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Single-incision Laparoscopic Cholecystectomy. How can We Reduce the Costs?
and reintroduced without any additional trocar directly DISCuSSION
to the abdominal cavity above the trocar, following the Single-incision laparoscopic cholecystectomy is a rela-
small incision of the fascia. Subsequently the grasper is tively new, effective and safe procedure with a signifi-
introduced with the same technique beneath the only one cant patient satisfaction. 13,14 Single-incision laparoscopic
trocar (Fig. 1). We do not use additional transcutaneous cholecystectomy compared to MILC has the same or
sutures suspending the gallbladder. The dissector, hook longer operation time, equivalent morbidity and quality
cautery, scissors and clip applicator are introduced res- of life. 6-10,14 The cosmetic results 2,3,9,14 and global patient
pectively through the only one trocar. The triangle of satisfaction are rated excellent by the patients under-
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Calot is dissected, the cystic artery and cystic duct are gone SILC. Despite higher complication rate in initial
separately identified, dissected, clipped and divided cases has been reported in some papers, SILC remain a
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between clips. Then the normal retrograde cholecystec- safe, although technically more challenging alternative
tomy is performed. The gallbladder dissection from the to traditional MILC. Losing the advantage of instru-
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liver bed and removing through the umbilical incision ment triangulation related to SILC procedure, causes the
finishes the procedure. technical difficulties for the surgeon. The use of port
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All procedures were completed successfully using devices allowing laparoscopic instrument placement and
SILS technique. The mean operative time was 76 minutes curved, articulated or wristed instruments makes the
(62–103). Conversion to MILC or open surgery was not SILS procedure less difficult. Improved cosmetic result
required in any case. The mean postoperative stay was is an advantage of SILC, with no data to prove the lower
1.9 days. Mortality was nil. All patients were satisfied pain or shorter recovery time.
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with the cosmetic results (Fig. 2).
Our procedure may represent an alternative to SILC.
It requires conventional straight non-articulating laparo-
scopic instruments, which we use in MILC procedures.
We need one forceps, one dissector, one scissors and clip
applier. We use only one conventional 10 mm trocar. To
reduce costs we gave up commercially available single
port devices (Fig. 1).
Although the trocars with low-profile backends helps
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to prevent collisions during instrument movement, we
use standard trocars. Crucial to avoid trocar’s backend
collisions remains the coordination between the operator
and the assistant manning the optics.
There were no postoperative complications. There
were no need for conversion either to standard MILC or
open cholecystectomy. The patients were pleased with
Fig. 1: Instrument placement. The 10 mm trocar in the middle.
A 30° 10 mm laparoscopic camera above and the grasper beneath the cosmetic results, with scar concealed in the umbilical
the trocar depression (Fig. 2).
The patient safety remains the same with additional
advantage of minimal costs. And the main goal of SILS,
which is eliminating the visible scar from abdominal
procedures, was achieved.

CONCLuSION
Single-incision laparoscopic cholecystectomy is feasible,
efficient, effective, safe procedure associated with high
cosmetic patient satisfaction, without visible evidence
that the operation occurred and with excellent cosmesis.
Our procedure, without any commercially available
port device allowing laparoscopic instrument placement,
is a reliable, low-cost alternative to conventional SILC, offe-
Fig. 2: No visible scar effect ring the same level of patient safety and patient cosmesis.
World Journal of Laparoscopic Surgery, January-April 2015;8(1):32-34 33