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Completion of single-incision laparoscopic cholecystectomy using the modified Konyang standard method

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Abstract

Background

To date, a surgical method for single-incision laparoscopic cholecystectomy (SILC) has not been standardized. Therefore, this study aimed to introduce a standardized surgical method for SILC, in addition to reporting our experience over 10 years.

Methods

Patients who underwent SILC at a single institution between April 2010 and December 2019 were included in this study. We analyzed the patient demographics and surgical outcomes according to the surgical method used: phase 1 (Konyang standard method, KSM) comprising initial 3-channel SILC, phase 2 (modified KSM, mKSM) comprising 4-channel SILC with a snake retractor, and phase 3 (commercial mKSM, C-mKSM) using a commercial 4-channel port.

Results

Of 1372 patients (mean age, 51.3 years; 781 [56.9%] women), 418 (30.5%) surgeries were performed for acute cholecystitis (AC), 33 (2.4%) were converted to multiport or open cholecystectomy, and 49 (3.6%) developed postoperative complications. The mean operation time (OT) and length of postoperative hospital stay (LOS) were 51.9 min and 2.6 days, respectively. Overall, 325 patients underwent SILC with the KSM, 660 with the mKSM, and 387 with the C-mKSM. In the C-mKSM group, the number of patients with AC was the lowest (26.8% vs. 38.2% vs. 20.4%, p < 0.001) and the OT (51.7 min vs. 55.4 min vs. 46.1 min, p < 0.001), estimated blood loss (24.5 mL vs. 15.5 mL vs. 6.1 mL, p < 0.001), and LOS (2.8 days vs. 2.5 days vs. 2.3 days, p = 0.001) were significantly improved. The surgical outcomes were better in the non-AC group than in the AC group.

Conclusion

Based on our 10 year experience, C-mKSM is a safe and feasible method of SILC in selected patients, although there were lower percentage of patients with AC compared to other groups.

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References

  1. Mühe E (1991) Laparoscopic cholecystectomy. Zeitschrift fur Gastroenterologie Verhandlungsband 26:204–206

    PubMed  Google Scholar 

  2. Begos DG, Modlin IM (1994) Laparoscopic cholecystectomy: from gimmick to gold standard. J Clin Gastroenterol 19:325–330

    Article  CAS  Google Scholar 

  3. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    CAS  PubMed  Google Scholar 

  4. Lurje G, Raptis DA, Steinemann DC, Amygdalos I, Kambakamba P, Petrowsky H, Lesurtel M, Zehnder A, Wyss R, Clavien PA, Breitenstein S (2015) Cosmesis and body image in patients undergoing single-port versus conventional laparoscopic cholecystectomy: a multicenter double-blinded randomized controlled trial (SPOCC-trial). Ann Surg 262:728–734

    Article  Google Scholar 

  5. Haueter R, Schütz T, Raptis DA, Clavien PA, Zuber M (2017) Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 104:1141–1159

    Article  CAS  Google Scholar 

  6. Arezzo A, Passera R, Bullano A, Mintz Y, Kedar A, Boni L, Cassinotti E, Rosati R, Fumagalli Romario U, Sorrentino M, Brizzolari M, Di Lorenzo N, Gaspari AL, Andreone D, De Stefani E, Navarra G, Lazzara S, Degiuli M, Shishin K, Khatkov I, Kazakov I, Schrittwieser R, Carus T, Corradi A, Sitzman G, Lacy A, Uranues S, Szold A, Morino M (2017) Multi-port versus single-port cholecystectomy: results of a multi-centre, randomised controlled trial (MUSIC trial). Surg Endosc 31:2872–2880

    Article  Google Scholar 

  7. Pisanu A, Reccia I, Porceddu G, Uccheddu A (2012) Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC). J Gastrointest Surg 16:1790–1801

    Article  Google Scholar 

  8. Qiu Z, Sun J, Pu Y, Jiang T, Cao J, Wu W (2011) Learning curve of transumbilical single incision laparoscopic cholecystectomy (SILS): a preliminary study of 80 selected patients with benign gallbladder diseases. World J Surg 35:2092–2101

    Article  Google Scholar 

  9. Chow A, Purkayastha S, Aziz O, Paraskeva P (2010) Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surg Endosc 24:709–714

    Article  Google Scholar 

  10. Chaudhary S, Bhullar JS, Subhas G, Mittal VK, Kolachalam R (2013) Single-incision laparoscopic cholecystectomy (SILC) using non-articulating instruments and conventional trocars-single surgeon experience. J Gastrointest Surg 17:809–813

    Article  Google Scholar 

  11. Ikumoto T, Yamagishi H, Iwatate M, Sano Y, Kotaka M, Imai Y (2015) Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis. World J Gastrointest Endosc 7:1327–1333

    Article  Google Scholar 

  12. Chuang SH, Chen PH, Chang CM, Lin CS (2013) Single-incision vs three-incision laparoscopic cholecystectomy for complicated and uncomplicated acute cholecystitis. World J Gastroenterol 19:7743–7750

    Article  Google Scholar 

  13. Kim MK, Choi IS, Moon JI, Lee SE, Yoon DS, Kwon SU, Choi WJ, Sung NS, Park SM (2018) Evolution of the Konyang standard method for single incision laparoscopic cholecystectomy: the result from a thousand case of a single center experience. Ann Surg Treat Res 95:80–86

    Article  Google Scholar 

  14. Mayhew D, Mendonca V, Murthy BVS (2019) A review of ASA physical status—historical perspectives and modern developments. Anaesthesia 74:373–379

