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Chuang SH. Mini-single-incision laparoscopic cholecystectomy: Pursuing the least invasive procedure. FORMOSAN JOURNAL OF SURGERY 2019. [DOI: 10.4103/fjs.fjs_130_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Tranchart H, Ketoff S, Lainas P, Pourcher G, Di Giuro G, Tzanis D, Ferretti S, Dautruche A, Devaquet N, Dagher I. Single incision laparoscopic cholecystectomy: for what benefit? HPB (Oxford) 2013; 15:433-8. [PMID: 23659566 PMCID: PMC3664047 DOI: 10.1111/j.1477-2574.2012.00612.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Accepted: 09/27/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND A single-incision laparoscopic cholecystectomy (SILC) was developed to improve outcomes as compared with the four-port classic laparoscopic cholecystectomy (CLC). Any potential benefits associated with a SILC have been suggested by previous studies reporting few patients with different surgical techniques. The aim of this study was to describe the experience with a standardized SILC as compared with CLC. METHODS From June 2010 to January 2012, 40 patients underwent a SILC [median age: 47.5 years (25-92)] and operative and peri-operative data were prospectively collected. Over the same period, 37 patients underwent a CLC. A 10-point visual analogue scale (VAS) was used for qualitative data. The costs of SILC and CLC were also compared. RESULTS For those patients undergoing a SILC the median operating time was 70 min (24-110). There were no conversions. An additional trocar was necessary in 16 patients. Four patients developed post-operative complications. The median immediate post-operative pain score was 5 (0-10). The median quality of life and cosmetic satisfaction at the initial post-operative visit were 10 (6-10) and 10 (5-10), respectively (VAS). Although the surgical results of both groups were similar, post-operative complications were exclusively reported in the SILC group (two incisional hernias). CONCLUSION Standardization of SILC is possible but associated with an important rate of additional trocar placement and a disturbing rate of incisional hernias.
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Affiliation(s)
- Hadrien Tranchart
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Serge Ketoff
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Guillaume Pourcher
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Giuseppe Di Giuro
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Dimitrios Tzanis
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Stefano Ferretti
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Antoine Dautruche
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Niaz Devaquet
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Surgery, Antoine Béclère HospitalClamart, France,Paris-Sud UniversityOrsay, France,Correspondence Ibrahim Dagher, Department of Minimally Invasive Surgery, Antoine Béclère Hospital, 157 rue de la Porte de Trivaux, 92141 Clamart cedex, France. Tel: +33 1 45 37 45 45. Fax: + 33 1 45 37 49 78. E-mail:
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Joseph M, Phillips M, Rupp CC. Single-Incision Laparoscopic Cholecystectomy: A Combined Analysis of Resident and Attending Learning Curves at a Single Institution. Am Surg 2012. [DOI: 10.1177/000313481207800148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Single-incision laparoscopic cholecystectomy (SILC) is a recent technical modification on standard laparoscopic cholecystectomy that has been shown to be safe and feasible. Recent studies suggest that experienced laparoscopic surgeons have a short learning curve to become proficient in SILC. However, little is known about the interaction of the learning curves of residents and attending surgeons at academic programs. We prospectively evaluated various metrics of both attending and resident surgeons as they progressed in their experience with SILC. Patients were placed into cohorts of 25 based on teaching surgeon experience. Data recorded included patient-specific and operative variables along with complications, conversion to standard laparoscopic cholecystectomy, and outcomes. One hundred one patients underwent SILC. Twelve per cent of patients required conversion to standard laparoscopic cholecystectomy. No significant difference was found in operative times compared within the experience-based cohorts ( P = 0.21). A reduction in operative time was shown in residents who were proficient in standard laparoscopic cholecystectomy (SLC) along their learning curve. Operative times remained the same for the teaching surgeon regardless of experience of resident surgeon. SILC has a short learning curve for resident surgeons who are proficient in standard laparoscopic surgery. SILC can be effectively taught with few complications and outcomes similar to SLC with preservation of operative efficiency and safety. Further studies are warranted, however, at a national/international level to define the place and use for SILC as well as the incorporation of single-incision techniques into resident curriculum.
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Affiliation(s)
- Mark Joseph
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Phillips
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Christopher C. Rupp
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Rupp CC, Farrell TM, Meyer AA. Single Incision Laparoscopic Cholecystectomy Using a “Two-Port” Technique Is Safe and Feasible: Experience in 101 Consecutive Patients. Am Surg 2011. [DOI: 10.1177/000313481107700731] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Single incision laparoscopic cholecystectomy (SILC) is a new minimally-invasive technique that has recently been developed to address several disease processes of the gallbladder. However, the safety and feasibility of this technique are still being evaluated. Utilizing a “two-port” technique with transabdominal suture retraction and a rigorous adherence to the critical view of safety, we evaluated our experience in a prospectively maintained database and compared this with standard laparoscopic cholecystectomy (SLC) over the same period. SILC was completed successfully in 87 per cent of patients. Operative times were found to be similar between SLC and SILC (75 and 76 minutes, respectively; P = 0.12). Operative blood loss, hospital stay, and short-term complications were not statistically different between SILC and SLC. Cholangiograms, obtained on a selective basis, were performed in 19 per cent of SILCs. No bile duct injuries occurred during SILC or SLC. Although our aggregate number is not enough to accurately assess the rate or safety of bile duct injuries, SILC seems to be safe and feasible when evaluating other metrics and does not seem to interfere with operative efficiency compared with SLC.
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Affiliation(s)
- Christopher C. Rupp
- Division of Gastrointestinal Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Timothy M. Farrell
- Division of Gastrointestinal Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anthony A. Meyer
- Division of Gastrointestinal Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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