Page 34 - World Journal of Laparoscopic Surgery

WJOLS

Leszek Sułkowski et al 10.5005/jp-journals-10033-1242
technique preSentatiOn

Single-incision Laparoscopic Cholecystectomy. How

can We Reduce the Costs? Presentation of a Technique
using Straight Non-articulating Instruments and One

Conventional Trocar, without Commercially Available

Single Port Devices

3
5
6
1 Leszek Sułkowski, Artur Pasternak, Mirosław Szura, Maciej Matyja, Rafał Solecki, Andrzej Matyja
4
2
ABSTRACT laparoscopic surgery (SILS) requires only one incision
Single-incision laparoscopic surgery (SILS) offers an approach in the umbilicus. Single-incision laparoscopic cholecys-
1
to cholecystectomy without visible evidence that the cholecys- tectomy (SILC) was described first in 1999. Although it
9
tectomy occurred. Cosmesis is the only documented benefit offers an approach to cholecystectomy without a visible
of the single-incision laparoscopic cholecystectomy (SILC),
while SILC remains equivalent to multi-incision laparoscopic scar, the systemic inflammatory response, postoperative
4,7
cholecystectomy (MILC) in all other respects. 14 pain and analgetic use are not reduced significantly.
We report our experience of performing SILC without any The same blood loss, operating time, pain of both SILC
commercially available port devices allowing laparoscopic and multi-incision laparoscopic cholecystectomy (MILC)
instrument placement. We use conventional, straight, non-
2
articulating laparoscopic instruments with a roticulating function procedures are reported. Good cosmetic effect is the
and only one conventional 10 mm trocar. only documented benefit of the SILS, while SILS remains
Single-incision laparoscopic cholecystectomy has a poten- equivalent to MILC in all other respects. 12,14 The SILC
12
tial to maximize benefits of MILC. Our procedure, without any
port device, is a reliable, low-cost alternative to conventional procedure is safe and easy for experienced laparoscopic
SILC, offering the same level of patient safety and cosmesis. surgeon and has manageable learning curve. 11,12 Single-
Keywords: Cost-effectiveness, Single-incision laparoscopic incision laparoscopic cholecystectomy compared to MILC
cholecystectomy, Single-incision laparoscopic surgery. is technically more challenging, but in contrast to MILC
How to cite this article: Sułkowski L, Pasternak A, Szura M, it gives access to each quadrant of the abdominal cavity
Matyja M, Solecki R, Matyja A. Single-incision Laparoscopic Cho- with one umbilical approach.
10
lecystectomy. How can we Reduce the Costs? Presentation of
a Technique using Straight Non-articulating Instruments and One Higher costs must be considered in SILC cases. In our
Conventional Trocar, without Commercially Available Single Port health system it was necessary to assess the economic
Devices. World J Lap Surg 2015;8(1):32-34. feasibility of SILC.
Source of support: Nil
Conflict of interest: None TeCHNIque PReSeNTATION
INTRODuCTION We report our experience of performing SILC without
any commercially available port device allowing lapa-
Laparoscopic surgery allows the surgeon to perform roscopic instrument placement. We use conventional,
abdominal surgery with minimal trauma. Single-incision
straight, non-articulating laparoscopic instruments
with a roticulating function and only one conventional
10 mm trocar.
3
2,5
1 Senior Assistant, Assistant Professor, Associate Professor
6
4 Assistant, Professor Single-incision laparoscopic cholecystectomy has
been performed in patient with gallbladder stones with
1 Department of General and Vascular Surgery, Regional
Specialist Hospital, Częstochowa, Poland or without inflammation, under general anesthetic with
2,3,5,6 First Department of General Surgery, Jagiellonian endotracheal intubation. A single vertical intraumbilical
University Kraków, Poland incision through the center of umbilical stalk is per-
4 Second Department of General Surgery, Jagiellonian formed, the umbilicus is pulled out. The pneumoperito-
University Kraków, Poland neum is induced using Veress needle access. The carbon
Corresponding Author: Leszek Sułkowski, Department of dioxide pneumoperitoneum to 13 mm Hg is established.
General and Vascular Surgery, Regional Specialistic Hospital The 10 mm trocar is introduced at the congenital umbili-
ul. Bialska 104/108, 42-200, Częstochowa, Poland, Phone: cal fascial defect to explore abdominal cavity with a 30º,
+48-792244177, e-mail: lecheque@wp.pl
10 mm laparoscopic camera. The camera is removed then
32