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      Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients

      , 1 , 2 , 1

      Surgical Endoscopy

      Springer-Verlag

      Cholecystectomy, Laparoscopic, LESS, NOTES, SILC, SILS, Single incision

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          Abstract

          Background

          Findings have shown that single-incision laparoscopic cholecystectomy (SILC) is feasible and reproducible. The authors have pioneered a two-trocar SILC technique at the University of Texas Southwestern. Their results for 100 patients are presented.

          Methods

          From January 2008 to March 2009, 100 patients with symptomatic gallbladder disease underwent SILC through a 1.5- to 2-cm umbilical incision using a two-port (5-mm) technique. For nearly all the patients, a 30° angled scope was used. The gallbladder was retracted, with two or three sutures placed along the gallbladder. These sutures were either fixated internally or placed through the abdominal wall to obtain a critical view of Calot’s triangle. The SILC procedure was performed using standard technique with 5-mm reticulating or conventional laparoscopic instruments. The cystic duct and artery were well visualized, clipped, and divided. Cholecystectomy was completed with electrocautery, and the specimen was retrieved through the umbilical incision.

          Results

          In this series, 80 women (85%) and 15 men (15%) with an average age of 33.8 years (range, 17–66 years) underwent SILC. Their mean BMI was 29.8 kg/m 2 (range, 17–42.5 kg/m 2), and 39% of these patients had undergone previous abdominal surgery. The mean operative time was 50.8 min (range, 23–120 min). The mean estimated blood loss was 22.3 ml (range, 5–125 ml), and 5% of the patients had an intraoperative cholangiogram. There were no conversions of the SILC technique. A two-trocar technique was feasible for 87% of the patients. For the remaining patients, either a three-channel port or three individual trocars were required. A SILC technique was used for 5% of the patients to manage acute cholecystitis or gallstone pancreatitis.

          Conclusion

          The SILC technique with a two-trocar technique is safe, feasible, and reproducible. The operating times are reasonable and can be lessened with experience. Even complex cases can be managed with this technique. Excellent exposure of the critical view was obtained in all cases. The SILC procedure is becoming the standard of care for most of the authors’ elective patients with gallbladder disease. Clinical trials are warranted before the SILC technique is adopted universally.

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          Most cited references 27

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          One-wound laparoscopic cholecystectomy.

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            ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005.

             A Kalloo,  ,  D Rattner (2006)
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              Laparoscopic cholecystectomy.

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                Author and article information

                Contributors
                homero.rivas@utsouthwestern.edu
                Journal
                Surg Endosc
                Surgical Endoscopy
                Springer-Verlag (New York )
                0930-2794
                1432-2218
                25 December 2009
                25 December 2009
                June 2010
                : 24
                : 6
                : 1403-1412
                Affiliations
                [1 ]Department of Surgery, Division of Gastrointestinal and Endocrine Surgery, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX 75390-8819 USA
                [2 ]Department of Surgery, Section of Minimally Invasive Surgery, Washington University in St. Louis, 660 S Euclid Ave., Box 8109, St. Louis, MO 63110 USA
                Article
                786
                10.1007/s00464-009-0786-7
                2869438
                20035355
                © The Author(s) 2009
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media, LLC 2010

                Surgery

                cholecystectomy, laparoscopic, less, single incision, notes, sils, silc

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