The Learning Curve for Single-Port Laparoscopic Cholecystectomy by Experienced Laparoscopic Surgeon

Soon Hwa Youn,Young Hoon Roh,Hong Jo Choi,Young Hoon Kim,Ghap Joong Jung,Mee Sook Roh 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.2

Purpose: Single-port laparoscopic surgery is a rapidly advancing technique in laparoscopic surgery. However, there is currently limited evidence on the learning curve for this procedure. The aim of this study was to estimate the number of single port laparoscopic cholecystectomies required until improvement in the performance of the technique ceases. Methods: This is a descriptive, single-center study using routinely collected clinical data from 70 patients who underwent single port laparoscopic cholecystectomy between May 2009 and June 2010 at Dong-A University Medical Center in Busan, Korea. The review includes the mean operating time, conversion cases, intra-operative GB perforation, post-operative wound infection and mean hospital stay. Results: The mean operating time of the first 30 cases (the learning period) was 91.83 minutes. After 30 operations (the experience period), it plateaued to an average of 75.25 minutes, which remained steady in the next 40 operations - a reduction of more than 16%. Reduction in the operating time was significant (P<0.001) between the learning period and the experience period. Other factors including additional ports, intraoperative gall bladder perforation, mean hospital stay, post-operative wound infection were not significantly different between the two periods. Conclusion: We suggest that the learning curve for single port laparoscopic cholecystectomy should be around thirty cases for a surgeon with prior conventional laparoscopic cholecystectomy experience and for self-taught single port technique.

Clinical Analysis of Single-Port Laparoscopic Cholecystectomies

Sun Choon Song,Chuan Yu Ho,Min Jung Kim,Woo Seok Kim,Dong Do You,Dong Wook Choi,Seong Ho Choi,Jin Seok Heo 대한외과학회 2011 Annals of Surgical Treatment and Research(ASRT) Vol.80 No.1

Purpose: Single-port laparoscopic cholecystectomy (SPLC) is a technique under development in the field of minimally-invasive surgery. We have considered the feasibility of SPLC based on the advantages or restrictions compared with multi-port procedures. Methods: Two hundred seventeen patients with benign gallbladder disease who underwent SPLC or multi-port laparoscopic cholecystectomy (MPLC) during the most recent 10 months were retrospectively reviewed. Results: Patients were divided into two or three groups based on the operative period and disease. The mean age and ASA scale were different between the three groups. The intra-operative bile leakage and post-operative hospital stay were significantly less in the SPLC group; however, the blood loss and operative time was greater in the SPLC group. When patients with empyema of the gallbladder were excluded and all patients were reassigned into two groups based on the operative method, the incidence of bile leakage and post-operative hospital stay were similar between the two groups. The mean blood loss and operative time were higher in the patients who underwent SPLC. The mean numeric rating scale (NRS) and requirement for opioid analgesics were similar in the two groups. Conclusion: With the exception of increased intra-operative hemorrhage and a longer operative time, the risks associated with SPLC were not greater than MPLC. With adequate analgesics, advances in laparoscopic instruments, and surgical experience, SPLC is expected to gain acceptance amongst physicians.

