title: Single-incision laparoscopic cholecystectomy at community hospitals in Honolulu, Hawai'i: a case series.
abstract: This study aims to demonstrate the feasibility of implementing single-incision laparoscopic cholecystectomy in a community hospital setting. Minimally invasive surgical approaches for cholecystectomy achieve equivalent outcomes to the open surgical approach with less post-operative pain, improved cosmesis, shorter hospital stays, and decreased complications. Surgeons are attempting to reduce incisional trauma further by decreasing the number of incisions. A retrospective chart review was conducted for demographics, operating time, blood loss, conversion rate, length of stay, and presence of operative complications on patients undergoing single-incision laparoscopic cholecystectomy at two community hospitals between 2008 and 2011. One hundred and three patients (79 females and 24 males) underwent single-incision laparoscopic cholecystectomy. The mean age was 49.8 years (range 18-88). Ninety-six patients (93.2%) underwent elective procedures while 7 patients (6.8%) underwent urgent procedures. The mean operating time was 89.7 (± 28.3) minutes and the average blood loss was 33.7 (± 27.4) milliliters. Ninety-five (92.2%) of the procedures were successfully completed with a single-incision approach and 8 (7.8%) were converted to a multi-incisional approach, while none were converted to an open approach. The median length of stay was 4.75 hours. The post-operative complication rate was 7.4% (7/95) and included four superficial wound infections, one bile leak, one acute renal failure, and one urinary tract infection. These outcomes for single-incision laparoscopic cholecystectomy are comparable to other case series reported in the literature, and this retrospective review illustrates that single-incision laparoscopic cholecystectomy is feasible in a community setting.
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Cori-Ann M
authors.initials: CA
authors.lastname: Hirai
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Daniel
authors.initials: D
authors.lastname: Murariu
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Cooper
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Oishi
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Steven D
authors.initials: SD
authors.lastname: Nishida
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Cedric Sf
authors.initials: CS
authors.lastname: Lorenzo
authors.affiliation: ARTEMIS Research Group (Association for Research, Training and Education in Minimally Invasive Surgery), Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI (all authors).
authors.forename: Racquel S
authors.initials: RS
authors.lastname: Bueno
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006254:Hawaii; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies