From multi-incision to single-incision laparoscopic cholecystectomy step-by-step: One surgeon's self-taught experience and retrospective analysis

Background/Objective: Single-incision laparoscopic cholecystectomy (SILC) is emerging as an alternative to standard four-incision laparoscopic cholecystectomy (4ILC). This study presents one surgeon's experience of SILC and a retrospective analysis of the data. Methods: Sixty-seven consecutive patients treated by a single surgeon and undergoing laparoscopic cholecystectomy (LC) for benign gallbladder diseases were enrolled. LCs were attempted with conventional instruments as follows: 24 three-incision laparoscopic cholecystectomies (3ILC); 10 two-incision laparoscopic cholecystectomies (2ILC); and 33 SILC. Results: The procedure conversion rate into the SILC, 2ILC, and 3ILC groups was 9.1%, 0%, and 8.3% respectively. Operative time was significantly longer with SILC (111.1 +/- 30.34 minutes) compared to 2ILC (79.1 +/- 15.74 minutes) and 3ILC (80.2 +/- 29.41 minutes) (p < 0.01). Postoperative pethidine dosage was significantly lower in the 2ILC group (0.29 +/- 0.358 mg/kg) compared to the 3ILC group (1.02 +/- 0.802 mg/kg) (p < 0.05). Length of hospital stay (LOS) was significantly shorter in the SILC group (2.52 +/- 0.566 days) compared to the 3ILC group (3.1 +/- 1.02 days) (p < 0.05). There were no complications. Conclusions: SILC is a safe and feasible procedure that is comparable to multi-incision laparoscopic cholecystectomy (MILC). We have introduced a recommended step-by-step training program. SILC needed longer operative time than MILC but has potential benefits in terms of LOS and post-operative pain. Copyright (C) 2012, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.