title: Single-port cholecystectomy: small scar, short learning curve.
abstract: 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.
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, Yale University School of Medicine, 40 Temple Street, Suite 7B, New Haven, CT 06510, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Solomon
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bell
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Duffy
authors.forename: Kurt E
authors.initials: KE
authors.lastname: Roberts
mesh_terms: 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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