Early experience and learning curve of solo single-incision distal gastrectomy for gastric cancer: a review of consecutive 100 cases

  • So Hyun Kang
  • Yo-Seok Cho
  • Sa-Hong Min
  • Young Suk Park
  • Sang-Hoon AhnEmail author
  • Do Joong Park
  • Hyung-Ho Kim



Single-incision distal gastrectomy (SIDG) is technically difficult due to limited range of motion and unstable field of view. Solo surgery using a passive scope holder may be the key in allowing SIDG to be safer and efficient. We report our initial 100 cases of, to what we know, the world’s first solo SIDG, and calculate the learning curve.


Prospectively collected database of 100 patients clinically diagnosed as gastric cancer who underwent solo SIDG from October 2013 until July 2016 was analyzed. All the operations were held by a single surgeon with no assistants. A passive laparoscopic scope holder was used to fix the field of view.


The mean operation time was 120.6 ± 30.2 min, and the average estimated blood loss was 33.5 ± 55.7 ml. Average body mass index was 23.4 ± 2.9 kg/m2. The median hospital stay was 5 (4–14) days, and the mean number of retrieved lymph nodes was 56.0 ± 22.8. There was no conversion to multiport or open surgery. Early complication of Clavien–Dindo grade III or more was 3%. Learning curve was calculated on operation time, and showed that an experienced surgeon in SIDG required 20 cases or less in stabilizing the operation time for solo SIDG.


Solo SIDG seems to be feasible and safe. The stable field of view created by a scope holder provides a favorable environment for a finer and more consistent operation. In addition, manpower can also be saved without affecting the quality of surgery.


Laparoscopic surgery Gastrectomy Stomach neoplasm Robotics Learning curve 


Compliance with ethical standards


So Hyun Kang, Yo-Seok Cho, Sa-Hong Min, Young Suk Park, Sang-Hoon Ahn, Do Joong Park, and Hyung-Ho Kim have no conflicts of interest or financial ties to disclose.


