Single-incision laparoscopic cholecystectomy in children using standard straight instruments: A surgeon's early experience
Journal of Laparoendoscopic and Advanced Surgical Techniques
Background: With the evolution of surgical techniques and instrumentation, surgeons have adapted methods to provide safe and effective therapy through less invasive operations. Conventional laparoscopy utilizes several small incisions in well-separated areas of the body, but more recently, surgeons have been performing minimally invasive procedures through a single incision. Specially designed ports and instruments have been employed to offset the disadvantage of losing the ability to have instruments separated in space while working through a single incision. We have reviewed our initial experience with single-incision laparoscopic cholecystectomy (SILC) in children using conventional straight laparoscopic instruments compared with those who underwent standard laparoscopic cholecystectomy (SLC). Methods: During the study period, a retrospective chart review was performed on 54 consecutive children who underwent laparoscopic cholecystectomy. Twenty-seven patients who underwent SILC (1 patient had splenectomy with cholecystectomy) were compared with 27 patients who underwent SLC by a single pediatric surgeon. Outcomes measured included successful completion rate, operative time, length of hospital stay, blood loss, and postoperative complications. Results: Fifty-four cholecystectomies were performed laparoscopically with no conversions to open. In the SILC group, 24 of 27 (89%) were successfully completed. Two patients required one additional trocar/incision (laparoscopic splenectomy with cholecystectomy) and another two additional trocars/incisions to complete the procedure. Operative time was longer in the SILC group than in the SLC group (116 versus 61 minutes; P value <.0001). Two umbilical wound infections occurred in the SILC group (7.4%) and 1 patient in the SLC group developed postoperative choledocholithiasis. Conclusions: In our experience, SILC in children using standard straight laparoscopic instruments is a safe and effective alternative to conventional four-incision laparoscopic cholecystectomy. This technique, although safe, may lead to longer operative times since there is a loss of instrument triangulation provided with SLC or use of articulating instruments. © 2011, Mary Ann Liebert, Inc.
Garcia-Henriquez, N., Shah, S., & Kane, T. (2011). Single-incision laparoscopic cholecystectomy in children using standard straight instruments: A surgeon's early experience. Journal of Laparoendoscopic and Advanced Surgical Techniques, 21 (6). http://dx.doi.org/10.1089/lap.2010.0512