title: Outcomes in laparoscopic cholecystectomy by single incision with SPIDER surgical system are comparable to conventional multiport technique: one surgeon's experience.
abstract: Single-incision laparoscopic cholecystectomy has emerged as an alternative to conventional multiport laparoscopic cholecystectomy (LC). Technical difficulty, prolonged surgical times and increased complication rates have been reported in single-incision laparoscopic surgery. One of the concerns is lack of triangulation of instruments. The SPIDER®surgical system is a single-incision laparoscopic device that utilizes flexible instruments with the purpose of achieving adequate triangulation. The purpose of this study is to compare the outcomes of SPIDER versus LC.
  
  
  
  A retrospective chart review of patients who underwent LC and SPIDER cholecystectomy by a single surgeon during a concurrent 44-month period at Baptist Health South Florida hospitals was performed focusing on demographics, indication for surgery, complications and incisional hernia rates. Exclusion criteria were concomitant surgery and hernia repair at the time of surgery.
  
  
  
  A total of 612 patients underwent minimally invasive cholecystectomy: 279 cases for SPIDER cholecystectomy and 333 for multiport LC. Baseline differences in patient characteristics between the SPIDER and LC groups were statistically significant. The SPIDER group had younger and healthier patients (lower ASA classification scores) with predominant diagnosis of cholelithiasis (69 %) compared to the LC group which had more complex cases. Total complications rate for both SPIDER and LC were 0.4 % (n = 1) and 3 % (n = 10), respectively. Conversion to open cholecystectomy occurred in one patient from the LC group (0.3 %). Conversion rate from SPIDER to additional ports or LC was performed in 5 cases (1.8 %) with no conversions to open surgery. Hemoperitoneum was reported in 2 cases, one for each approach, requiring reoperation.
  
  
  
  Single-incision laparoscopic cholecystectomy with SPIDER is a safe and feasible technique with similar outcomes to multiport LC. However, statistical significant difference was reported in baseline characteristics of both groups. No incisional hernias were reported in this case series for either technique.
authors.affiliation: Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Escobar-Dominguez
authors.affiliation: Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Garcia-Quintero
authors.affiliation: Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA.
authors.forename: Christian
authors.initials: C
authors.lastname: Hernandez-Murcia
authors.affiliation: Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA. jcverdeja@hotmail.com.|Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA. jcverdeja@hotmail.com.
authors.forename: Juan-Carlos
authors.initials: JC
authors.lastname: Verdeja
mesh_terms: D000328:Adult; D000368:Aged; D000818:Animals; D001657:Biliary Dyskinesia / Q000601:surgery; D016022:Case-Control Studies; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D002769:Cholelithiasis / Q000601:surgery*; D061887:Conversion to Open Surgery; D005260:Female; D005431:Florida; D006465:Hemoperitoneum / Q000453:epidemiology; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010195:Pancreatitis / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D066231:Surgeons
keywords: Flexible laparoscopy; SPIDER cholecystectomy; Single-incision cholecystectomy; Single-incision laparoscopic cholecystectomy; Single-port cholecystectomy