Ann Surg Treat Res.  2016 Feb;90(2):72-78. 10.4174/astr.2016.90.2.72.

One-year experience with single incision laparoscopic cholecystectomy in a single center: without the use of inverse triangulation

• Ryu YB
• Lee JW
• Park YH
• Lim MS
• Cho JW
• Jeon JY

• KMID: 2166825
• DOI: http://doi.org/10.4174/astr.2016.90.2.72

Abstract

PURPOSE
Single incision laparoscopic cholecystectomy (SILC) is generally performed with the use of inverse triangulation. In this study, we performed 3-channel or 4-channel SILC without the use of inverse triangulation. We evaluated the adequacy and feasibility of SILC using our surgical method.
METHODS
We retrospectively reviewed our series of 309 SILCs performed between March 2014 and February 2015.
RESULTS
Among 309 SILCs, male were 148 and female were 161 patients, mean age was 48.7 +/- 15.3 years old and mean body mass index was 24.8 +/- 3.8 kg/m2. Forty patients had previously undergone abdominal surgery including 6 cases of upper abdominal surgery. SILC after percutaneous transhepatic gallbladder (GB) drainage was completed in 8.7% of cases. There were 10 cases of emergency SILC. SILC was performed for noncomplicated GB including symptomatic GB stone and polyp in 66.7% of cases, acute cholecystitis in 33.3%. Overall, 96.8% of procedures were successfully completed without additional port. The reason for addition of an extra port or open conversion included technical difficulties due to severe adhesion and bleeding. The mean operating time was 60.7 +/- 22.3 minutes. The overall complication rate was 4.8%: 9 patients of wound seroma, 1 case of bile leakage from GB bed, 4 cases of intra-abdominal abscess or fluid collection, and 1 case of incisional hernia were developed. There was no case of common bile duct injury.
CONCLUSION
Our surgical method of SILC without the use of inverse triangulation is safe, feasible and effective technique.

Keyword

Single incision laparoscopic cholecystectomy; Laparoscopy; Single-port; Inverse triangulation

MeSH Terms

Abdominal Abscess
Bile
Body Mass Index
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute
Common Bile Duct
Drainage
Emergencies
Female
Gallbladder
Hemorrhage
Hernia
Humans
Laparoscopy
Male
Polyps
Retrospective Studies
Seroma
Wounds and Injuries

Figure

• 

  Fig. 1 (A) Port placement for 3-channel single incision laparoscopic cholecystectomy (SILC) using a Gloveport 431 (Meditech Inframed, Seoul, Korea). Camera (a), long articulated grasper for gallbladder traction by operator left hand (b), Hem-O-Lok clip applier (Weck Closure Systems, PA, USA) by operator right hand (c), not used (d). (B). Placement of instruments during 3-channel SILC: Note that Hem-O-Lok applier in operator right hand and long articulated grasper in left hand. (C) Visualization of the cystic duct after applying Hem-O-Lok and cystic artery.

• 

  Fig. 2 (A) Port placement for 4-channel single incision laparoscopic cholecystectomy (SILC) using a Gloveport 431 (Meditech Inframed, Seoul, Korea). Camera (a), long articulated grasper for gallbladder (GB) fundus traction by assistant hand (b), dissector by operator right hand (c), long articulated grasper for GB neck traction by operator left hand (d). (B) Placement of instruments during 4-channel SILC: Note that long articulated grasper for GB fundus traction by assistant hand below camera, dissector in operator right hand and long articulated grasper in operator lefthand. (C) Visualization of GB neck traction and dissection.

• 

  Fig. 3 Gloveport 431 (Meditech Inframed, Seoul, Korea) has a pouch which is built-in wound protecting specimen retrieval system.

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