title: Fundus-first transumbilical single-incision laparoscopic cholecystectomy with a cholangiogram: a feasibility study.
abstract: BACKGROUND
  An increasing number of techniques are emerging in the literature describing single-incision laparoscopic cholecystectomy (SILC). The advent of a new surgical approach is a reminder of the increase in bile duct injuries in the past when laparoscopic cholecystectomy was first introduced. With this in mind, the authors describe a safe and reproducible approach to SILC.
  
  
  METHODS
  Between August 2008 and August 2009, 20 patients with symptomatic gallbladder disease underwent SILC using a totally transumbilical fundus-first approach with an intraoperative cholangiogram. Data including pain scores were collected prospectively.
  
  
  RESULTS
  In this initial series, the median operative time was 103 min (range, 55-177 min), including the time for two patients undergoing additional procedures at the time of surgery. Intraoperative cholangiograms were completed for 18 of 19 patients. Additional ports were required in four patients for safe completion of the procedure. The mean pain score 12 h postoperatively was 2.5 on a visual analogue scale with a range of 0-10. There was no morbidity or mortality.
  
  
  CONCLUSIONS
  According to the findings, SILC with an intraoperative cholangiogram can be performed safely using a fundus-first approach. However, for SILC to become the operation of choice for the treatment of gallbladder disease, evidence is required to demonstrate its advantage over laparoscopic cholecystectomy.
authors: Department of Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK. ameetpatel1@nhs.net
authors: Ameet G
authors: AG
authors: Patel
authors: B
authors: B
authors: Murgatroyd
authors: K
authors: K
authors: Carswell
authors: A
authors: A
authors: Belgaumkar
mesh_terms: D000328:Adult; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005748:Gastric Fundus; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D014472:Umbilicus; D055815:Young Adult