Page 8 - Jourmal of World Association of Laparoscopic Surgeon

10.5005/jp-journals-10033-1172
Kadhim Abdullah et al
ORIGINAL ARTICLE
Efficacy and Safety of Single Port Laparoscopic

Cholecystectomy: A Single Institute Experience

Kadhim Abdullah, Shah Jalal Sarker, Hitendra Patel, Bijindra Patel

ABSTRACT Minimal invasive surgery has very limited tissue trauma
and potentially less pain and wound complications, short
Background: Over the past 5 years, minimal access surgery
has been moved toward a new less invasive single port access hospital stay and faster return to work, no or minimum pain
1-5
surgery. Like any new technique, there is a need to ensure that postoperatively and excellent cosmoses. It also costs less.
basic tenets of safety and efficacy are maintained. In this study, Therefore, it has crossed all traditional boundaries to
we demonstrate the efficacy and safety of single port
laparoscopic surgery for cholecystectomy in 22 consecutive specialties and disciplines.
cases in single institution. On the other hand there are limitations of minimal access
Materials and methods: It is a case series of 22 patients surgery, it has no tactile feedback, and surgeons depend on
(20 females/2 males) who underwent single port laparoscopic two-dimension images instead of three and lack of depth
cholecystectomy (SPLC) a single laparoscopic surgeon at perceptions. Furthermore, in laparoscopic procedure
Barts and the Royal London NHS Trust performed all surgeries surgeon might find it difficult to control bleeding and more
using straight conventional instruments from July 2009 to
May 2011. chance to injure nearby structure due to hand eye in
coordination or loss of triangulation. Moreover, longer
Results: In our series, the operations were performed by SPLC
successful in 21 patients. In one case an extra-port was added operating time due to instruments crashing and crowding
due to inadequate exposure. The mean age was 37.27 years and training requirements might cause conversion to open
2
(24-70). The mean BMI was 25.25 kg/m (21.1-35). The mean surgery. 5
operative time was 69.21 minutes (30-90). Gallbladder
perforations were recorded in three cases. Minor bleeding was With more experiences gained and further developments
found in one case. The mean hospital stay was <24 (10.05) in surgical innovation and instrumentation, surgeons over
hours. Visual analog scale was used to record pain severity the last few years made an effort to further minimize tissue
and the mean was less than one. All patients had uneventful
recovery. invasiveness and access trauma and therefore results in less
6-9
pain, quick recovery and better cosmoses results. In this
Conclusion: The results from current series show SPLC to be
a promising technique. We established in this series that SPLC new approach one skin incision is to be made almost always
is a safe, efficacious and feasible technique, but it took longer in the umbilicus and then either single or multiple facial
to perform than standard surgery. It can be performed using incisions are made through which one multichannel port
straight instruments. However, routine application of this novel
technique requires evaluation of its safety and effectiveness in inserted. The Transumbilical technique for cholecystectomy,
large randomized studies. without additional incisions, was described first by Navarre
et al in 1997 and later by Piskun et al in 1999, but failed to
Abbreviation: SILS: Single incision laparoscopic surgery;
SIMPLS: Single incision multiport laparoscopic surgery; OPUS: gain popularity due to lack of proper instrumentation. 10,11
One port umbilical surgery; TUES: Transumbilical endoscopic According to some surgeons, single port laparoscopic
surgery; SPAS: Single port access surgery, are acronyms of cholecystectomy (SPLC) should only be offered to those
LESS: Laparoendoscopic single site surgery.
with favorable anatomy and pathology similar to other
Keywords: Single incision laparoscopic, Cholecystectomy, indication of standard laparoscopic cholecystectomy.
Single port access surgery, Laparoendoscopic single sit.
The aim of single port is to minimize the access trauma,
How to cite this article: Abdullah K, Sarker SJ, Patel H, Patel B. better cosmoses, less postoperative pain and at the same
Efficacy and Safety of Single Port Laparoscopic Cholecystec-
tomy: A Single Institute Experience. World J Lap Surg 2013; time maintain the dissection principles and safety issue and
6(1):6-10. get the same outcome of standard laparoscopic chole-
cystectomy.
Source of support: Nil
In SPLC, special skills are needed to be mastered to
Conflict of interest: None declared overcome some difficulties like working in limited spaces
with few instrument, loss of triangulation and poor visibility
INTRODUCTION
due to instrument camera interface, there is little doubt that
Gallbladder surgery has developed from most invasive open this procedure lacks clear evidence about patient’s eligibility
surgery with extensive tissue trauma; prolonged recovery and common techniques and instruments to make it the
period and high morbidity to minimal invasive surgery. standard way of laparoscopic cholecystectomy.
6