Page 9 - Jourmal of World Association of Laparoscopic Surgeon

WJOLS

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

Like any other procedure, techniques, SPLC procedure DATA COLLECTION
requires proof to support the claim and the safety and
efficacy offered in this approach in addition to its feasibility The data was extracted from patient’s electronic health
and its cost effectiveness. Another issue that needs to be records and operative notes. We used NICE audit support
addressed is how the patient feels about it and if it meets guidelines of SPLC in addition to the defined outcomes of
the patients’ expectations, because what seems good and laparoscopic cholecystectomy. Both demographic and
satisfactory is not necessarily shared by patients and social operative characteristics were collected.
situations. The defined outcomes were recorded based on previous
Safety and efficacy can be evaluated by carefully and systematic reviews and published papers. Patients were
continuously monitoring the results of the published studies. informed in great detail about the operative strategy of
By following the principle of evidence base medicine, having single incision in the umbilicus with possibility of
evidence should be obtained from large clinical trials in several more incisions or a conversion to an open technique
multiple centers in addition to series studies. This evidence prior to the surgery. Operative time is defined as the time
can be then presented as proof of safety and efficacy of the from incision to time of closure. Pre- and postoperative
approach. Maintaining continuous medical education and outcomes (operative time, complications, hospital stay,
transparent communication to patients about their estimated blood loss, conversion and pain score) were
experience, outcomes and potential risks is an addition recorded.
measure to support application of this procedure. Patient satisfaction and postoperative complications
Our aim is to demonstrate the safety and efficacy of were also recorded by answering questionnaire on telephone
SPLC by presenting the outcomes of our initial experience. conversation directly with the patients or their relatives in
non-English speaker patients.
MATERIALS AND METHODS
SINGLE INCISION LAPAROSCOPIC
Inclusion Criteria CHOLECYSTECTOMY TECHNIQUE
A group of 22 nonselected cases with symptomatic Single incision in length of 12 to 15 mm was made through
gallbladder diseases underwent single incision laparoscopic umbilicus down to the midline fascia. A stay suture was
cholecystectomy at Brats and Royal London NHS Trust placed on each side of the facial incision. The peritoneum
between July 2009 and May 2011, 21 patients had a was tented up and opened under direct vision. Then
completed successful procedure and one case had extra- multichannel port (Covidien SILS, Triport or Gelport) was
port added to be completed. There were 20 female patients introduced into the abdominal cavity (open method access).
and two males. Data was collected from both clinical case Stay sutures were tightened around the port to ensure
notes and electronic database of the hospitals and reviewed effective pneumoperitoneum. Carbon dioxide (CO ) was
2
retrospectively. insufflating at high flow rate to less than 12 mm Hg
There were no restrictions on age, pathology and pressure. Two to three 5 mm trocars were put through the
associated comorbidity. This study presents our institute’s port along with 5 mm 30º laparoscopy. Straight conventional
initial experience of SPLC. It obtained the necessary instruments were used in all procedures.
approval from the health authority of the trust. All operations An endoloop was introduced in the right hypochondrium
were performed by one experienced laparoscopic surgeon to retract gallbladder for good exposure of Calot triangle
(BP). One case was excluded due to extensive intra- and cystic artery, duct and identify biliary anatomy. Critical
abdominal adhesion. Only conventional straight instruments view of safety was achieved by demonstrating both structure
were used in this study including 5 mm 30º laparoscope. entering the gallbladder and the cystic—common bile duct
Preoperative blood tests and abdominal ultrasound were relationship underneath liver in all cases. We do not usually
routinely examined for all patients who were to have the carry out intraoperative cholangiogram as routine practice
operation. in our hospitals. After good exposure and dissection, cystic

duct and artery were clipped separately. Division of both
Exclusion Criteria
structures were performed by endo scissors.
Two criterias were considered as exclusion from our study. Gallbladder was then dissected away from liver bed
One is patient with previous upper abdominal surgery and by monopolar electrocautery. Meticulous hemostasis was
2
another is BMI more than 40 kg/m . performed and saline washout before retrieving the
No acute cholecystitis cases were involved in this series gallbladder from abdominal cavity by endo-bag through
however, there was no intention to exclude these cases. umbilical incision. 0 Vicryl stitches was used to close
World Journal of Laparoscopic Surgery, January-April 2013;6(1):6-10 7