Brief Article
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World J Gastroenterol. Aug 7, 2013; 19(29): 4786-4790
Published online Aug 7, 2013. doi: 10.3748/wjg.v19.i29.4786
Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy
Ming-Xin Pan, Zhi-Wei Liang, Yuan Cheng, Ze-Sheng Jiang, Xiao-Ping Xu, Kang-Hua Wang, Hai-Yan Liu, Yi Gao
Ming-Xin Pan, Yuan Cheng, Ze-Sheng Jiang, Xiao-Ping Xu, Kang-Hua Wang, Hai-Yan Liu, Yi Gao, Second Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
Zhi-Wei Liang, Department of Hepatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, Henan Province, China
Author contributions: Pan MX, Liang ZW, and Cheng Y contributed equally to this work; Gao Y and Pan MX designed the trial; Wang KH collected and analyzed these data; Liu HY, Jiang ZS, Xu XP and Liang ZW performed the research; Liang ZW and Cheng Y revised the paper.
Supported by Science and Technology Projects of Haizhu District of Guangzhou, China, No. 2012-cg-26
Correspondence to: Yi Gao, MD, Second Department of Hepatobiliary Surgery, Zhujiang Hospital, Southern Medical University, No. 253, Gongye Avenue, Haizhu District, Guangzhou 510282, Guangdong Province, China.
Telephone: +86-20-62743207 Fax: +86-20-62783586
Received: May 14, 2013
Revised: June 15, 2013
Accepted: June 19, 2013
Published online: August 7, 2013

AIM: To investigate the learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy (SILC).

METHODS: The clinical data of 180 consecutive transumbilical suture-suspension SILCs performed by a team in our department during the period from August 2009 to March 2011 were retrospectively analyzed. Patients were divided into nine groups according to operation dates, and each group included 20 patients operated on consecutively in each time period. The surgical outcome was assessed by comparing operation time, blood loss during operation, and complications between groups in order to evaluate the improvement in technique.

RESULTS: A total of 180 SILCs were successfully performed by five doctors. The average operation time was 53.58 ± 30.08 min (range: 20.00-160.00 min) and average blood loss was 12.70 ± 11.60 mL (range: 0.00-100.00 mL). None of the patients were converted to laparotomy or multi-port laparoscopic cholecystectomy. There were no major complications such as hemorrhage or biliary system injury during surgery. Eight postoperative complications occurred mainly in the first three groups (n = 6), and included ecchymosis around the umbilical incision (n = 7) which resolved without special treatment, and one case of delayed bile leakage in group 8, which was treated by ultrasound-guided puncture and drainage. There were no differences in intraoperative blood loss, postoperative complications and length of postoperative hospital stay among the groups. Bonferroni’s test showed that the operation time in group 1 was significantly longer than that in the other groups (F = 7.257, P = 0.000). The majority of patients in each group were discharged within 2 d, with an average postoperative hospital stay of 1.9 ± 1.2 d.

CONCLUSION: Following scientific principles and standard procedures, a team experienced in multi-port laparoscopic cholecystectomy can master the technique of SILC after 20 cases.

Keywords: Single incision laparoscopic surgery, Cholecystectomy, Learning curve, Suture-suspension

Core tip: As a new technology, single-incision laparoscopic cholecystectomy (SILC) is more difficult to perform than multi-port laparoscopic cholecystectomy with higher technical demands. Thus, SILC may have a specific learning curve. The present study retrospectively analyzed the surgical outcomes of transumbilical suture-suspension SILC performed by the same team in our department to investigate the learning curve of this technology, thereby guiding the surgeons to pass the initial learning period smoothly, safely, and quickly.