title: Single incision cholecystectomy using a clipless technique with LigaSure in a resource limited environment: The Bahamas experience.
abstract: BACKGROUND
  Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure.
  
  
  METHODS
  Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2-2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10mm 30-degree laparoscope, a 5mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure.
  
  
  RESULTS
  All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5min and estimated operative blood loss was 24ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%.
  
  
  CONCLUSIONS
  SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment.
authors.affiliation: Doctors Hospital, Nassau, Bahamas. Electronic address: rossdownes@yahoo.com.
authors.forename: Ross O
authors.initials: RO
authors.lastname: Downes
authors.affiliation: University Hospital of the West Indies, Mona, Kingston, Jamaica. Electronic address: michaelm500@yahoo.com.
authors.forename: Michael
authors.initials: M
authors.lastname: McFarlane
authors.affiliation: Doctors Hospital, Nassau, Bahamas. Electronic address: cdig@themednetgroup.com.
authors.forename: Charles
authors.initials: C
authors.lastname: Diggiss
authors.affiliation: Doctors Hospital, Nassau, Bahamas. Electronic address: jiferenta@doctorshosp.com.
authors.forename: James
authors.initials: J
authors.lastname: Iferenta
keywords: Cholecystectomy; Laparoscopy; LigaSure; SILC; SILS; Single incision; Single port