Solo Three-incision Laparoscopic Cholecystectomy Using a Laparoscopic Scope Holder for Acute Cholecystitis

Choi, Soyeon; Choi, YoungRok; Han, Ho Seong; Yoon, Yoo Seok; Cho, Jai Young; Kwon, Seonguk; Jang, Jae Seong; Choi, Jangkyu; Kim, Sungho

Abstract

PURPOSE
L aparoscopic cholecystectomy (LC) i s a c ommonly p erformed procedure for t he management of acute cholecystitis. The presence of an inexperienced scopist or a shortage of manpower could be problematic in emergency surgical cases. To overcome these potential problems while ensuring a stable surgical view during LC, we performed solo surgery.
METHODS
We retrospectively reviewed the results of 22 patients who underwent solo three-incision LC (S-TILC) and 31 patients who underwent the conventional three-incision LC (C-TILC) from March 1, 2015, to August 31, 2015. We compared the two groups with respect to the patients' clinical characteristics, and intraoperative and postoperative results; and severity grade as defined by the updated Tokyo guidelines 2013 (TG13) criteria.
RESULTS
No significant differences in baseline characteristics were found between the two groups. The intraoperative perforation rates were higher in the C-TILC group than in the S-TILC group (p=0.016). Two cases were converted to human-assisted LC in the S-TILC group because of severe adhesions and the scope holder breaking down. No significant differences were found between the groups with respect to length of hospital stay; postoperative diet habit; or rates of post-cholecystectomy diarrhea, abdominal pain, wound complication, or complication according to the Clavien-Dindo grade.
CONCLUSION
S-TILC and C-TILC were comparable in terms of results, and this solo surgery in LC could be performed for cases of acute cholecystitis during shortage of skilled manpower.