Surgical Endoscopy

, Volume 24, Issue 6, pp 1374–1379 | Cite as

Single-port laparoscopic cholecystectomy: initial experience

  • John R. Romanelli
  • Thomas B. RoshekIII
  • David C. Lynn
  • David B. Earle
Article

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.

Keywords

Cholecystectomy Laparoscopic surgery Single-port surgery 

References

  1. 1.
    Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695Google Scholar
  2. 2.
    Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9:361–364CrossRefPubMedGoogle Scholar
  3. 3.
    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 165:29–34CrossRefPubMedGoogle Scholar
  4. 4.
    Pelosi MA, Pelosi MA III (1992) Laparoscopic appendectomy using a single umbilical puncture (minilaparoscopy). J Reprod Med 37:588–594PubMedGoogle Scholar
  5. 5.
    Inoue H, Takeshita K, Endo M (1994) Single-port laparoscopy assisted appendectomy under local pneumoperitoneum condition. Surg Endosc 8:714–716CrossRefPubMedGoogle Scholar
  6. 6.
    Kala Z, Hanke I, Neumann C (1996) A modified technic in laparoscopy-assisted appendectomy: a transumbilical approach through a single port. Rozhl Chir 75:15–18PubMedGoogle Scholar
  7. 7.
    Esposito C (1998) One-trocar appendectomy in pediatric surgery. Surg Endosc 12:177–178CrossRefPubMedGoogle Scholar
  8. 8.
    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]CrossRefPubMedGoogle Scholar
  9. 9.
    Romanelli JR, Mark L, Omotosho PA (2008) Single-port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228CrossRefPubMedGoogle Scholar
  10. 10.
    Gumbs AA, Milone L, Sinha P, Bessler M (2009) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13:533–534 [Epub 16 August 2008]CrossRefPubMedGoogle Scholar
  11. 11.
    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]CrossRefPubMedGoogle Scholar
  12. 12.
    Rao PP, Bhagwat SM, Rane A, Rao PP (2008) The feasibility of single-port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB Oxford 10:336–340CrossRefPubMedGoogle Scholar
  13. 13.
    Mutter D, Leroy J, Cahill R, Marescaux J (2008) A simple technical option for single-port cholecystectomy. Surg Innov 15:332–333CrossRefPubMedGoogle Scholar
  14. 14.
    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 121:2463–2464PubMedGoogle Scholar
  15. 15.
    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]CrossRefPubMedGoogle Scholar
  16. 16.
    Bucher P, Pugin F, Buchs N, Ostermann S, Charara F, Morel P (2009) Single-port access laparoscopic cholecystectomy (with video). World J Surg 33:1015–1019CrossRefPubMedGoogle Scholar
  17. 17.
    Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 23:1393–1397 [Epub 1 January 2009]CrossRefPubMedGoogle Scholar
  18. 18.
    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]CrossRefPubMedGoogle Scholar
  19. 19.
    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 19:215–217CrossRefPubMedGoogle Scholar
  20. 20.
    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 19:219–222CrossRefPubMedGoogle Scholar
  21. 21.
    Langwieler TE, Nimmesgern T, Back M (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23:1138–1141 [Epub 5 March 2009]CrossRefPubMedGoogle Scholar
  22. 22.
    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]CrossRefPubMedGoogle Scholar
  23. 23.
    Remzi FH, Kirat HT, Kaouk JH, Geisler DP (2008) Single-port laparoscopy in colorectal surgery. Colorectal Dis 10:823–826 [Epub 5 August 2008]CrossRefPubMedGoogle Scholar
  24. 24.
    Bucher P, Pugin F, Morel P (2008) Single-port access laparoscopic right hemicolectomy. Int J Colorectal Dis 23:1013–1016 [Epub 8 July 2008]CrossRefPubMedGoogle Scholar
  25. 25.
    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]CrossRefPubMedGoogle Scholar
  26. 26.
    Castellucci SA, Curcillo PG, Ginsberg PC, Saba SC, Jaffe JS, Harmon JD (2008) Single-port access adrenalectomy. J Endourol 22:1573–1576CrossRefPubMedGoogle Scholar
  27. 27.
    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]CrossRefPubMedGoogle Scholar
  28. 28.
    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]CrossRefPubMedGoogle Scholar
  29. 29.
    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]CrossRefPubMedGoogle Scholar
  30. 30.
    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]CrossRefPubMedGoogle Scholar
  31. 31.
    Garg S, Gundeti M, Mushtaq I (2006) The single-instrument-port laparoscopic (SIMPL) nephrectomy. J Pediatr Urol 2:194–196 [Epub 19 September 2005]CrossRefPubMedGoogle Scholar
  32. 32.
    Romanelli JR, Desilets DJ, Earle DB (2008) Pancreatic pseudocystgastrostomy with a peroral flexible stapler: a human NOTES anastomosis in two patients. Gastrointest Endosc 68:981–987CrossRefPubMedGoogle Scholar
  33. 33.
    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427 [Epub 4 April 2009]CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • John R. Romanelli
    • 1
  • Thomas B. RoshekIII
    • 1
  • David C. Lynn
    • 1
  • David B. Earle
    • 1
  1. 1.Department of Surgery, Baystate Medical CenterTufts University School of MedicineSpringfieldUSA

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