Single-port cholecystectomy: small scar, short learning curve.
BACKGROUND
This past year has borne witness to the acceptance of single-port laparoscopic surgery into mainstream clinical practice. This study describes a surgeon's experience with single-port laparoscopic cholecystectomy and delineates a learning curve for this technically demanding procedure utilizing improvements in operative time as a proxy for technical facility.


METHODS
Through a 2-cm vertical transumbilical incision, three 5-mm ports or SILS™ Ports were placed using the Veress technique. One extracorporeal stay suture was utilized to provide cephalad retraction of the gallbladder fundus, and a roticulating instrument was used at the infundibulum for lateral retraction. The hilum was dissected and the cystic duct and artery were clipped and divided. One 5-mm port was removed and another upgraded to one 10-mm port to allow the introduction of a retrieval bag to facilitate the removal of the gallbladder from the abdomen. Patient demographic data, operative time, length of stay, surgical pathology, and complications were recorded.


RESULTS
Fifty-two of 54 patients successfully underwent single-port cholecystectomies. Two patients required conversion to either a conventional laparoscopic cholecystectomy or open cholecystectomy. The average age was 41 years and average BMI was 30.2 kg/m(2). Mean operative time was 80 min. Length of stay was 0.3 days. The complication rate was 3/54 (5.5%). When patients were divided into sequential quintiles (n = 10), operative times decreased significantly after the first 10 patients (p = 0.0001) and then remained flat (p = 0.233). Operative times for obese patients (BMI >30) were greater than those for nonobese patients, but these results failed to reach statistical significance (85.3 vs. 69.7 min, p = 0.07).


CONCLUSIONS
The significant improvement in operative times after the first quintile followed by consistent results without subsequent variability suggests that the learning curve for the single-port cholecystectomy, in the hands of a fellowship-trained laparoscopic surgeon, is approximately ten cases.
Solomon
Daniel
D
Section of Gastrointestinal Surgery, Department of Surgery, Yale University School of Medicine, 40 Temple Street, Suite 7B, New Haven, CT 06510, USA.
Bell
Robert L
RL
Duffy
Andrew J
AJ
Roberts
Kurt E
KE
D000293:Adolescent; D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000193:education* / Q000379:methods*; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D055815:Young Adult
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