title: From multi-incision to single-incision laparoscopic cholecystectomy step-by-step: one surgeon's self-taught experience and retrospective analysis.
abstract: OBJECTIVE
  Single-incision laparoscopic cholecystectomy (SILC) is emerging as an alternative to standard four-incision laparoscopic cholecystectomy (4ILC). This study presents one surgeon's experience of SILC and a retrospective analysis of the data.
  
  
  METHODS
  Sixty-seven consecutive patients treated by a single surgeon and undergoing laparoscopic cholecystectomy (LC) for benign gallbladder diseases were enrolled. LCs were attempted with conventional instruments as follows: 24 three-incision laparoscopic cholecystectomies (3ILC); 10 two-incision laparoscopic cholecystectomies (2ILC); and 33 SILC.
  
  
  RESULTS
  The procedure conversion rate into the SILC, 2ILC, and 3ILC groups was 9.1%, 0%, and 8.3% respectively. Operative time was significantly longer with SILC (111.1±30.34 minutes) compared to 2ILC (79.1±15.74 minutes) and 3ILC (80.2±29.41 minutes) (p<0.01). Post-operative pethidine dosage was significantly lower in the 2ILC group (0.29±0.358 mg/kg) compared to the 3ILC group (1.02±0.802 mg/kg) (p<0.05). Length of hospital stay (LOS) was significantly shorter in the SILC group (2.52±0.566 days) compared to the 3ILC group (3.1±1.02 days) (p<0.05). There were no complications.
  
  
  CONCLUSIONS
  SILC is a safe and feasible procedure that is comparable to multi-incision laparoscopic cholecystectomy (MILC). We have introduced a recommended step-by-step training program. SILC needed longer operative time than MILC but has potential benefits in terms of LOS and post-operative pain.
authors.affiliation: Division of General Surgery, Department of Surgery, Mackay Memorial Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan. a4882@ms7.mmh.org.tw
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Chuang
mesh_terms: D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000193:education* / Q000379:methods* / Q000706:statistics & numerical data; D061887:Conversion to Open Surgery; D005240:Feasibility Studies; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008614:Meperidine / Q000008:administration & dosage; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control; D011380:Programmed Instructions as Topic; D012189:Retrospective Studies; D013624:Taiwan; D013996:Time and Motion Studies
chemical_list: D000701:Analgesics, Opioid; D008614:Meperidine