title: Single-incision laparoscopic cholecystectomy for biliary dyskinesia in children: a simple, safe, and inexpensive technique.
abstract: OBJECTIVE
  To evaluate a low-cost technique for single-incision laparoscopic cholecystectomy (SILC) in children with biliary dyskinesia.
  
  
  METHODS
  Eighteen children with biliary dyskinesia underwent SILC between March and September 2010. Two 5-mm trocars and a directly introduced grasper were inserted through a 2-cm vertical transumbilical incision. Instrument collisions were minimized by using low-profile trocars and a bariatric laparoscope with a right-angle light adaptor. An internally anchored retracting device suspended the gallbladder, obviating the need for an additional trocar. No other special equipment was used.
  
  
  RESULTS
  There were 15 girls and 3 boys with a mean age of 15.9 years (range, 9-18 years). Sixteen (88.9%) underwent true SILC. One patient was converted to a four-port laparoscopic procedure because of uncertainty of ductal anatomy. Another required a 5-mm subxiphoid port for liver retraction. Mean operative time was 82 minutes (range, 42-105 minutes): 94 minutes (range, 75-105 minutes) for the first 6 patients, 85 minutes (range, 60-102 minutes) for the second 6, and 68 minutes (range, 42-90 minutes) for the last 6. Operative times between the first and last groups were significantly different (P=.02). Sixteen patients were discharged home the following day and the remaining 2 on the second postoperative day. There were no complications. The hospital costs of the disposable equipment needed to perform SILC at our institution was $205.05 less than that needed for the four-port operation ($516.32 versus $721.37), a 28.4% savings.
  
  
  CONCLUSIONS
  SILC is safe and feasible in children with biliary dyskinesia. The operative time decreased with experience. The disposable equipment needed was less expensive than that used for the standard laparoscopic technique.
authors.affiliation: Department of Pediatric Surgery, Bronson Children’s Hospital, Kalamazoo, Michigan 49007, USA. leinwanm@bronsonhg.org
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Leinwand
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Elgamal
mesh_terms: D000293:Adolescent; D001657:Biliary Dyskinesia / Q000601:surgery*; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000191:economics / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male