title: Hybrid single-port cholecystectomy in children.
abstract: OBJECTIVE
  Multiple single-port or single-incision techniques have been successfully implemented for laparoscopic cholecystectomy in adults and children. These techniques require either a large multichannel port or a larger skin incision to accommodate multiple  ports or instruments. Inspired by a first generation single-port instrument, we developed a safe and effective technique for a single-port laparoscopic cholecystectomy with virtually scarless results.
  
  
  METHODS
  Over a 14-mo period, 20 patients (19 females, 1 male) underwent the hybrid  single-port cholecystectomy. A straight 10-mm Storz telescope with inbuilt 6-mm working channel in combination with 2 portless 2.3-mm percutaneous graspers was used. The dissection is carried out with 43-cm bariatric length instruments. The cystic artery and duct are sealed with WECK Hem-o-lok  clips or the Harmonic scalpel.
  
  
  RESULTS
  Range (mean) age: 7.7 y to 19.5 y (15.5), BMI: 11.6kg/m(2) to 42.3kg/m(2) (27), operative duration 48 min to 120 min (79), postoperative length of stay: 5 h to 78 h (24).
  
  
  METHODS
  13 patients cholecystolithiasis, 7 patients  biliary dyskinesia. Conversion to conventional 4-port cholecystectomy was required in 2 patients. No intra- or postoperative complications occurred.
  
  
  CONCLUSIONS
  The hybrid single-port technique is easy to master. It provides traditional anatomical exposure and allows application  of conventional laparoscopic principles.
authors: Cleveland Clinic Foundation, Department of Pediatric Surgery, Pediatric Institute & Children's Hospital, Cleveland, OH 44195, USA. Seifarf@ccf.org
authors: Federico G
authors: FG
authors: Seifarth
authors: José R
authors: JR
authors: Ramirez
authors: David K
authors: DK
authors: Magnuson
mesh_terms: D000293:Adolescent; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult