgery. However, more difficult surgeries for acute cholecystitis were performed in group II. Nevertheless, no differences in operative outcomes, such as operative time, rate of bile spillage, open conversion rate, intraoperative complication, and postoperative hospital stay were observed between groups. In addition, CVS identification time was rather shorter in group II, compared with group I. CONCLUSION: Results of this study showed that nSILC using a snake liver retractor can allow for achievement of CVS safely and for expansion of indication for SILC through improvement of exposure and obtaining adequate traction.

Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution / 대한외과학회지

PURPOSE: The aim of our study was to compare single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) with respect to clinical outcomes. METHODS: Patients with less than a 28 body mass index (BMI) and a benign gall bladder disease were enrolled in this study. From January 2011 to February 2012, 30 consecutive patients who underwent SILC were compared with 30 patients who underwent CLC during the same period. In this study, all operations were performed by one surgeon. In each group, patient characteristics and perioperative data were collected. RESULTS: There was no significant difference in the preoperative characteristics. There was no significant difference in the postoperative laboratory result (alanine aminotransferase, aspartate aminotransferase, and alanine aminotransferase), number of conversion and complication cases, and length of hospital stay. The operation time was significantly longer in the SILC group (78.5 +/- 17.8 minutes in SILC group vs. 34.9 +/- 5.75 minutes in CLC group, P < 0.0001). The total nonsteroidal antiinflammatory drug usage during perioperative period showed significantly higher in SILC groups (162 +/- 51 mg in the SILC group vs. 138 +/- 30 mg in the CLC group), but there was no statistically significant difference in opioid usage between two groups. The postoperative pain score was significantly higher in the SILC group at second, third, and tenth postoperative day. Satisfaction of postoperative wound showed superiority in SILC group. CONCLUSION: SILC seems to be an acceptable alternative to CLC with acceptable results. However, it is not enough to propose any real benefits of SILC when compared with CLC in terms of operation time and postoperative pain.