title: Single port access laparoscopic cholecystectomy (with video).
abstract: BACKGROUND
  Single port access (SPA) surgery is a rapidly evolving field due to the complexity of NOTES (natural orifice translumenal endoscopic surgery). SPA combines the cosmetic advantage of NOTES and possibility to perform surgical procedure with standard laparoscopic instruments. We report a technique of umbilical SPA cholecystectomy using standard laparoscopic instruments and complying with conventional surgical principle and technique of minimally invasive cholecystectomy.
  
  
  METHODS
  Preliminary, prospective experience of SPA cholecystectomy in 11 patients (median age, 46 (range, 27-63) years) scheduled for cholecystectomy was evaluated. Diagnoses for cholecystectomy were: symptomatic gallbladder lithiasis (n = 7), previous acute cholecystitis (n = 3), and biliary pancreatitis (n = 1).
  
  
  RESULTS
  SPA cholecystectomy was feasible in all patients (median body mass index, 24 (range, 20-34) kg/m(2)) who were scheduled for preliminary experience using conventional laparoscopic instruments. Median operative time was 52 (range, 40-77) minutes. Intraoperative cholangiography was performed in all patients, except one, and was considered normal. No peroperative or postoperative complications were recorded. Median hospital stay was less than 24 h.
  
  
  CONCLUSIONS
  SPA cholecystectomy is feasible and seems to be safe when performed by experienced laparoscopic surgeons using standard laparoscopic instrumentation. SPA cholecystectomy may be safer than the NOTES approach at this time. It has to be determined whether this approach would benefit patients, other than cosmesis, compared with standard laparoscopic cholecystectomy.
authors.affiliation: Department of Surgery, University Hospital Geneva, 24 rue Micheli-du-Crest, 1211 Geneva, Switzerland. pascal.bucher@hcuge.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Bucher
authors.forename: François
authors.initials: F
authors.lastname: Pugin
authors.forename: Nicolas
authors.initials: N
authors.lastname: Buchs
authors.forename: Sandrine
authors.initials: S
authors.lastname: Ostermann
authors.forename: Fadi
authors.initials: F
authors.lastname: Charara
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*