[Single-port transumbilical endoscopic cholecystectomy: a new standard?].
OBJECTIVE
Single-port transumbilical laparoscopic cholecystectomy (SPTLC) may become a standard procedure in the surgical treatment of acute and chronic gallbladder diseases. The initial experience with this new technique is reported.


METHODS
186 patients underwent laparoscopic single-port laparoscopic cholecystectomy between September 2008 and February 2010 at the Vivantes Klinikum Am Urban, Berlin, Germany. All these operations were performed with conventional straight laparascopic instruments using a single-port system.


RESULTS
Conversion to a three-port technique or open procedure became necessary in four patients after failure to perform the single-port method. The average age of the 120 women (64%) and 66 men (36%) was 45 (range 15-88 years) years. The ASA grade (American Society of Anesthesiologists) averaged 2 (range, 1-3) and the BMI 28.5 (range 17-49). Mean operative time was 63 min (range, 28-17 min). 48 patients (26%) had histopathological evidence of acute cholecystitis. During a mean follow-up period of 39 weeks (range 1-78 weeks), 11 patients (6%) developed complications related to the surgery, five of these patients (3%) requiring a subsequent re-operation.


CONCLUSIONS
Single-port transumbilical laparoscopic cholecystectomy for acute and chronic gallbladder disease is a feasible approach for routine cholecystectomy. After a short learning curve the operation time and rate of complications are comparable to standard multi-port laparoscopic cholecystectomy. A limitation of the procedure are very obese patients and multiple previously performed abdominal operations.
Jacob
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Klinik für Gefäss- und Viszeralchirurgie, Vivantes Klinikum Am Urban, Berlin. dr.djacob@me.com
Raakow
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D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D002764:Cholecystitis / Q000601:surgery*; D041881:Cholecystitis, Acute / Q000601:surgery; D002908:Chronic Disease; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D011183:Postoperative Complications / Q000601:surgery; D012086:Reoperation; D013525:Surgical Instruments; D014472:Umbilicus / Q000601:surgery; D055815:Young Adult