title: Tips and tricks to avoid bile duct injury in SILC: an experience of 500 cases.
abstract: Conventional laparoscopic cholecystectomy is the gold standard surgical treatment for symptomatic gallstones. Surgeons have attempted to minimize the number of incisions via single-incision laparoscopic cholecystectomy (SILC), which offers benefits including improved cosmesis, possibly less postoperative pain, and improved patient satisfaction. However, studies show that there is an increased risk of operative complications-in particular bile duct injuries. We report 500 consecutive cases of SILC performed without bile duct injury.
  
  
  
  A retrospective study of 500 continuous cases of SILC performed by the same surgeon at a single institution was conducted. Data on patient demographics, operative details, and postoperative outcomes were collected and evaluated. Detailed analysis of surgical techniques specifically to reduce bile duct injury was performed and described in this study.
  
  
  
  In total, 500 patients underwent SILC during the study period. Eight patients needed additional ports to complete the surgery, while one was converted to an open surgery. No serious intraoperative complications, such as bile duct injury, were encountered.
  
  
  
  Our experience shows that with due care and caution during SILC, with particular attention towards achieving the critical view of safety and a standardized technique, bile duct injury in SILC can be avoided.
authors.affiliation: Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Tony
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Surgery, National University Hospital, Singapore, Singapore.
authors.forename: Guowei
authors.initials: G
authors.lastname: Kim
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery and Liver Transplant Program, University Surgical Cluster, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore. cfscky@gmail.com.
authors.forename: Stephen
authors.identifier: 0000-0001-9424-2147
authors.initials: S
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000293:injuries*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011184:Postoperative Period; D012189:Retrospective Studies; D012306:Risk; D012449:Safety; D066231:Surgeons; D055815:Young Adult
keywords: Bile duct injury; Cholecystectomy; Single-incision laparoscopic surgery