Skip to main content
SpringerLink
Log in

Single-access laparoscopic cholecystectomy with routine intraoperative cholangiogram

  • Technique
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

While laparoscopy is now the standard for cholecystectomy, recent papers have focused on single-incision approaches. Intraoperative cholangiography remains an integral part of laparoscopic cholecystectomy but has not yet been well described within the single-access literature. We discuss our method of single-incision laparoscopic cholecystectomy with routine intraoperative cholangiograms.

Methods

A retrospective review of our surgical database was completed. One hundred twenty-three patients undergoing laparoscopic cholecystectomy were identified (83 standard laparoscopy, 40 single-incision laparoscopy). Patient demographics including age and body mass index (BMI), and indications for surgery, operative time, intra- and postoperative complications, and ability to complete cholangiography were analyzed.

Results

All patients with standard laparoscopy had successful cholangiograms. Two patients did not undergo cholangiography based on a preoperative decision (pregnancy). In the 40 patients who underwent single-incision cholecystectomy, 38 cholangiograms were completed (95%). One patient with acute cholecystitis had a small cystic duct which could not be cannulated. The second had a cystic duct through which the cholangiocatheter could not be advanced. Comparative analysis of patient demographics showed a significant difference in patient age between the two groups, as well as a significantly greater number of patients undergoing single-incision cholecystectomy for symptomatic cholelithiasis as opposed to acute cholecystitis.

Discussion

Completion of intraoperative cholangiography is an important aspect of cholecystectomy in order to identify choledocholithiasis and verify anatomy. With the advent of single-access laparoscopy, standard operative principles should not be compromised. Cholangiography may provide a safer approach to cholecystectomy when adopting a new technique. We present our technique of single-incision cholecystectomy and routine cholangiography with a 95% success rate. The ability to perform single-incision intraoperative cholangiograms will allow a safe, more minimally invasive approach to cholecystectomy with suspected choledocholithiasis and obviate the need to convert to standard multiport laparoscopy for the sole reason of completing cholangiograms.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech A 9(4):361–364

    Article  PubMed  CAS  Google Scholar 

  2. Romanelli JR, Mark L, Omotosho PA (2008) Single port laparoscopic cholecystectomy with the TriPort system: a case report. Surg Innov 15:223–228

    Article  PubMed  Google Scholar 

  3. Tacchino R, Greco F, Matera D (2009) Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23:896–899

    Article  PubMed  CAS  Google Scholar 

  4. Ersin S, Firat O, Sozbilen M (2010) Single-incision laparoscopic cholecystectomy: is it more than a challenge? Surg Endosc 24:68–71

    Article  PubMed  Google Scholar 

  5. Cuesta MA, Berends F, Veenhof A (2008) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22:1211–1213

    Article  PubMed  Google Scholar 

  6. Rao PP, Bhagwat SM, Rane A, Rao P (2008) The feasiblity of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB 10(5):336–340

    Article  PubMed  Google Scholar 

  7. 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(2):215–217

    Article  PubMed  Google Scholar 

  8. Zhu JF, Hu J, Ma YZ, Xu MZ, Li F (2009) Transumbilical endoscopic surgery: a preliminary clinical report. Surg Endosc 23:813–817

    Article  PubMed  Google Scholar 

  9. Hirano Y, Watanabe T, Uchida T, Yoshida S, Tawaraya K, Kato H, Hosokawa O (2010) Single-incision laparoscopic cholecystectomy: single institution experience and literature review. World J Gastroenterol 16(2):270–274

    Article  PubMed  Google Scholar 

  10. Langwieler TE, Nimmesgern T, Back M (2009) Single-port access in laparoscopic cholecystectomy. Surg Endosc 23:1138–1141

    Article  PubMed  Google Scholar 

  11. Merchant AM, Cook MW, White BC, Davis SS, Sweeney JE, Lin E (2009) Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointes Surg 13:159–162

    Article  Google Scholar 

  12. Lee SK, You YK, Park JH, Kim HJ, Lee KK, Kim DG (2009) Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech A 19(4):495–499

    Article  PubMed  Google Scholar 

  13. Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 23:1393–1397

    Article  PubMed  Google Scholar 

  14. Hussain A, Mahmood H, Singhal T, Balakrishnan S, Nicholls J, El-Hassani S (2009) Long-term study of port-site incisional hernia after laparoscopic procedures. JSLS 13(3):346–349

