Abstract
Background
As surgeons embrace the concept of increasingly less invasive surgery, techniques using only a single small incision have begun to gain traction. Several commercially available products have emerged recently. The TriPortTM system and the SILSTM Port are single-port devices that allow the surgeon to perform laparoscopic surgery through a 2- to 3-cm periumbilical incision. This study aimed to ascertain whether these devices allow safe and reliable access for laparoscopic cholecystectomy.
Methods
From March 2008 to June 2009, single-port laparoscopic cholecystectomy was attempted for 22 patients with an average age of 40 years (range, 23–73 years). The data collected prospectively after institutional review board approval included demographics, operative time, complications, and reasons for conversion to standard four-port laparoscopic surgery.
Results
The operation was completed successfully for 21 of the 22 patients (15 women and 7 men) using five different techniques. The mean body mass index (BMI) of the patients was 32.7 kg/cm2 (range, 22.3–46.1 kg/cm2). Three of the patients had previously undergone laparoscopic Roux-en-Y gastric bypass. The mean operative time was 80.8 min (range, 51–156 min). One patient experienced a Richter’s hernia postoperatively, which required a reoperation and subsequent bowel resection. One patient required conversion to a standard four-port laparoscopic cholecystectomy because the articulating instrument could not reach the gallbladder from the umbilicus.
Conclusion
The results from the current series show single-port laparoscopic cholecystectomy to be a promising technique. A variety of patient demographics appear suited to this approach. The operative time in this series compares favorably with that for the standard four-port operation. The feasibility of single-port laparoscopic cholecystectomy is now established. However, routine application of this novel technique requires an evaluation of its safety and cost effectiveness in larger studies. In addition, its superiority over standard laparoscopic cholecystectomy in terms of postoperative pain, cosmesis, and overall patient satisfaction requires further study. Refinements in instrumentation will enable wider use of this novel minimally invasive approach.
Similar content being viewed by others
References
Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695
Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364
Bresadola F, Pasqualucci A, Donini A, Chiarandini P, Anania G, Terrosu G, Sistu MA, Pasetto A (1999) Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg 165:29–34
Pelosi MA, Pelosi MA III (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594
Inoue H, Takeshita K, Endo M (1994) Single-port laparoscopy assisted appendectomy under local pneumoperitoneum condition. Surg Endosc 8:714–716
Kala Z, Hanke I, Neumann C (1996) A modified technic in laparoscopy-assisted appendectomy: a transumbilical approach through a single port. Rozhl Chir 75:15–18
Esposito C (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12:177–178
Cuesta MA, Berends F, Veenhof AA (2008) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22:1211–1213 [Epub 18 October 2007]
Romanelli JR, Mark L, Omotosho PA (2008) Single-port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228
Gumbs AA, Milone L, Sinha P, Bessler M (2009) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13:533–534 [Epub 16 August 2008]
Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E (2009) Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 13:159–162 [Epub 30 October 2008]
Rao PP, Bhagwat SM, Rane A, Rao PP (2008) The feasibility of single-port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB Oxford 10:336–340
Mutter D, Leroy J, Cahill R, Marescaux J (2008) A simple technical option for single-port cholecystectomy. Surg Innov 15:332–333
Guo W, Zhang ZT, Han W, Li JS, Jin L, Liu J, Zhao XM, Wang Y (2008) Transumbilical single-port laparoscopic cholecystectomy: a case report. Chin Med J Engl 121:2463–2464
Nguyen NT, Reavis KM, Hinojosa MW, Smith BR, Wilson SE (2009) Laparoscopic transumbilical cholecystectomy without visible abdominal scars. J Gastrointest Surg 13:1125–1128 [Epub 15 August 2008]
Bucher P, Pugin F, Buchs N, Ostermann S, Charara F, Morel P (2009) Single-port access laparoscopic cholecystectomy (with video). World J Surg 33:1015–1019
Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 23:1393–1397 [Epub 1 January 2009]
Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single-site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192 [Epub 22 November 2008]
Kroh M, Rosenblatt S (2009) Single-port laparoscopic cholecystectomy and inguinal hernia repair: first clinical report of a new device. J Laparoendosc Adv Surg Tech A 19:215–217
Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG (2009) Single-port-access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 19:219–222
Langwieler TE, Nimmesgern T, Back M (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23:1138–1141 [Epub 5 March 2009]
Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA (2009) Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 23:1660–1666 [Epub 5 May 2009]
Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826 [Epub 5 August 2008]
Bucher P, Pugin F, Morel P (2008) Single-port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016 [Epub 8 July 2008]
Leroy J, Cahill RA, Peretta S, Marescaux J (2008) Single-port sigmoidectomy in an experimental model with survival. Surg Innov 15:260–265 [Epub 19 September 2008]
Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD (2008) Single-port access adrenalectomy. J Endourol 22:1573–1576
Nguyen NT, Hinojosa MW, Smith BR, Reavis KM (2008) Single-laparoscopic-incision transabdominal (SLIT) surgery–adjustable gastric banding: a novel minimally invasive surgical approach. Obes Surg 18:1628–1631 [Epub 2 October 2008]
Saber AA, Elgamal MH, Itawi EA, Rao AJ (2008) Single-incision laparoscopic sleeve gastrectomy (SILS): a novel technique. Obes Surg 18:1338–1342 [Epub 8 August 2008]
Reavis KM, Hinojosa MW, Smith BR, Nguyen NT (2008) Single-laparoscopic-incision transabdominal surgery sleeve gastrectomy. Obes Surg 18:1492–1494 [Epub 10 August 2008]
Desai MM, Stein R, Rao P, Canes D, Aron M, Rao PP, Haber GP, Fergany A, Kaouk J, Gill IS (2009) Embryonic natural orifice transumbilical endoscopic surgery (E-NOTES) for advanced reconstruction: initial experience. Urology 73:182–187 [Epub 16 September 2008]
Garg S, Gundeti M, Mushtaq I (2006) The single-instrument-port laparoscopic (SIMPL) nephrectomy. J Pediatr Urol 2:194–196 [Epub 19 September 2005]
Romanelli JR, Desilets DJ, Earle DB (2008) Pancreatic pseudocystgastrostomy with a peroral flexible stapler: a human NOTES anastomosis in two patients. Gastrointest Endosc 68:981–987
Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427 [Epub 4 April 2009]
Disclosures
John R. Romanelli, Thomas B. Roshek, and David C. Lynn have no conflicts of interest or financial ties to disclose. David B. Earle has served on the Consultant and Scientific Advisory Board of SurgiQuest, Inc., has received fellowship grant support from Covidien, Inc., and has been a consultant for Atrium Medical Corporation.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Romanelli, J.R., Roshek, T.B., Lynn, D.C. et al. Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24, 1374–1379 (2010). https://doi.org/10.1007/s00464-009-0781-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0781-z