title: Single port laparoscopic cholecystectomy: which technique, which surgeon, for which patient? A study of the implementation in a teaching hospital.
abstract: BACKGROUND
  Single port cholecystectomy is increasingly performed. This procedure can be challenging, and we lack factors predicting the operative difficulty.
  
  
  OBJECTIVE
  To assess the role of surgeon experience and identify possible predictive factors of intraoperative difficulties.
  
  
  METHODS
  Sixty-one selected patients were prospectively enrolled between January 2008 and August 2010. Six surgeons were involved (3 seniors, 3 juniors). Anthropometrics of the patients, types of ports, exposure methods and intraoperative data were recorded. Pain was assessed with the visual analogic scale at postoperative day 1 (POD 1 VAS).
  
  
  RESULTS
  Fifty-eight patients with symptomatic gallstones and three with acute cholecystitis underwent single port cholecystectomy. The mean BMI, weight and height were 25.7 kg/m(2) (SD 4.45), 71.8 kg (SD 14.83) and 166 cm SD 0.07, respectively. Mean operative time was 68.4 min (SD 26.98). Anthropometrics had no influence on operative time. Senior surgeons performed more rapidly, but the difference was not significant. The overall mean POD 1 VAS was 2.26, (SD 1.81). The mean hospital stay was 2.22 days, (SD 0.9). No complications occurred. An additional exposure method was necessary in 19 procedures. This cluster presented a significantly higher operating time (81.5 min, SD 31.69 vs. 62.7, SD 22.74; p = 0.01) and POD 1 VAS (1.92 vs. 3; p = 0.031).
  
  
  CONCLUSIONS
  Single trocar cholecystectomy can be implemented safely in teaching hospitals. Anthropometrics are not predictive of operative difficulties. The need for additional exposure systems affects the operative time and pain negatively, reflecting greater technical difficulties. Research to optimize instruments may help to solve these problems.
authors.affiliation: IRCAD-EITS, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. didier.mutter@ircad.fr
authors.forename: D
authors.initials: D
authors.lastname: Mutter
authors.forename: C
authors.initials: C
authors.lastname: Callari
authors.forename: M
authors.initials: M
authors.lastname: Diana
authors.forename: B
authors.initials: B
authors.lastname: Dallemagne
authors.forename: J
authors.initials: J
authors.lastname: Leroy
authors.forename: J
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D002983:Clinical Competence; D004867:Equipment Design; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006784:Hospitals, Teaching; D006801:Humans; D020706:Laparoscopes; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult