• complications
• laparoscopic cholecystectomy
• patients perception
• quality of life
• satisfaction
• saudi arabia

• Acute cholecystitis
• Cholecystectomy
• Laparoscopy
• Pain

• Inguinal hernia
• Laparoscopic
• Meta-analysis
• Single-incision

• Humans
• Hernia, Inguinal/surgery
• Herniorrhaphy/methods
• Laparoscopy/methods
• Length of Stay
• Surgical Instruments
• Treatment Outcome

• Adult
• Humans
• Child
• Female
• Male
• Cholecystectomy, Laparoscopic/adverse effects
• Cholecystectomy
• Cholelithiasis/surgery
• Cholecystitis/surgery
• Postoperative Complications/epidemiology
• Postoperative Complications/surgery

• Acute cholecystitis
• Cholecystitis
• Gallbladder
• Laparoscopy
• Surgical wound

The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established.

This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Difficult surgery (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were defined to comprehensively evaluate surgical difficulty and postoperative outcomes, respectively.

Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m² were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, p < 0.001) and PPO (5.0% vs. 15.9%, p = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC.

SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.

Single incision laparoscopic cholecystectomy has become more popular recently. Because it yields shorter hospitalization, less postoperative pain, and better cosmetic outcomes. As it minimizes the number of incisions, it causes less trauma to the anterior abdominal wall and this decreases the operative mortality and morbidity. In this study, our aim is to share our results from the procedure so that surgeons in the field may consider adopting this approach when performing a laparoscopic cholecystectomy.

This is a retrospective study of 125 patients that underwent single-incision cholecystectomy. These patients underwent the procedure in a specialized center. We extracted data and surveyed patients who underwent the procedure between 2017 and 2019, and that were performed by the same consultant using the standard tools of laparoscopic surgery. All patients were followed for 12 months. The postoperative survey includes; the cosmetic appearance of the surgical site, pain management after the procedure, and patient satisfaction with this experience.

Most of the patients were satisfied with postoperative pain management and their cosmetic appearance. Most of the patients were females diagnosed with cholelithiasis preoperatively. The mean age of the patients was 37.43 ± 10.72 years, the mean BMI of the participants was 29.68 ± 6.51 kg/m² and the mean operative time was 25.56 ± 10.42 min.

Single incision laparoscopic cholecystectomy has the potential to become the procedure of choice for cholecystectomy.

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Single incision laparoscopic cholecystectomy has become more popular recently. Because it yields shorter hospitalization, less postoperative pain, and better cosmetic outcomes.

•

Single-incision laparoscopic enucleation (SILE) is a challenging procedure.

• Insufflation
• Laparoscopic surgery
• Pneumoperitoneum
• Preperitoneal insufflation
• Pressure profile test
• Veress needle

• Abdominal Wall/surgery
• Animals
• Insufflation/adverse effects
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Needles
• Peritoneal Cavity
• Pneumoperitoneum, Artificial/adverse effects
• Pneumoperitoneum, Artificial/methods
• Swine

• Feasibility
• laparoscopic left lateral sectionectomy
• reduced ports

• Electromagnetic system
• magnetic control
• magnetic needle steering
• suture
• tissue ligation
• tissue penetration

The search for less traumatic surgical procedures without compromising efficacy and safety, together with the technological advances and greater experience of the teams, led to the development of operative techniques with increasingly smaller incisions, the so-called “minimally invasive surgeries”.

To evaluate the technical aspects and results of single port cholecystectomy.

Were analyzed 170 patients between 18-74 years submitted to videolaparoscopic cholecystectomies by single port, regardless of elective or urgent indication, without restriction of patient selection.

Among the 170 operations, 158 were exclusively performed by single port, and the conversion rate was 7% (inclusion of other accessory trocars or conversion to multiportal). Conversion to open surgery occurred in three cases (1.76%). The mean surgical time was 67.97 min, showing a marked decrease when was reached close to 50 cases and a stabilization after 100 surgeries. The overall complication rate was 10%, with minor complications such as: incisional pain, hematomas, granulomas, port access hernias (9.41%).