  1. 1.
    Tacchino R, Greco F, Matera D (2009) Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23:896–899CrossRefGoogle Scholar
  2. 2.
    Kim S-J, Choi B-J, Lee SC (2015) Novel approach of single-port laparoscopic appendectomy as a solo surgery: a prospective cohort study. Int J Surg 21:1–7CrossRefGoogle Scholar
  3. 3.
    Law WL, Fan JKM, Poon JTC (2009) Single incision laparoscopic left colectomy for carcinoma of distal transverse colon. Colorectal Dis 12:698–701CrossRefGoogle Scholar
  4. 4.
    Park YS, Park DJ, Kim KH, Park DJ, Ahn S-H, Kim H-H (2015) Single incisional laparoscopic sleeve gastrectomy and adolescent bariatric surgery: case report and brief review. J Metab Bariatr Surg 4:40–45CrossRefGoogle Scholar
  5. 5.
    Romanelli JR, Earle DB (2009) Single-port laparoscopic surgery: an overview. Surg Endosc 23:1419–1427CrossRefGoogle Scholar
  6. 6.
    Lakdawala M, Agarwal A, Dhar S, Dhulla N, Remedios C, Bhasker AG (2015) Single-incision sleeve gastrectomy versus laparoscopic sleeve gastrectomy. A 2-year comparative analysis of 600 patients. Obes Surg 25:607–614CrossRefGoogle Scholar
  7. 7.
    Omori T, Oyama T, Akamatsu H, Tori M, Ueshima S, Nishida T (2011) Transumbilical single-incision laparoscopic distal gastrectomy for early gastric cancer. Surg Endosc 25:2400–2404CrossRefGoogle Scholar
  8. 8.
    Ahn S-H, Park DJ, Son S-Y, Lee C-M, Kim H-H (2013) Single-incision laparoscopic total gastrectomy with D1 + beta lymph node dissection for proximal early gastric cancer. Gastric Cancer 17:392–396CrossRefGoogle Scholar
  9. 9.
    Park DJ, Lee J-H, Ahn S-H, Eng AKH, Kim H-H (2012) Single-port laparoscopic distal gastrectomy with D1 + β lymph node dissection for gastric cancers. Surg Laparosc Endosc Percutan Tech 22:e214–e216CrossRefGoogle Scholar
  10. 10.
    Ahn S-H, Son S-Y, Jung DH, Park DJ, Kim H-H (2014) Pure single-port laparoscopic distal gastrectomy for early gastric cancer: comparative study with multi-port laparoscopic distal gastrectomy. J Am Coll Surg 219:933–943CrossRefGoogle Scholar
  11. 11.
    Choi B-J, Jeong WJ, Kim S-J, Lee SC (2017) Solo-surgeon single-port laparoscopic anterior resection for sigmoid colon cancer: comparative study. J Laparoendosc Adv Surg Tech 28:330–336CrossRefGoogle Scholar
  12. 12.
    Fujii S, Watanabe K, Ota M, Yamagishi S, Kunisaki C, Osada S, Ike H, Ichikawa Y, Endo I, Shimada H (2011) Solo surgery in laparoscopic colectomy: a case-matched study comparing robotic and human scopist. Hepatogastroenterology 58:406–410CrossRefGoogle Scholar
  13. 13.
    Kang SH, Lee Y, Park YS, Ahn S-H, Park DJ, Kim H-H (2017) Solo single-incision laparoscopic resectional Roux-en-Y gastric bypass for morbid obesity with metabolic syndrome. Obes Surg 27:3314–3319CrossRefGoogle Scholar
  14. 14.
    Shabbir A, Lee J-H, Lee M-S, Park DJ, Kim H-H (2010) Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy. Surg Endosc 24:3237–3240CrossRefGoogle Scholar
  15. 15.
    Kodera Y, Sano T (2016) Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 20:1–19Google Scholar
  16. 16.
    Irino T (2015) The Hit and Away technique: optimal usage of the ultrasonic scalpel in laparoscopic gastrectomy. Surg Endosc 30:1–6Google Scholar
  17. 17.
    Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibañes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo Classification of surgical complications. Ann Surg 250:187–196CrossRefGoogle Scholar
  18. 18.
    Poon JTC, Cheung C-W, Fan JKM, Lo OSH, Law W-L (2012) Single-incision versus conventional laparoscopic colectomy for colonic neoplasm: a randomized, controlled trial. Surg Endosc 26:2729–2734CrossRefGoogle Scholar
  19. 19.
    Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848CrossRefGoogle Scholar
  20. 20.
    Chambers WM, Bicsak M, Lamparelli M, Dixon AR (2011) Single-incision laparoscopic surgery (SILS) in complex colorectal surgery: a technique offering potential and not just cosmesis. Colorectal Dis 13:393–398CrossRefGoogle Scholar
  21. 21.
    Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L, Kinross J, Paraskeva P (2012) Single-incision laparoscopic surgery (SILS) vs. conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26:1205–1213CrossRefGoogle Scholar
  22. 22.
    Abdelrahman AM, Bingener J, Yu D, Lowndes BR, Mohamed A, McConico AL, Hallbeck MS (2016) Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial. Surg Endosc 30:1205–1211CrossRefGoogle Scholar
  23. 23.
    Yang YS, Kim SH, Jin CH, Oh KY, Hur MH, Kim SY, Yim HS (2014) Solo surgeon single-port laparoscopic surgery with a homemade laparoscope-anchored instrument system in benign gynecologic diseases. J Minim Invasive Gynecol 21:695–701CrossRefGoogle Scholar
  24. 24.
    Kim W, Kim H-H, Han SU, Kim MC, Hyung WJ, Ryu SW, Cho GS, Kim CY, Yang H-K, Park DJ, Song KY, Lee SI, Ryu SY, Lee JH, Lee H-J, Korean Laparo-endoscopic Gastrointestinal Surgery Study (KLASS) Group (2016) decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage I gastric cancer: short-term outcomes from a Multicenter Randomized Controlled Trial (KLASS-01). Ann Surg 263:28–35CrossRefGoogle Scholar
  25. 25.
    Lee B, Lee YT, Park YS, Ahn S-H, Park DJ, Kim H-H (2018) Learning curve of pure single-port laparoscopic distal gastrectomy for gastric cancer. J Gastric Cancer 18:182–188CrossRefGoogle Scholar
  26. 26.
    Antoniou SA, Morales-Conde S, Antoniou GA, Granderath FA, Berrevoet F, Muysoms FE, Bonham Group (2016) Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 20:1–10CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgerySeoul National University Bundang HospitalSeongnam-siSouth Korea
  2. 2.Department of Surgery, College of MedicineSeoul National UniversitySeoulSouth Korea

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