title: Therapeutic advances: single incision laparoscopic hepatopancreatobiliary surgery.
abstract: Single-port laparoscopic surgery (SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery - cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS - surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique.
authors.affiliation: Stephen Kin Yong Chang, Kai Yin Lee, Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, National University Singapore Hospital, Singapore 119228, Singapore.
authors.forename: Stephen Kin Yong
authors.initials: SK
authors.lastname: Chang
authors.affiliation: Stephen Kin Yong Chang, Kai Yin Lee, Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, National University Singapore Hospital, Singapore 119228, Singapore.
authors.forename: Kai Yin
authors.initials: KY
authors.lastname: Lee
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002983:Clinical Competence; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D059032:Learning Curve; D061646:Operative Time; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cholecystectomy; Hepatectomy; Liver resection; Pancreatectomy; Single port laparoscopic