Single-port cholecystectomy: small scar, short learning curve
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This past year has borne witness to the acceptance of single-port laparoscopic surgery into mainstream clinical practice. This study describes a surgeon’s experience with single-port laparoscopic cholecystectomy and delineates a learning curve for this technically demanding procedure utilizing improvements in operative time as a proxy for technical facility.
Through a 2-cm vertical transumbilical incision, three 5-mm ports or SILSTM Ports were placed using the Veress technique. One extracorporeal stay suture was utilized to provide cephalad retraction of the gallbladder fundus, and a roticulating instrument was used at the infundibulum for lateral retraction. The hilum was dissected and the cystic duct and artery were clipped and divided. One 5-mm port was removed and another upgraded to one 10-mm port to allow the introduction of a retrieval bag to facilitate the removal of the gallbladder from the abdomen. Patient demographic data, operative time, length of stay, surgical pathology, and complications were recorded.
Fifty-two of 54 patients successfully underwent single-port cholecystectomies. Two patients required conversion to either a conventional laparoscopic cholecystectomy or open cholecystectomy. The average age was 41 years and average BMI was 30.2 kg/m2. Mean operative time was 80 min. Length of stay was 0.3 days. The complication rate was 3/54 (5.5%). When patients were divided into sequential quintiles (n = 10), operative times decreased significantly after the first 10 patients (p = 0.0001) and then remained flat (p = 0.233). Operative times for obese patients (BMI >30) were greater than those for nonobese patients, but these results failed to reach statistical significance (85.3 vs. 69.7 min, p = 0.07).
The significant improvement in operative times after the first quintile followed by consistent results without subsequent variability suggests that the learning curve for the single-port cholecystectomy, in the hands of a fellowship-trained laparoscopic surgeon, is approximately ten cases.
KeywordsCholecystectomy Education Surgical Technical
Dr. Roberts is a paid consultant to Covidien. D. Solomon, R. L. Bell, and A. J. Duffy have no conflicts of interest or financial ties to disclose.
- 4.Edwards C, Bradshaw A, Ahearne P, Dematos P, Humble T, Johnson R, Mauterer D, Soosaar P (2010) Single-incision laparoscopic cholecystectomy is feasible: initial experience with 80 cases. Surg Endosc 24. doi: 10.1007/s00464-010-0943-z
- 5.Erbella J Jr, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24. doi: 10.1007/s00464-010-0886-4