title: Single-incision laparoscopic common bile duct exploration with conventional instruments: an innovative technique and a comparative study.
abstract: BACKGROUND
  Single-incision laparoscopic surgery developed rapidly in recent years. We introduce an innovative technique: single-incision laparoscopic common bile duct exploration (SILCBDE) with conventional instruments. A retrospective comparison between SILCBDE and standard laparoscopic common bile duct exploration (LCBDE) was analyzed.
  
  
  METHODS
  Thirty-four patients who underwent LCBDE for choledocholithiasis in a period of 17 months were enrolled. Seventeen standard LCBDEs and 17 SILCBDEs were attempted. Simultaneous cholecystectomies were performed.
  
  
  RESULTS
  The stone clearance rate was 94.1% (16 patients) in the standard LCBDE group and 100% in the SILCBDE group. There was no statistical difference in demographic distribution, clinical presentations, and operative results between the two groups, except the SILCBDE group had a higher rate of acute cholecystitis than the standard LCBDE group (76.5 vs. 35.3%; p < 0.05). One procedure (5.9%) in the SILCBDE group was converted to a four-incision transcystic LCBDE. The complication rate was 11.8% (two patients) in the standard LCBDE group and 5.9% (one patient) in the SILCBDE group. The average follow-up period was 4.2 months.
  
  
  CONCLUSIONS
  SILCBDE is as safe and efficacious as standard LCBDE in experienced hands. Choledochoscope manipulation and bile duct repair are the key skills. Long-term follow-up and further prospective randomized trials are anticipated.
authors.affiliation: Department of Biological Science and Technology, National Chiao Tung University, No.75 Po-Ai Street, Hsin-Chu, 30068, Taiwan.
authors.forename: Shu-Hung
authors.initials: SH
authors.lastname: Chuang
authors.forename: Pai-Hsi
authors.initials: PH
authors.lastname: Chen
authors.forename: Chih-Ming
authors.initials: CM
authors.lastname: Chang
authors.forename: Yung-Fa
authors.initials: YF
authors.lastname: Tsai
authors.forename: Chih-Sheng
authors.initials: CS
authors.lastname: Lin
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D041881:Cholecystitis, Acute / Q000150:complications; D042883:Choledocholithiasis / Q000150:complications / Q000601:surgery*; D003135:Common Bile Duct / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies