Abstract
Background
An important aspect of a new surgical technique is whether it can be performed by other surgeons in other institutions. The authors report the first 297 cases in a multi-institutional and multinational review of laparoscopic cholecystectomy performed via a single portal of entry.
Methods
Data were collected retrospectively for the initial patients undergoing single-port cholecystectomy by 13 surgeons who performed these procedures in their institutions after training by the authors. The review included operative time, blood loss, incision length, length of hospital stay (LOS), necessary additional trocars, and other parameters important to cholecystectomy. A database of all the single-port-access (SPA) surgeries performed by the surgeons included demographic and procedural details, LOS, complications, and initial follow-up data.
Results
To date, 297 single-port cholecystectomies have been performed for a variety of diagnoses, primarily cholelithiasis. The average operative time was 71 min, and the average LOS was 1–2 days. The average blood loss was minimal. The use of additional port sites outside the umbilicus occurred in 34 of the cases. Of the 35 intraoperative cholangiograms performed, 34 were successful. No significant complications occurred except for seromas and minor postoperative wound infections. These results are comparable with those for standard multiport cholecystectomy. In addition, no access site hernias (ASH) occurred.
Conclusions
The findings demonstrate that SPA surgery is an alternative to multiport laparoscopy with fewer scars and better cosmesis. One factor affecting the rate for adoption of SPA surgery among other surgeons is the reproducibility of this new procedure. Although this study had insufficient data to determine fully the benefits of SPA surgery, the feasibility of this procedure with safe, acceptable results was demonstrated in this initial large series across multinational institutions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Vecchio R, MacFayden BV, Palazzo F (2000) History of laparoscopic surgery. Panminerva Med 42:87–90
de la Fuente SG, Demaria EJ, Reynolds JD, Portenier DD, Pryor AD (2007) New developments in surgery: natural transluminal endoscopic surgery (NOTES). Arch Surg 142:295–297
Slim K, Pezet D, Stencl J Jr, Lechner C, Le Roux S, Lointier P, Chipponi J (1995) Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg 19:394–397
Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695
Mori T, Ikeda Y, Okamoto K, Sakata K, Ideguchi K, Nakagawa K, Yasumitsu T (2002) A new technique for two-trocar laparoscopic cholecystectomy. Surg Endosc 16:589–591
Kalloo A, Singh V, Jagannath S et al (2004) Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity. Gastrointest Endosc 60:114–117
Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens A, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis. Gastrointest Endosc 61:601–606
Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG (2009) Single port access (SPATM) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech 19:219–222. doi:10.1089/lap.2008.0275
Curcillo PG, King SA, Podolsky ER, Rottman SJ (2009) Single port access (SPA™): minimal access surgery through a single incision. Surg Technol Int 18:19–25
Curcillo PG, Wu A, Podolsky E, Rottman, Drahota L, Dunham RH, Katz L, Kharod A (2008) Single port access (SPA) cholecystectomy – initial validation of a single incision approach. Surg Endosc 22(Suppl 1):S281. doi:10.1007/s00464-008-9822-2
Wu AS, Podolsky ER, King SA, Curcillo PG (2009) Single port access (SPA) technique – video. Surg Endosc 23:S194. doi:10.1007/s00464-009-0396.4V029
Tacchino R, Greco F, Matera D (2009) Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23:896–899
Merchant AM, Cook MW, White BC, Davis SS, Sweeney JF, Lin E (2009) Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 13:159–162
Rao PP, Bhagwat SM, Rane A, Rao PP (2008) The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB (Oxford) 10:336–340
Palanivelu C, Rajan PS, Rangarajan M, Parthasarathi R, Senthilnathan P, Praveenraj P (2008) Transumbilical flexible endoscopic cholecystectomy in humans: first feasibility study using a hybrid technique. Endoscopy 40:428–431
Yegiyants S, Collins JC (2008) Operative strategy can reduce the incidence of major bile duct injury in laparoscopic cholecystectomy. Am Surg 74:985–987, javascript:PopUpMenu2_Set(Menu18942628)
Podolsky ER, Wu AS, Curcillo PG (2009) Single port access (SPATM) cholecystectomy: preservation of the critical view. Surg Endosc 23:S311. doi:10.1007/s00464-009-0399-1
Ladocsi LT, Benitez LD, Filippone DR, Nance FC (1997) Intraoperative cholangiography in laparoscopic cholecystectomy: a review of 734 consecutive cases. Am Surg 63:150–156
Ahmad NZ, Byrnes G, Naqvi SA (2008) A meta-analysis of ambulatory versus inpatient laparoscopic cholecystectomy. Surg Endosc 22:1928–1934
Gurusamy K, Junnarkar S, Farouk M, Davidson BR (2008) Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy. Br J Surg 95:161–168
Livingston EH, Rege RV (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188:205–211
Disclosures
Andrew S. Wu, Erica R. Podolsky, Namir Katkhouda, Alex Saenz, Robert Dunham, Marc Neff, Chad Copper, and Rodney Mason have no conflicts of interest or financial ties to disclose. Paul G. Curcillo speaks about single-port-access surgery for Storz Endoscopy, Ethicon Inc., Olympus, Inc., and Microline. Casey GraybealI provides educational and instructional assistance to Ethicon by virtue of telesurgery, which is covered by a “consulting” agreement, and has a consulting agreement with Carefusion (previously Cardinal Health) to serve on their Surgical Advisory Board. Marc Bessler receives fellowship support from Covidien and Ethicon and does consulting for these institutions and Olympus as well. Andrew A. Gumbs is a consultant for Ethicon, a proctor and course instructor for Covidien, a proctor for Novare Surgical and course instructor and lecturer for Applied Medical. Michael Norton is a stockholder in Axcess Instruments Inc. Dr Iannelli is a consultant for Covindien Inc. for single-port laparoscopic surgery. Ashkan Moazzez, Larry Cohen, Angela Mouhlas, and Alex Poor have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Additional information
SPATM is a Trademark of Drexel University College of Medicine.
Rights and permissions
About this article
Cite this article
Curcillo, P.G., Wu, A.S., Podolsky, E.R. et al. Single-port-access (SPATM) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24, 1854–1860 (2010). https://doi.org/10.1007/s00464-009-0856-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-009-0856-x