Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease.
BACKGROUND
Since the introduction of laparoscopic surgery, surgeons have not only been concerned about clinical outcomes, but also surgical scars. Although natural orifice transluminal endoscopic surgery (NOTES) is promising, it is not applicable to clinical practice thus far due to safety concerns. As a transitional procedure between standard laparoscopic surgery and NOTES, single-port transumbilical laparoscopic surgery might be an ideal alternative. The main advantage of single-port transumbilical laparoscopic surgery is that it is performed with existing instruments. Thus, we applied single-port surgery for cholecystectomies and the clinical outcomes were analyzed.


METHODS
Between July and October 2008, 37 adults with gallbladder pathologies were enrolled in this study. Only one transumbilical incision was made for accessing the abdominal cavity and a multichannel port system was assembled with existing devices. Standard laparoscopic instruments were used to perform the cholecystectomy.


RESULTS
There were 13 males and 24 females. The mean age of the patients was 47.5 +/- 12.2 years. Twenty-nine patients had gallbladder stones, 7 patients had gallbladder polyps, and 1 patient had biliary dyskinesia. The mean operative time was 83.6 +/- 40.2 minutes. Gallbladder perforations occurred in 11 patients. In 5 patients, the procedure was converted to a standard laparoscopic technique due to technical difficulties. Complications occurred in 2 patients; specifically, a mesenteric injury was caused by the inadvertent grasping of the small-bowel mesentery during the removal of the wound retractor and an inadvertent injury of the right hepatic duct. The mean hospital stay was 2.7 +/- 1.5 days.


CONCLUSIONS
Our series has demonstrated the feasibility and safety of single-port transumbilical laparoscopic cholecystectomy. When technical difficulties arise, early conversion to a standard laparoscopic technique is advised to avoid serious complications. Additional studies randomizing standard laparoscopic cholecystectomy and single-port transumbilical cholecystectomy are necessary for defining the exact role of this procedure.
Kuon Lee
Sang
S
Department of Surgery, Division of Liver Transplantation and Hepatobiliopancreatic Surgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
You
Young Kyoung
YK
Park
Jung Hyun
JH
Kim
Hyung-Jin
HJ
Lee
Kyung Keun
KK
Kim
Dong Goo
DG
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000517:prevention & control; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014472:Umbilicus