Yonsei Med J.  2013 Nov;54(6):1471-1477. 10.3349/ymj.2013.54.6.1471.

Single-Fulcrum Laparoscopic Cholecystectomy in Uncomplicated Gallbladder Diseases: A Retrospective Comparative Analysis with Conventional Laparoscopic Cholecystectomy

• Hwang HK
• Choi SH
• Kang CM
• Lee WJ

• KMID: 1798145
• DOI: http://doi.org/10.3349/ymj.2013.54.6.1471

Abstract

PURPOSE
Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC).
MATERIALS AND METHODS
Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study.
RESULTS
There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4+/-12.2 years vs. 52.5+/-13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7+/-14.1 min vs. 47.5+/-17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1+/-1.3 vs. 4.0+/-1.9, p<0.001, 2.0+/-0.9 vs. 2.4+/-0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801+/-289.9 vs. US $ 2003+/-617.4, p=0.004). There were no differences in hospital stay or complication rates.
CONCLUSION
SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.

Keyword

Laparoscopic; cholecystectomy; single incision; single port

MeSH Terms

Adult
Aged
Cholecystectomy, Laparoscopic/economics/*statistics & numerical data
Female
Gallbladder Diseases/economics/*surgery
Humans
Length of Stay/statistics & numerical data
Male
Middle Aged
Postoperative Complications
Retrospective Studies
Treatment Outcome

Figure

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  Fig. 1 Conventional trocars (2 mm, 5 mm, and 10 mm trocars) are used for single fulcrum laparoscopic cholecystectomy, rather than a specialized one-port system.

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  Fig. 2 Principle of action mechanism via a single fulcrum. Actual external (A) and internal (B) views and schematic features (C) during the dissection of the anterior aspect of Calot's triangle: the 2 mm grasper in the right hand was pulled at the right lateral side. The infundibulum of the GB was retracted on the right side and the anterior aspect of Calot's triangle was exposed and dissected by a 5 mm hook coagulator in the left hand. Actual external (D) and internal (E) views and schematic features (F) during the dissection of posterior Calot's triangle: the 2 mm grasper in the left hand was pulled to the left side. The infundibulum of GB was then retracted at the left side. The posterior aspect of Calot's triangle was exposed and dissected by a 5 mm hook coagulator in the right hand. An "X" was made by the 2 mm grasper and 5 mm hook coagulator at the trocar insertion site (C and F). GB, gall bladder.

• 

  Fig. 3 Change in operation time with SFLC. The gray diagram depicts total operative time (skin-to-skin). The black diagram is the actual cholecystectomy time (from starting dissection to detaching gallbladder from liver bed). The estimated learning curve was fitted and defined as y=90.31x-0.13, with R (range)2=0.261. The dotted-line is the moving average for every 10 cases of total operation time. We see that both the estimated learning curve and moving average in total operation time decreased as experience was accumulated. SFLC, single-fulcrum laparoscopic cholecystectomy.

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