Single port cholecystectomy can, after standardization and surgical team training, be a safe surgical procedure associated with a recognized aesthetic advantage.

Single incision laparoscopic cholecystectomy (SILC) is increasingly performed worldwide. Accordingly, the Konyang Standard Method (KSM) for SILC has been developed over the past 6 years. We report the outcomes of our procedures.

Between April 2010 and December 2016, 1,005 patients underwent SILC at Konyang University Hospital. Initially 3-channel SILC with KSM was changed to 4-channel SILC using a modified technique with a snake retractor for exposure of Calot triangle; we called this a modified KSM (mKSM). Recently, we have used a commercial 4-channel (Glove) port for simplicity.

SILC was performed in 323 patients with the KSM, in 645 with the mKSM, and in 37 with the commercial 4-channel port. Age was not significantly different between the 3 groups (P = 0.942). The postoperative hospital days (P = 0.051), operative time (P < 0.001) and intraoperative bleeding volume (P < 0.001) were significantly improved in the 3 groups. Drain insertion (P = 0.214), additional port insertion (P = 0.639), and postoperative complications (P = 0.608) were not significantly different in all groups. Postoperative complications were evaluated with the Clavien-Dindo classification. There were 3 cases (0.9%) over grade IIIb (bile duct injury, incisional hernia, duodenal perforation, or small bowel injury) with KSM and 3 (0.5%) with mKSM.

We evaluated the evolution of the KSM for SILC. The use of the mKSM with a commercial 4-channel port may be the safest and most effective method for SILC.

• Laparoscopic cholecystectomy
• Laparoscopy
• Single-incision

Surgeries with single port access have been gaining ground among surgeons who seek minimally invasive procedures. Although this technique uses only one access, the incision is larger when compared to laparoscopic cholecystectomy and this fact can lead to a higher incidence of incisional hernias.

To compare the incidence of incisional hernia after laparoscopic cholecystectomy and by single port.

A total of 57 patients were randomly divided into two groups and submitted to conventional laparoscopic cholecystectomy (n=29) and laparoscopic cholecystectomy by single access (n=28). The patients were followed up and reviewed in a 40.4 month follow-up for identification of incisional hernias.

Follow-up showed 21,4% of incisional hernia in single port group and 3.57% in conventional technique.

There was a higher incidence of late incisional hernia in patients submitted to single port access cholecystectomy compared to conventional laparoscopic cholecystectomy.

• Comparison
• Early results
• Laparoscopic cholecystectomy
• Multi port
• Quality of life
• Single incision

• Distal pancreatectomy
• Robotic surgery
• Single-incision surgery

• Biliary surgery
• Hepatobiliary surgery
• Indocyanine green fluorescence
• Liver surgery
• Robotic surgical procedures

To evaluate the clinical advantages of single-port laparoscopic hepatectomy (SPLH) compare to multi-port laparoscopic hepatectomy (MPLH).

We retrospectively reviewed the medical records of 246 patients who underwent laparoscopic liver resection between January 2008 and December 2015 at our hospital. We divided the surgical technique into two groups; SPLH and MPLH. We performed laparoscopic liver resection for both benign and malignant disease. Major hepatectomy such as right and left hepatectomy was also done with sufficient disease-free margin. The operative time, the volume of blood loss, transfusion rate, and the conversion rate to MPLH or open surgery was evaluated. The post-operative parameters included the meal start date after operation, the number of postoperative days spent in the hospital, and surgical complications was also evaluated.

Of the 246 patients, 155 patients underwent SPLH and 91 patients underwent MPLH. Conversion rate was 22.6% in SPLH and 19.8% in MPLH (P = 0.358). We performed major hepatectomy, which was defined as resection of more than 2 sections, in 13.5% of patients in the SPLH group and in 13.3% of patients in the MPLH group (P = 0.962). Mean operative time was 136.9 ± 89.2 min in the SPLH group and 231.2 ± 149.7 min in the MPLH group (P < 0.001). The amount of blood loss was 385.1 ± 409.3 mL in the SPLH group and 559.9 ± 624.9 mL in the MPLH group (P = 0.016). The safety resection margin did not show a significant difference (0.84 ± 0.84 cm in SPLH vs 1.04 ± 1.22 cm in MPLH, P = 0.704). Enteral feeding was started earlier in the SPLH group (1.06 ± 0.27 d after operation) than in the MPLH group (1.63 ± 1.27 d) (P < 0.001). The mean hospital stay after operation was non-significantly shorter in the SPLH group than in the MPLH group (7.82 ± 2.79 d vs 7.97 ± 3.69 d, P = 0.744). The complication rate was not significantly different (P = 0.397) and there was no major perioperative complication or mortality case in both groups.

Single-port laparoscopic liver surgery seems to be a feasible approach for various kinds of liver diseases.

• Hepatectomy
• Laparoscopy
• Minimally invasive surgery
• Treatment outcome
• Feasibility study

• Adult
• Aged
• Blood Loss, Surgical/statistics & numerical data
• Blood Transfusion/statistics & numerical data
• Conversion to Open Surgery/statistics & numerical data
• Feasibility Studies
• Female
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay/statistics & numerical data
• Liver Diseases/surgery
• Male
• Margins of Excision
• Middle Aged
• Operative Time
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Retrospective Studies
• Treatment Outcome

• SILC
• SILS
• TILC
• cholecystectomy
• laparoscopic
• single-incision laparoscopic surgery
• two-incision laparoscopic surgery

• Adult
• Attitude of Health Personnel
• Cholecystectomy, Laparoscopic/instrumentation
• Cholecystectomy, Laparoscopic/methods
• Cholelithiasis/surgery
• Cicatrix/prevention & control
• Esthetics
• Female
• Humans
• Length of Stay
• Male
• Middle Aged
• Operative Time
• Prospective Studies

Single-incision laparoscopic cholecystectomy (SILC) is widely used as a treatment option for gallbladder disease. However, obesity has been considered a relative contraindication to this approach due to more advanced technical difficulties. The aim of this report was to review our experience with SILC to evaluate the impact of body mass index (BMI) on the surgical outcome.

Between May 2009 and February 2013, 237 patients underwent SILC at our institute. Pre- and post-operative data of the 17 obese patients (O-group) (BMI ≥30 kg/m²) and 220 non-obese patients (NO-group) (BMI <29.9 kg/m²) were compared retrospectively. SILC was performed under general anaesthesia, using glove technique. Indications for surgery included benign gallbladder disease, except for emergent surgeries.

Mean age of patients was significantly higher in the NO-group than O-group (58.9 ± 13.5 years vs. 50.8 ± 14.0 years, P = 0.025). SILC was successfully completed in 233 patients (98.3%). Four patients (1.7%) in the NO-group required an additional port, and one patient was converted to an open procedure. The median operative time was 70 ± 25 min in the NO-group and 75.2 ± 18.3 min in the O-group. All complications were minor, except for one case in the NO-group that suffered with leakage of the cystic duct stump, for which endoscopic nasobiliary drainage was need.

Our findings show that obesity, intended as a BMI ≥30 kg/m², does not have an adverse impact on the technical difficulty and post-operative outcomes of SILC. Obesity-related comorbidities did not increase the risks for SILC.

