Page 11 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

Efficacy and Safety of Single Port Laparoscopic Cholecystectomy: A Single Institute Experience

hospital. Patients were surveyed between 1 month and All these benefits of the reduced port surgery, in addition
2 years postoperatively (Table 3). Fourteen patients were to the fact that minimal scar and excellent patient’s
surveyed by telephonic conversations (63.63%) about pain, satisfaction, has encouraged us to carry on performing more
readmission and lumps in site of surgery, after being cases. The limitations of this series are small number
discharge from hospital or whether or not they sought help involved, single institute and all cases were performed by
from general practitioner or emergency medical help. All one surgeon and it is a retrospective study for single
14 patients were satisfied with the results (100%). No pathology. It would be of great benefit if we compare its
contact details were found in three cases. There was no reply results to that of conventional laparoscopic cholecystectomy
in five cases. The mean time for analgesia usage was 4.14 to see how different it is in term of operative and
days, simple analgesia was taken on need only. postoperative outcomes in relatively similar groups,
demographically and pathologically. In case of limited
DISCUSSION enrolment number, the chance of developing the morbidity
The same surgical principles and instruments of standard is narrowed and the statistical significance is reduced.
laparoscopic cholecystectomy were used in SPLC. Therefore, larger numbers of multicenters and wider range
Although, the operative time was longer than the average of pathology and techniques are needed to determine long-
standard approach but it has reduced significantly after the term safety and continued monitoring of these parameters
first 18 cases. The learning curve reduced from 90 minutes will only make us confident in adopting this approach
to become less than 50 minutes in the last four cases. We worldwide.
have used a multichannel port to complete all procedures. This series demonstrated clearly that laparoscopic
No significant morbidity was reported and there was no cholecystectomy by single port access is safe, feasible and
mortality or conversion to standard or open surgery. One reproducible procedure with few complications. The
patient had one extra-port to complete the procedure due to hospital stay and need for analgesia was minimal. The
inadequate exposure. No bowel, vascular or biliary injuries patient satisfaction is very good with no single negative
were encountered. By reviewing our series results, we have response about this type of surgery.
noticed that the majority of our patients were safely sent
home on the same day of the surgery, the level of the pain CONCLUSION
on the lower margin of the scale and consequently less The high success rates (95.45%) with no mortality or
analgesia were taken, and all has shown a quick recovery. morbidity make us conclude that this technique is safe and
Patients who underwent this approach in hospitals have efficacious in patients with symptomatic cholelithiasis. The
expressed their satisfaction with the results months after patients were satisfied with the final results with no short-
being discharged from the hospital by answering some or long-term morbidity. The operative time was longer than
questions about the need for analgesia and development of but comparable to that of conventional laparoscopic
complications and hospital readmission and finally the cholecystectomy. The learning curve reduced after the first
overall satisfactions with results of this approach. 18 operations. The same surgical principles of conventional

Table 3: Postoperative survey of 14 patients who underwent SPLC
Patients How long did you use Have you sought any Have you noticed any Have you been Are you satisfied
painkiller for regular and medical help for your swelling or lump at site readmitted due with the results
what type did you use? pain? NHS directs, of operation? to an issue with of your operation
GP or hospital A&E? your operation?
1 N N N N Y
2 N N N N Y
3 N N N N Y
4 7D/simple/PRN N N N Y
5 N N N N Y
6 14/simple/PRN GP N N Y
7 N N N N Y
8 14D/simple/PRN A&E N N Y
9 N N N N Y
10 N GP N N Y
11 N N N N Y
12 4D/simple/PRN N N N Y
13 5D/simple/PRN N N N Y
14 14D/simple/PRN N N N Y
N: No; D: Day; Y: Yes; PRN: As required; Simple: Simple Nonopoid analgesia
World Journal of Laparoscopic Surgery, January-April 2013;6(1):6-10 9