초기 단일 통로 복강경 담낭절제술을 통해 얻은 교훈

이유니,김우영,최은혜 대한내시경복강경외과학회 2012 Journal of Minimally Invasive Surgery Vol.15 No.3

Purpose: Single-incision laparoscopic surgery (SILS) is a rapidly evolving technique which bridges traditional laparoscopic surgery and natural orifice transluminal endoscopic surgery (NOTES). We previously published a study comparing single port laparoscopic cholecystectomy (SPLC) and three port laparoscopic cholecystectomy (TPLC). We concluded that age, sex, diagnosis, body mass index (BMI), length of hospital stay, and mobilization between SPLC and TPLC produced no effect on the surgical requirements or outcomes between the two techniques. However, there were significant differences in operating time and pain scale. Thus, in this study we aimed to analyze those factors which reduced operating time. Methods: This retrospective medical record review enrolled 49 patients who had received SPLC at Presbyterian Medical Center from April 2009 to November 2010. Patient age, sex,BMI, length of hospital stay, operating time, pathological reports, and incidents of iatrogenic gallbladder (GB) perforation and complications were assessed and analyzed. For determining those factors which necessitated long operating times,we assessed the operating times relative to incidents of iatrogenic GB perforation, pathologic report results, surgeon experience and patient BMI. Results: The ratio of men to women in the study population was 1 : 6. The average patient age was 46 years (range of 21 to 93 years). The average BMI was 24.1 (range of 18.5to 31.5). The mean duration of hospital stay was 5.12 days (range of 2 to 15 days). The average operating time was 118minutes (range of 75 minutes to 185 minutes). The pathologic report assessments revealed cases of acute calculous cholecystitis (n=4, 8.2%), chronic calculous cholecystitis (n=37,76.1%) and GB polyp (n=8, 16.3%). Iatrogenic perforation of the GB occurred in 5 cases. Minor complications such as surgical site infection and umbilical skin burn occurred in 6cases. Longer operating times were required in the GB perforation cases than in the non-perforation cases (155±21.21 minutes versus 113.9±30.71 minutes, p=0.008). Of the cases of acute and chronic calculous cholecystitis and GB polyp, those including acute calculous cholecystitits required the longest operation times. The average operating time for the first 25 cases was 134.6±33.16 minutes and the average operating time for the remainder was 100.8±20.41minutes (p=0.001). There was no significant difference in operating time between the BMI>24 and BMI<24 groups (125.9±35.17 minutes versus 111.2±27.65 minutes,respectively, p=0.112). Conclusion: We found 3 factors related to a reduction in operation time: (i) avoidance of iatrogenic perforation of the GB, (ii) application of treatment to case of chronic calculous cholecystitis and GB polyp, and (iii) accumulation of case experience by the attending surgeon.

Review of 100 cases of single port laparoscopic cholecystectomy

Eun Jung Koo,Soon Hwa Youn,Yang Hyun Baek,Young Hoon Roh,Hong Jo Choi,Young Hoon Kim,Ghap Joong Jung 대한외과학회 2012 Annals of Surgical Treatment and Research(ASRT) Vol.82 No.3

Purpose: Single port laparoscopic cholecystectomy (SPLC) is a new advanced technique in laparoscopic surgery. Many laparoscopic surgeons seek to gain skill in this new technique. However, little data has been accumulated and published formally yet. This article reports the achievement of 100 cases of SPLC with the hopes it will encourage laparoscopic surgery centers in the early adoption of SPLC. Methods: A retrospective review of 100 prospectively selected cases of SPLC was carried out. All patients had received elective SPLC by a single surgeon in our center from May 2009 to December 2010. Our review suggests patients’ character, perioperative data and postoperative outcomes. Results: Forty-two men and 58 women with an average age of 45.8 years had received SPLC. Their mean body mass index (BMI) was 23.85 ㎏/㎡. The mean operating time took 76.75 minutes. However, operating time was decreased according to the increase of experience of SPLC cases. Twenty-one cases were converted to multi-port surgery. BMI, age, previous low abdominal surgical history did not seem to affect conversion to multi-port surgery. No cases were converted to open surgery. Mean duration of hospital stay was 2.18 days. Six patients had experienced complications from which they had recovered after conservative treatment. Conclusion: SPLC is a safe and practicable technique. The operating time is moderate and can be reduced with the surgeon’s experience. At first, strict criteria was indicated for SPLC, however, with surgical experience, the criteria and area of SPLC can be broadened. SPLC is occupying a greater domain of conventional laparoscopic cholecystectomy.

Single-Fulcrum Laparoscopic Cholecystectomy in Uncomplicated Gallbladder Diseases: A Retrospective Comparative Analysis with Conventional Laparoscopic Cholecystectomy

황호경,최성훈,강창무,이우정 연세대학교의과대학 2013 Yonsei medical journal Vol.54 No.6

Purpose: Single-fulcrum laparoscopic cholecystectomy (SFLC) is a variant type of single incision and multi-port technique that does not use specialized one-port devices or articulating instruments. We retrospectively compared perioperative outcomes of SFLC with those of conventional laparoscopic cholecystectomy (CLC). Materials and Methods: Between March 2009 and December 2010, SFLC was performed in 130 patients. Among them, 105 patients with uncomplicated gallbladder disease (no inflammation or no clinical symptoms) and another 105 patients who underwent CLC were selected for this study. Results: There was no open conversion. In comparison with CLC, SFLC was performed more often in young (46.4±12.2 years vs. 52.5±13.6 years, p=0.001) female patients (80/25 vs. 62/43, p=0.008). The total operation time was longer in SFLC (56.7±14.1 min vs. 47.5±17.1 min, p<0.001), but pain scores immediately after operation and at discharge time were lower for SFLC than for CLC (3.1±1.3 vs. 4.0±1.9, p<0.001, 2.0±0.9 vs. 2.4±0.8, p=0.002). Total cost was lower for SFLC than for CLC (US $ 1801±289.9 vs. US $ 2003±617.4, p=0.004). There were no differences in hospital stay or complication rates. Conclusion: SFLC showed greater technical feasibility and cost benefits in treating uncomplicated benign gallbladder disease than CLC.

Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy

Sun Min Lee,Jin Hong Lim 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.1

Backgrounds/Aims: Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. However, as a result of the ongoing trend toward minimally invasive laparoscopy, single-incision laparoscopic cholecystectomy (SILC) has evolved. Single-incision robotic cholecystectomy (SIRC) can overcome several limitations of manual SILC. The purpose of this study is to evaluate and compare the safety and feasibility of SIRC and SILC. Methods: This study retrospectively reviewed data for all patients who underwent SIRC or SILC from March 2018 to July 2019 in a single institution. The following variables were analyzed: age, sex, body mass index, pain scale, length of stay, and complications. The data were analyzed using the Independent two sample t-test or the Fisher’s exact test. Results: A total of 343 patients underwent SIRC or SILC during the study period. After excluding patients with acute cholecystitis, 197 SIRC and 103 SILC patients were analyzed in this study. The surgery time and postoperative hospital stay did not differ between SIRC and SILC. However, the SIRC patients experienced less bile spillage during the surgery than did the SILC patients (SIRC vs. SILC: 24 (23.3%) vs. 11 (5.6%) cases, respectively; p<0.001). Although there was no difference in the incidence of postoperative complications between procedures, additional pain control was administered more frequently in SILC patients (SILC 1.08±0.893, SIRC 0.58±0.795; p<0.001). Conclusions: While both SILC and SIRC are effective for single-incision cholecystectomy, SIRC was superior to SILC in terms of technical stability. Moreover, it has the advantage of postoperative pain control.

단일 지렛대 원리를 이용한 단일통로 복강경 담낭절제술: 변형된 단일절개, 다투관침 방법

장지영,최성훈,황호경,강창무,이우정 대한내시경복강경외과학회 2011 Journal of Minimally Invasive Surgery Vol.14 No.2

Purpose: Several techniques and devices have recently been introduced for single-incision laparoscopic cholecystectomy. We describe our technique using standard laparoscopic instruments and ports, and report the initial results. Methods: Between March 2009 and June 2010, 60 consecutive patients underwent single-fulcrum laparoscopic cholecystectomy for benign gallbladder disease. The general patient characteristics and perioperative results, including the operation time, conversion rate and complications, were assessed retrospectively. Results: Seventeen (28.3%) patients were male and 43 (71.7%) patients were female. The mean age was 47.4±12.4 years, and the mean total operation time was 57.5±13.9 min. The operation time became stable after 30 cases. There was no conversion to conventional laparoscopic cholecystectomy or open surgery. Additional trocars were required in three patients due to intraoperative complications, which were managed successfully with additional trocars. The intraoperative complications included loosening of the clips on the cystic duct, vertical laceration of the cystic duct, and burn injuries to the duodenal wall. There was no postoperative morbidity. Conclusion: Despite the limited sample size in this series, the results suggest that single-fulcrum laparoscopic cholecystectomy is safe and feasible for the treatment of benign gallbladder disease. Nevertheless, a further prospective randomized controlled trial comparing this technique with conventional techniques will be needed to confirm its true clinical value.

