Outpatient single-incision laparoscopic cholecystectomy in 22 patients with gallbladder disease.
BACKGROUND
Transumbilical single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It has been described by some authors as scarless surgery. To our knowledge, however, there has been no study on outpatient SILC. The present study was designed to determine the safety, feasibility and benefits of transumbilical outpatient SILC.


METHODS
Twenty-two patients underwent transumbilical outpatient SILC at our department from December 2008 to October 2009. In all patients, the preoperative work-up and operation were completed in the outpatient clinic. To perform the operation, a 2- to 2.5-cm semi-circular incision was made around the umbilicus and three 5-mm trocars were inserted separately by direct puncture. A 5-mm flexible laparoscope, an UltraCision harmonic scalpel and curved instruments were used to perform the laparoscopic cholecystectomy (LC) procedure.


RESULTS
All patients except one were operated on successfully. The conversion rate to standard LC was 5%. In the 21 successfully completed patients, the median duration of operation was 56.5 minutes and estimated operative blood loss was 16.2 ml. The time to resume liquid food was 10.8 hours and semi-liquid food was 16.2 hours after the operation. Nine patients went home on the same day, and 12 on the second day after the operation. The mean postoperative hospital observation time was 18.5 hours. Urinary retention was observed in 1 patient. The follow-up was conducted for all patients at 2 weeks after surgery. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 95%.


CONCLUSIONS
Outpatient SILC is a safe and feasible technique for operating with fewer scars and reducing perioperative discomfort at the same time. A direct puncture method to insert trocars is technically feasible. Using a flexible laparoscope and curved instruments make the procedure easier and more time-saving.
Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China.
Wu
W
Ji
Kai
K
Ding
Rong
R
Yang
Xing-Dong
XD
Liu
Ning
N
Li
Jie-Shou
JS
Li
D000293:Adolescent; D000328:Adult; D000556:Ambulatory Surgical Procedures / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002921:Cicatrix / Q000517:prevention & control; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013518:Surgery, Plastic / Q000379:methods; D014472:Umbilicus / Q000601:surgery; D055815:Young Adult