Single institution experience of single incision trans-umbilical laparoscopic cholecystectomy using conventional laparoscopic instruments.
BACKGROUND
Since the implement of laparoscopic cholecystectomy as the gold standard treatment for gall bladder stones, there has been a trend toward minimizing the required number and size of ports to reduce postoperative pain with better cosmetic results. We conducted this study to evaluate the feasibility, safety, advantages and complications of single incision laparoscopic cholecystectomy using the conventional laparoscopic instruments.


METHODS
Eighty patients (68 females and 12 males) with uncomplicated symptomatic gall bladder stones underwent elective laparoscopic cholecystectomy via single trans-umbilical incision using the conventional laparoscopic instruments.


RESULTS
The mean operative time was 61.75 min (range: 40-105 min) and the mean estimated blood loss was 17.21 ml (range: 5-90 ml). Gall bladder perforation occurred in five cases (6.25%) with calculi spillage in four of them. It was managed by using laparoscopic stone removal forceps. Troublesome cystic artery bleeding occurred in 2 cases (2.5%) while gall bladder bed bleeding happened in one case (1.25%) with liver cirrhosis and managed by argon beam coagulation. An intraoperative cholangiography was performed in 3 cases and a drain was inserted in one case. There was no conversion to the open technique in any of the cases. 49 patients (94.2%) discharged on the 1st postoperative day and 3 patients (5.8%) discharged on the 2nd postoperative day. The average wound length measured on 3rd postoperative month was 1.58 cm (range, 1.3-2.1 mm); while average score of patient satisfaction of the surgery was of 9.32 (range, 7-10).


CONCLUSIONS
In uncomplicated gall bladder disease; single incision laparoscopic cholecystectomy is feasible and safe. It has an excellent esthetic results and high grade of patient satisfaction. It could be performed with the conventional laparoscopic instruments and its scale of application could be widened once enough experience attained.
Department of General Surgery, Theodore Bilharz Research Institute, P.O. Box 30, Imbaba, 12411 Giza, Egypt.
A M
AM
Abdelaziz Hassan
Magdy M A
MM
Elsebae
Magid M A
MM
Nasr
A I
AI
Nafeh
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D042882:Gallstones / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017060:Patient Satisfaction; D011183:Postoperative Complications; D014472:Umbilicus / Q000601:surgery*