title: Four-channel single incision laparoscopic cholecystectomy using a snake retractor: comparison between 3- and 4-channel SILC 4-channel single incision cholecystectomy.
abstract: OBJECTIVE
  Single incision laparoscopic cholecystectomy (SILC) is a widely used method of performing cholecystectomy. A common technique used in SILC is a 3-channel method. However, exposure of Calot's triangle is limited in conventional 3-channel SILC. Therefore, we herein report the adequacy and feasibility of 4-channel SILC using a snake retractor.
  
  
  METHODS
  Four hundred and fifteen SILC cases were performed between April 2010 and February 2013. We performed 326 SILC cases between April 2010 and September 2012 using the 3-channel method. We introduced a snake retractor for liver traction in October 2012, and 89 cases of 4-channel SILC using snake retractor have been performed since.
  
  
  RESULTS
  Thirty patients (9.2%) in the 3-channel SILC group, and 23 patients (25.8%) in the 4-channel SILC group, were treated with percutaneous transhepatic gallbladder drainage insertion because of acute inflammation of the gallbladder (GB) before operation (P < 0.001). The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709). In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043). There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.
  
  
  CONCLUSIONS
  Benign diseases of the GB can be operated on using SILC with the 4-channel method using a snake retractor.
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Nak Song
authors.initials: NS
authors.lastname: Sung
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: In Seok
authors.initials: IS
authors.lastname: Choi
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Ju Ik
authors.initials: JI
authors.lastname: Moon
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Ra
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Sang Eok
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Choi
keywords: 4-channel; Cholecystectomy; Laparoscopy; Single incision