• Bariatric surgery
• obesity
• single-incision laparoscopic cholecystectomy

• opportunity cost
• single incision laparoscopic cholecystetomy
• conventional laparoscopic cholecystetomy
• economic evaluation

• Cholecystectomy, Laparoscopic/economics
• Cholecystectomy, Laparoscopic/methods
• Cholecystectomy, Laparoscopic/statistics & numerical data
• Costs and Cost Analysis/statistics & numerical data
• Humans
• Length of Stay
• Models, Economic
• Natural Orifice Endoscopic Surgery/economics
• Natural Orifice Endoscopic Surgery/statistics & numerical data
• Operative Time
• Umbilicus

• Cholecystectomy
• Cost
• Hernia
• Incisional hernia
• Robotic
• Robotic surgery
• Single-site
• da Vinci

• LESS
• surgical instrument
• workload

• Adult
• Biomechanical Phenomena
• Computer Simulation
• Endoscopy/instrumentation
• Ergonomics
• Female
• Forearm/physiopathology
• Humans
• Laparoscopy/instrumentation
• Male
• Middle Aged
• Movement
• Musculoskeletal Pain/etiology
• Occupational Health
• Posture
• Rotation
• Shoulder/physiopathology
• Task Performance and Analysis
• Upper Extremity/physiopathology
• Workload
• Wrist/physiopathology

• Conventional Instruments
• SILC
• Safety

• additional port
• factor
• single-incision laparoscopic cholecystectomy

• SILS
• laparoscopic cholecystectomy
• single-incision

• Adult
• Aged
• Cholecystectomy, Laparoscopic/methods
• Female
• Gallbladder Diseases/surgery
• Gallstones/surgery
• Humans
• Male
• Middle Aged
• Minimally Invasive Surgical Procedures
• Needles
• Polyps/surgery
• Postoperative Complications/epidemiology
• Retrospective Studies
• Surgical Instruments
• Suture Techniques
• Treatment Outcome

• cholecystectomy
• robotics
• single-port laparoscopy

• Adult
• Aged
• Cholecystectomy, Laparoscopic/methods
• Cholecystitis/surgery
• Cholecystolithiasis/surgery
• Conversion to Open Surgery
• Databases, Factual
• Female
• Gallbladder Diseases/surgery
• Hernia, Ventral/epidemiology
• Humans
• Male
• Middle Aged
• Operative Time
• Pain, Postoperative/prevention & control
• Peritonitis/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Hemorrhage/epidemiology
• Retrospective Studies
• Robotic Surgical Procedures/methods
• Surgical Instruments
• Surgical Wound Infection/epidemiology
• Young Adult

• cholecystectomy
• gallbladder stone
• robotic surgery
• single incision laparoscopic surgery

• laparoscopic cholecystectomy
• needle grasper
• single port

Within the past few years, there has been a push for an even more minimally invasive approach to biliary disease with the adoption of single-incision laparoscopic cholecystectomy. We sought to compare 4 individual surgeon experiences to define whether there exists a learning curve for performing single-incision laparoscopic cholecystectomy.

We performed a retrospective review 290 single-incision laparoscopic cholecystectomies performed by a group of general surgeons, with varying levels of experience and training, at 3 institutions between May 2008 and September 2010. The procedure times were recorded for each single-incision laparoscopic cholecystectomy, ordered chronologically for each surgeon, and subsequently plotted on a graph. The patients were also combined into cohorts of 5 and 10 cases to further evaluate for signs of improvement in operative efficiency.

Of the 4 surgeons involved in the study, only 1 (surgeon 4, laparoscopic fellowship trained with <5 years' experience) confirmed the presence of a learning curve, reaching proficiency within the first 15 cases performed. The other surgeons had more variable procedure times, which did not show a distinct trend. When we evaluated the cases by cohorts of 5 cases, surgeon 4 had a significant difference between the first and last cohort. Increased body mass index resulted in a slightly longer operative time (P < .0063). The conversion rate to multiport laparoscopic surgery was 3.1%.

Our results indicate that among experienced general surgeons, there does not seem to be a significant learning curve when transitioning from conventional laparoscopic cholecystectomy to single-incision laparoscopic cholecystectomy. The least experienced surgeon in the group, surgeon 4, appeared to reach proficiency after 15 cases. Greater than 5 years of experience in laparoscopic surgery appears to provide surgeons with a sufficient skill set to obviate the need for a single-incision laparoscopic cholecystectomy learning curve.

