Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases
An important aspect of a new surgical technique is whether it can be performed by other surgeons in other institutions. The authors report the first 297 cases in a multi-institutional and multinational review of laparoscopic cholecystectomy performed via a single portal of entry.
Data were collected retrospectively for the initial patients undergoing single-port cholecystectomy by 13 surgeons who performed these procedures in their institutions after training by the authors. The review included operative time, blood loss, incision length, length of hospital stay (LOS), necessary additional trocars, and other parameters important to cholecystectomy. A database of all the single-port-access (SPA) surgeries performed by the surgeons included demographic and procedural details, LOS, complications, and initial follow-up data.
To date, 297 single-port cholecystectomies have been performed for a variety of diagnoses, primarily cholelithiasis. The average operative time was 71 min, and the average LOS was 1–2 days. The average blood loss was minimal. The use of additional port sites outside the umbilicus occurred in 34 of the cases. Of the 35 intraoperative cholangiograms performed, 34 were successful. No significant complications occurred except for seromas and minor postoperative wound infections. These results are comparable with those for standard multiport cholecystectomy. In addition, no access site hernias (ASH) occurred.
The findings demonstrate that SPA surgery is an alternative to multiport laparoscopy with fewer scars and better cosmesis. One factor affecting the rate for adoption of SPA surgery among other surgeons is the reproducibility of this new procedure. Although this study had insufficient data to determine fully the benefits of SPA surgery, the feasibility of this procedure with safe, acceptable results was demonstrated in this initial large series across multinational institutions.
KeywordsCholecystectomy Laparoscopic cholecystectomy Multi-institutional Reduced-port surgery Single-port access SPA cholecystectomy Single incision laparoscopic cholecystectomy
Andrew S. Wu, Erica R. Podolsky, Namir Katkhouda, Alex Saenz, Robert Dunham, Marc Neff, Chad Copper, and Rodney Mason have no conflicts of interest or financial ties to disclose. Paul G. Curcillo speaks about single-port-access surgery for Storz Endoscopy, Ethicon Inc., Olympus, Inc., and Microline. Casey GraybealI provides educational and instructional assistance to Ethicon by virtue of telesurgery, which is covered by a “consulting” agreement, and has a consulting agreement with Carefusion (previously Cardinal Health) to serve on their Surgical Advisory Board. Marc Bessler receives fellowship support from Covidien and Ethicon and does consulting for these institutions and Olympus as well. Andrew A. Gumbs is a consultant for Ethicon, a proctor and course instructor for Covidien, a proctor for Novare Surgical and course instructor and lecturer for Applied Medical. Michael Norton is a stockholder in Axcess Instruments Inc. Dr Iannelli is a consultant for Covindien Inc. for single-port laparoscopic surgery. Ashkan Moazzez, Larry Cohen, Angela Mouhlas, and Alex Poor have no conflicts of interest or financial ties to disclose.
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