Published in:
01-04-2013 | How I do it
Single-Incision Laparoscopic Cholecystectomy (SILC) Using Non-articulating Instruments and Conventional Trocars—Single Surgeon Experience
Published in: Journal of Gastrointestinal Surgery | Issue 4/2013
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Purpose
Single-incision laparoscopic cholecystectomy (SILC) was first described in 1999. Many techniques using newer instruments have emerged but none has been standardized. We describe our technique and experience, using non-articulating instruments with conventional trocars.
Method
Patients who underwent SILC over 2 years (July 2009–July 2011) were included in the study group. All consecutive laparoscopic cholecystectomies done during the same period by the same surgeon were included in the control group. Demographic data, previous abdominal surgeries, bile spillage, conversion, and duration of surgery were analyzed.
Results
Seventy patients underwent SILC while 115 patients had laparoscopic cholecystectomy. Ninety-three percent of SILCs were done in women as compared to 68 % in the control group (p < 0.0001). More SILC patients were younger (65 % were 30–50 years old) as compared to control patients (40 % were 50–70 years old, p < 0.001). The mean duration of SILC was 68 ± 2.15 min as compared to 66 ± 6.27 min in controls (p < .0001). Of the initial 20 SILC, nine required insertion of additional instruments and one was converted to conventional laparoscopic cholecystectomy. The subsequent 50 cases of SILC had only one conversion (p = 0.001). In the first 20 SILC, one patient (out of three) with BMI above 35 kg/m2 required conversion to laparoscopic cholecystectomy and one required insertion of an additional instrument. In the subsequent 50 cases, all the six patients with BMI above 35 (up to 40) were operated on successfully without any additional instrument insertion or conversion.
Conclusions
SILC has a learning curve. Patients with symptomatic cholelithiasis, biliary dyskinesia, and cholecystitis, age less than 75 years, and BMI <40 can undergo SILC. With experience, SILC using conventional laparoscopy instruments has comparable outcomes to laparoscopic cholecystectomy in properly selected patients and is economical.