    PubMed  Google Scholar 

  15. Connor S (2009) Single-port-access cholecystectomy: history should not be allowed to repeat. World J Surg 33:1020–1021

    Article  PubMed  Google Scholar 

  16. Martins MVD, Skinovsky J, Coelho DE, Ramos A, Neto MPG, Rodrigues J, Carli L, Cavazolla LT, Campos J, Thuller F, Brunetti A (2009) Cholecystectomy by single trocar access (SITRACC): the first multicenter study. Surg Innov 16(4):313–316

    Article  Google Scholar 

  17. Curcillo PG, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, Dunham R, Fendley S, Neff M, Copper C, Bessler M, Gumbs AA, Norton M, Iannelli A, Mason R, Moazzez A, Cohen L, Mouhlas A, Poor A (2009) Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc doi:10.1007/s00464-009-0856-x, February, 5 2010

  18. Millat PB (2005) Open pneumoperitoneum because of quality assurance. Surg Endosc 19:1297–1299

    Article  PubMed  CAS  Google Scholar 

  19. Moberg AC, Montgomery A (2005) Primary access-related complications with laparoscopy. Surg Endosc 19:1196–1199

    Article  PubMed  Google Scholar 

  20. Ahmad G, Duffy JMD, Phillips K, Watson A (2008) Laparoscopic entry techniques. Cochrane Database Syst Rev 2:CD006583–CD006583

    PubMed  Google Scholar 

  21. Massarweh NN, Flum DR (2007) Role of intraoperative cholangiography in avoiding bile duct injury. J Am Coll Surg 204(4):656–664

    Article  PubMed  Google Scholar 

  22. Ludwig K, Bernhardt J, Steffen H, Lorenz D (2002) Contribution of intraoperative cholangiography to incidence and outcome of common bile duct injuries during laparoscopic cholecystectomy. Surg Endosc 16(7):1098–1104

    Article  PubMed  CAS  Google Scholar 

  23. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T (2003) Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 289(13):1639–1644

    Article  PubMed  Google Scholar 

  24. Fogli L, Boschi S, Patrizi P, Berta RD, Sahlani UA, Capizzi D, Capizzi FD (2009) Laparoscopic cholecystectomy without intraoperative cholangiography: audit of long-term results. J Laparoendosc Adv Surg Tech A 19(2):191–193

    Article  PubMed  Google Scholar 

  25. Bucher P, Pugin F, Buchs N, Ostermann S, Charara F, Morel P (2009) Single port access laparoscopic cholecystectomy (with video). World J Surg 33:1015–1019

    Article  PubMed  Google Scholar 

  26. Rawlings A, Hodgett SE, Matthews BD, Strasberg SM, Quasebarth M, Brunt LM (2010) Single-incision laparoscopic cholecystectomy: initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg 211(1):1–7

    Article  PubMed  Google Scholar 

Download references

Disclosures

Dr. Alfons Pomp is a consultant for Covidien, Ethicon Endo-Surgery, and WL Gore & Associates. Dr. Gregory Dakin is a consultant for Novare Surgical Systems, Inc. and Covidien. Dr. Melissa Bagloo is an Advanced Minimally Invasive Surgery Fellow currently completing a fellowship which is in part supported by Covidien. Mormino has no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Section of Laparoscopic and Bariatric Surgery, Weill Cornell Medical College, 525 East 68th Street, Room F763, Box 294, New York, NY, 10065, USA

    Melissa B. Bagloo, Gregory F. Dakin & Alfons Pomp

  2. Weill Cornell Graduate School of Medical Sciences, New York, NY, USA

    Lori P. Mormino

Authors
  1. Melissa B. Bagloo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gregory F. Dakin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lori P. Mormino
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Alfons Pomp
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gregory F. Dakin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bagloo, M.B., Dakin, G.F., Mormino, L.P. et al. Single-access laparoscopic cholecystectomy with routine intraoperative cholangiogram. Surg Endosc 25, 1683–1688 (2011). https://doi.org/10.1007/s00464-010-1408-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-010-1408-0

Keywords

Search

Navigation