Single Port Laparoscopic Cholecystectomy in a Patient with Situs Inversus Totalis: A Case Report

The use and application of a laparoscopic cholecystectomy has been regarded as a first-choice treatment option for benign gallbladder disease, even if patients have situs inversus totalis. Furthermore, surgical procedures in general are becoming less invasive, because of both patient and surgeon preferences for reduced trauma and improved cosmetic outcomes attributable to minimized incisions. A 37 years old man was aware of situs inversus totalis with chronic cholecystitis. The operation was successfully performed without any specific complications. Single port laparoscopic cholecystectomy, in an experienced operator, is possible even in patients with situs inversus totalis.

The Learning Curve for Single-Port Laparoscopic Cholecystectomy by Experienced Laparoscopic Surgeon

PURPOSE: Single-port laparoscopic surgery is a rapidly advancing technique in laparoscopic surgery. However, there is currently limited evidence on the learning curve for this procedure. The aim of this study was to estimate the number of single port laparoscopic cholecystectomies required until improvement in the performance of the technique ceases. METHODS: This is a descriptive, single-center study using routinely collected clinical data from 70 patients who underwent single port laparoscopic cholecystectomy between May 2009 and June 2010 at Dong-A University Medical Center in Busan, Korea. The review includes the mean operating time, conversion cases, intra-operative GB perforation, post-operative wound infection and mean hospital stay. RESULTS: The mean operating time of the first 30 cases (the learning period) was 91.83 minutes. After 30 operations (the experience period), it plateaued to an average of 75.25 minutes, which remained steady in the next 40 operations - a reduction of more than 16%. Reduction in the operating time was significant (P<0.001) between the learning period and the experience period. Other factors including additional ports, intraoperative gall bladder perforation, mean hospital stay, post-operative wound infection were not significantly different between the two periods. CONCLUSION: We suggest that the learning curve for single port laparoscopic cholecystectomy should be around thirty cases for a surgeon with prior conventional laparoscopic cholecystectomy experience and for self-taught single port technique.

Early Experience of Single Port Laparoscopic Cholecystectomy & Comparisons of Single Port and Three Port Laparoscopic Cholecystectomy / 대한내시경복강경외과학회지

PURPOSE: Laparoscopic cholecystectomy is a standard procedure for cholelithiasis. However, with the advance of minimal invasive surgery, much research has recently been performed into single port laparoscopic surgery (SPLS).1 The aim of this study is to evaluate single port laparoscopic cholecystectomy (SPLC) in comparison to the classical method (three port laparoscopic cholecystectomy, TPLC) through our initial experience. METHODS: This study was performed retrospectively by a review of medical charts and phone calls to patients. We checked for chronic calculous cholecystitis or cholesterol polyps in 56 patients who had undergone cholecystectomy between April 2009 and February 2010. We divided into two groups the patients who had undergone SPLC and TPLC. We then checked the sex, age, hospital day, operating time, mobilization time, pain scale, cosmetic satisfaction, surgical wound infection and BMI for each patient. RESULTS: Cosmetic satisfaction with SPLC was higher than with the classical method, but this was not significant. Hospital day and mobilization time of SPLC were shorter, but this was also not significant. There was no difference in patient age, hospital day, mobilization and BMI between SPLC and TPLC. The operating time and pain scale with TPLC were less than with SPLC. CONCLUSION: SPLC has the benefit of cosmetic satisfaction and relatively fewer complications. However, the operating time and pain scale of SPLC are higher than those of TPLC. Therefore, SPLC requires much concentration and effort from the surgeon to compensate for its deficiencies.