One-year experience with single incision laparoscopic cholecystectomy in a single center

Yun Beom Ryu,Jung Woo Lee,Yo Han Park,Man Sup Lim,Ji Woong Cho,Jang Yong Jeon 대한외과학회 2016 Annals of Surgical Treatment and Research(ASRT) Vol.90 No.2

Purpose: Single incision laparoscopic cholecystectomy (SILC) is generally performed with the use of inverse triangulation. In this study, we performed 3-channel or 4-channel SILC without the use of inverse triangulation. We evaluated the adequacy and feasibility of SILC using our surgical method. Methods: We retrospectively reviewed our series of 309 SILCs performed between March 2014 and February 2015. Results: Among 309 SILCs, male were 148 and female were 161 patients, mean age was 48.7 ± 15.3 years old and mean body mass index was 24.8 ± 3.8 kg/m2. Forty patients had previously undergone abdominal surgery including 6 cases of upper abdominal surgery. SILC after percutaneous transhepatic gallbladder (GB) drainage was completed in 8.7% of cases. There were 10 cases of emergency SILC. SILC was performed for noncomplicated GB including symptomatic GB stone and polyp in 66.7% of cases, acute cholecystitis in 33.3%. Overall, 96.8% of procedures were successfully completed without additional port. The reason for addition of an extra port or open conversion included technical difficulties due to severe adhesion and bleeding. The mean operating time was 60.7 ± 22.3 minutes. The overall complication rate was 4.8%: 9 patients of wound seroma, 1 case of bile leakage from GB bed, 4 cases of intra-abdominal abscess or fluid collection, and 1 case of incisional hernia were developed. There was no case of common bile duct injury. Conclusion: Our surgical method of SILC without the use of inverse triangulation is safe, feasible and effective technique.

Safety and feasibility for single-incision laparoscopic cholecystectomy with new technique in patients with acute cholecystitis

Tae-Seok Kim,Yong-Seok Kim,Han-Hong Lee,Jae-Im Lee,Chang-Hyeok An,Jeong-Soo Kim 한국간담췌외과학회 2013 한국간담췌외과학회 학술대회지 Vol.2013 No.4

단일통로 복강경 담낭 절제수술의 초기경험

정진용,최은혜,김우영 대한내시경복강경외과학회 2010 Journal of Minimally Invasive Surgery Vol.13 No.1

Purpose: Laparoscopic cholecystectomy is a standard procedure for cholelithiasis. However, with the advance of minimal invasive surgery, much research has recently been performed into single port laparoscopic surgery (SPLS).1 The aim of this study is to evaluate single port laparoscopic cholecystectomy (SPLC) in comparison to the classical method (three port laparoscopic cholecystectomy, TPLC) through our initial experience. Methods: This study was performed retrospectively by a review of medical charts and phone calls to patients. We checked for chronic calculous cholecystitis or cholesterol polyps in 56 patients who had undergone cholecystectomy between April 2009 and February 2010. We divided into two groups the patients who had undergone SPLC and TPLC. We then checked the sex, age, hospital day, operating time,mobilization time, pain scale, cosmetic satisfaction, surgical wound infection and BMI for each patient. Results: Cosmetic satisfaction with SPLC was higher than with the classical method, but this was not significant. Hospital day and mobilization time of SPLC were shorter, but this was also not significant. There was no difference in patient age,hospital day, mobilization and BMI between SPLC and TPLC. The operating time and pain scale with TPLC were less than with SPLC. Conclusion: SPLC has the benefit of cosmetic satisfaction and relatively fewer complications. However, the operating time and pain scale of SPLC are higher than those of TPLC. Therefore, SPLC requires much concentration and effort from the surgeon to compensate for its deficiencies.