• Education
• Laparoscopic cholecystectomy
• Learning curve
• Proficiency
• Single-incision laparoscopic surgery

Single-incision laparoscopic surgery is gaining popularity among minimally invasive surgeons and is now being applied to a broad number of surgical procedures. Although this technique uses only 1 port, the diameter of the incision is larger than in standard laparoscopic surgery. The long-term incidence of port-site hernias after single-incision laparoscopic surgery has yet to be determined.

All patients who underwent a single-incision laparoscopic surgical procedure from May 2008 through May 2009 were included in the study. Single-incision laparoscopic surgical operations were performed either by a multiport technique or with a 3-trocar single-incision laparoscopic surgery port. The patients were seen at 30 to 36 months' follow-up, at which time they were examined for any evidence of port-site incisional hernia. Patients found to have hernias on clinical examination underwent repairs with mesh.

A total of 211 patients met the criteria for inclusion in the study. The types of operations included were cholecystectomy, appendectomy, sleeve gastrectomy, gastric banding, Nissen fundoplication, colectomy, and gastrojejunostomy. We found a port-site hernia rate of 2.9% at 30 to 36 months' follow-up.

Port-site incisional hernia after single-incision laparoscopic surgical procedures remains a major setback for patients. The true incidence remains largely unknown because most patients are asymptomatic and therefore do not seek surgical aid.

Laparoscopic single-incision surgery is fraught with significant technical drawbacks but has witnessed increased growth mainly for its presumed aesthetic advantages. Recently, a single-site robotic platform has been introduced to alleviate some of the technical challenges with laparoscopic single-site surgery, although literature on this topic is scant. The aim of this study is to analyze the experience of a single surgeon with single-site robotic cholecystectomies since the U.S. Food and Drug Administration gave its approval in December 2011, and to evaluate the robotic platform's safety and short-term surgical outcomes.

From February 1st 2012 to February 28th 2013, patients who underwent single-site cholecystectomy at an academic institution in the United States were retrospectively reviewed from a prospectively maintained database. The following variables were analyzed: age, sex, body mass index, previous surgeries, total operative time, port insertion time, docking time, console time, estimated blood loss, closure time, conversion to open or multiport approach, postoperative outcomes for wound infection, bile leak, biliary ductal injury, right hepatic artery injury, reoperations, readmission, and mortality. Indication for cholecystectomy was symptomatic gallbladder disease. No exclusion criteria were used and no cost analysis was performed.

During the study period, 31 patients were enrolled. The mean patient age, body mass index, weight, and operative time was 33.6 years, 32.2 kg/m², 86.3 kg, and 81.4 minutes, respectively. There were no conversions to the open or traditional multiport approach, and no major complications of biliary ductal or hepatic artery injury, bile leak, reoperations, or mortality occurred. There was 1 case of superficial wound infection.

Single-site robotic cholecystectomy is feasible and safe and requires a minimal learning curve to transition from traditional multiport to single-port robotic cholecystectomy.

• Robotic cholecystectomy
• Single site

• Flexible laparoscopy
• SPIDER cholecystectomy
• Single-incision cholecystectomy
• Single-incision laparoscopic cholecystectomy
• Single-port cholecystectomy

• Bile duct injury
• Cholecystectomy
• Single-incision laparoscopic surgery

• Inverse triangulation
• Laparoscopy
• Single incision laparoscopic cholecystectomy
• Single-port

• Cholecystectomy
• GB (gall bladder)
• Laparoscopic
• SILC
• SILS
• Single incision

• Cholecystectomy
• Laparoscopy
• Morbidity
• Single incision

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Body Height
• Body Weight
• Cholecystectomy, Laparoscopic/methods
• Feasibility Studies
• Female
• Gallbladder Diseases/surgery
• Humans
• Male
• Middle Aged
• Operative Time
• Retrospective Studies
• Risk Factors
• Young Adult