Single port access laparoscopic cholecystectomy (with video).
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.
Bucher
Pascal
P
Department of Surgery, University Hospital Geneva, 24 rue Micheli-du-Crest, 1211 Geneva, Switzerland. pascal.bucher@hcuge.ch
Pugin
François
F
Buchs
Nicolas
N
Ostermann
Sandrine
S
Charara
Fadi
F
Morel
Philippe
P
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*