    Article  CAS  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes 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: five-year experience. Ann Surg 250:187–196

    Article  Google Scholar 

  16. Yin H, Wang Z, Xu J, Guan Y, Zhai B, Zhao L (2011) A specific instrument to facilitate single-incision laparoscopic cholecystectomy: an initial experience. Surg Innov 18:289–293

    Article  Google Scholar 

  17. Supe AN, Kulkarni GV, Supe PA (2010) Ergonomics in laparoscopic surgery. J Min Access Surg 6:31–36

    Article  Google Scholar 

  18. Trejo A, Jung MC, Oleynikov D, Hallbeck MS (2007) Effect of handle design and target location on insertion and aim with a laparoscopic surgical tool. Appl Ergon 38:745–753

    Article  Google Scholar 

  19. Matsui Y, Ryota H, Sakaguchi T, Nakatani K, Matsushima H, Yamaki S, Hirooka S, Yamamoto T, Kwon AH (2014) Comparison of a flexible-tip laparoscope with a rigid straight laparoscope for single-incision laparoscopic cholecystectomy. Am Surg 80:1245–1249

    Article  Google Scholar 

  20. Binenbaum SJ, Teixeira JA, Forrester GJ, Harvey EJ, Afthinos J, Kim GJ, Koshy N, McGinty J, Belsley SJ, Todd GJ (2009) Single-incision laparoscopic cholecystectomy using a flexible endoscope. Arch Surg 144:734–738

    Article  Google Scholar 

  21. Fronza JS, Linn JG, Nagle AP, Soper NJ (2010) A single institution’s experience with single incision cholecystectomy compared to standard laparoscopic cholecystectomy. Surg 148:731–734

    Article  Google Scholar 

  22. Podolsky ER, Curcillo PG 2nd (2010) Reduced-port surgery: preservation of the critical view in single-port-access cholecystectomy. Surg Endosc 24:3038–3043

    Article  Google Scholar 

  23. Funamizu N, Okamoto T, Kumamoto T, Kazama T, Watanabe A, Fujioka S, Yanaga K (2019) Effective method of gallbladder retraction for single-incision laparoscopic cholecystectomy. Asian J Endosc Surg 12:222–226

    Article  Google Scholar 

  24. Mangieri CW, Hendren BP, Strode MA, Bandera BC, Faler BJ (2019) Bile duct injuries (BDI) in the advanced laparoscopic cholecystectomy era. Surg Endosc 33:724–730

    Article  Google Scholar 

  25. Barrett M, Asbun HJ, Chien HL, Brunt LM, Telem DA (2018) Bile duct injury and morbidity following cholecystectomy: a need for improvement. Surg Endosc 32:1683–1688

    Article  Google Scholar 

  26. Strasberg SM, Hertl M, Soper NJ (1995) An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 180:101–125

    CAS  PubMed  Google Scholar 

  27. Massarweh NN, Flum DR (2007) Role of intraoperative cholangiography in avoiding bile duct injury. J Am Coll Surg 204:656–664

    Article  Google Scholar 

  28. Ausania F, Holmes LR, Ausania F, Iype S, Ricci P, White SA (2012) Intraoperative cholangiography in the laparoscopic cholecystectomy era: why are we still debating? Surg Endosc 26:1193–1200

    Article  CAS  Google Scholar 

  29. Byun GY, Lee SR, Koo BH (2018) Safety of single-incision laparoscopic cholecystectomy for acute cholecystitis. ANZ J Surg 88:755–759

    Article  Google Scholar 

  30. Sato N, Kohi S, Tamura T, Minagawa N, Shibao K, Higure A (2015) Single-incision laparoscopic cholecystectomy for acute cholecystitis: a retrospective cohort study of 52 consecutive patients. Int J Surg 17:48–53

    Article  Google Scholar 

  31. Koizumi N, Kobayashi H, Takagi T, Fukumoto K (2017) Is single-incision laparoscopic cholecystectomy feasible for acute cholecystitis? A consecutive study of 60 cases. Surg Laparosc, Endosc Percutaneous Tech 27:379–383

    Article  Google Scholar 

  32. Kim SG, Moon JI, Choi IS, Lee SE, Sung NS, Chun KW, Lee HY, Yoon DS, Choi WJ (2016) Risk factors for conversion to conventional laparoscopic cholecystectomy in single incision laparoscopic cholecystectomy. Ann Surg Treat Res 90:303–308

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea

    Min Ho Um, Seung Jae Lee, In Seok Choi, Ju Ik Moon, Sang Eok Lee, Nak Song Sung, Seong Uk Kwon, In Eui Bae, Seung Jae Rho, Sung Gon Kim, Dae Sung Yoon & Won Jun Choi

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  1. Min Ho Um
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Correspondence to Seung Jae Lee.

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Drs. Min Ho Um, Seung Jae Lee, In Seok Choi, Ju Ik Moon, Sang Eok Lee, Nak Song Sung, Sung Uk Kwon, In Eui Bae, Seung Jae Rho, Sung Gon Kim, Dae Sung Yoon, and Won Jun Choi have no conflict of interest or financial ties to disclose.

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Um, M.H., Lee, S.J., Choi, I.S. et al. Completion of single-incision laparoscopic cholecystectomy using the modified Konyang standard method. Surg Endosc 36, 4992–5001 (2022). https://doi.org/10.1007/s00464-021-08856-6

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