Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard.
BACKGROUND
The aim of this pilot study was to describe our initial experience with single-incision laparoscopic cholecystectomy (SILC) using conventional laparoscopic equipment in comparison with concurrent patients undergoing conventional multiincision laparoscopic cholecystectomy.


METHODS
During the 7-month study period, data from all consecutive patients undergoing SILC by two surgeons were retrospectively analyzed and compared with data from patients undergoing conventional laparoscopic cholecystectomy by the same surgeons during the same time period. Outcomes measures included completion rate of attempted SILC, operative time, length of hospital stay, postoperative pain, and assessment of complications.


RESULTS
From 51 laparoscopic cholecystectomies performed during the study period, 29 were attempted using single-incision technique and 22 were performed using the conventional four incisions. Of the attempted SILC cases, 14 (48%) were successfully completed, with the remainder requiring one to three additional skin incisions. There were no conversions to open in either group. Operative time was significantly longer in SILC cases compared with conventional laparoscopic cholecystectomy (85 versus 67 minutes; p = 0.01). There was a tendency toward greater postoperative pain in the SILC group. No substantial difference in complications was identified.


CONCLUSIONS
SILC using conventional laparoscopic instrumentation is an effective alternative to standard four-incision laparoscopic cholecystectomy in selected patients. Development of a standardized technique and additional experience is needed for more consistent success. Additional studies of SILC are needed to demonstrate safety, define selection criteria, and determine any benefits over conventional laparoscopic cholecystectomy.
Department of Surgery, University of Missouri, Columbia, University Hospitals and Clinics, Columbia, MO, USA. philipps@health.missouri.edu
Scott R
SR
Philipp
Brent W
BW
Miedema
Klaus
K
Thaler
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001660:Biliary Tract Diseases / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D004867:Equipment Design; D005260:Female; D006801:Humans; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome