Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 25, 2015; 7(19): 1327-1333
Published online Dec 25, 2015. doi: 10.4253/wjge.v7.i19.1327
Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis
Taro Ikumoto, Hidetsugu Yamagishi, Mineo Iwatate, Yasushi Sano, Masahito Kotaka, Yasuo Imai
Taro Ikumoto, Mineo Iwatate, Yasushi Sano, Masahito Kotaka, Gastrointestinal Cancer Center and Institute of Minimally-invasive Endoscopic Care, Sano Hospital, Kobe, Hyogo 655-0031, Japan
Taro Ikumoto, Yasuo Imai, Department of Diagnostic Pathology, Dokkyo Medical University, Mibu-machi, Shimotuga-gun, Tochigi 321-0293, Japan
Hidetsugu Yamagishi, Department of Anatomic and Diagnostic Pathology, Dokkyo Medical University, Mibu-machi, Shimotuga-gun, Tochigi 321-0293, Japan
Author contributions: Ikumoto T collected and analyzed the data and wrote the manuscript; Ikumoto T, Iwatate M and Sano Y designed the study; Yamagishi H and Imai Y offered technical support about pathological diagnosis; Kotaka M provided administrative support; and all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by the Sano Hospital Institutional Review Board.
Informed consent statement: All study participants provided informed consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflict of interest directly relevant to the contents of this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Taro Ikumoto, MD, Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu-machi, Shimotuga-gun, Tochigi 321-0293, Japan. tikumoto@imec-kobe.com
Telephone: +81-282-872130 Fax: +81-282-861681
Received: June 26, 2015
Peer-review started: June 27, 2015
First decision: August 16, 2015
Revised: September 3, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: December 25, 2015
Abstract

AIM: To assess the safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis.

METHODS: All patients who underwent SILC at Sano Hospital (Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.

RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients (41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines (TG13) for the severity of cholecystitis, 86 and 14 patients had grade I and grade II acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performed in 12 patients (12%). Postoperative complications of Clavien-Dindo grade III or greater were observed in 4 patients (4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.

CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.

Keywords: Acute cholecystitis, Single-port access surgery, Single incision laparoscopic cholecystectomy, Single incision laparoscopic surgery, Laparo-endoscopic single-site surgery

Core tip: Single-incision laparoscopic cholecystectomy (SILC) has attracted attention as a minimally invasive procedure. A scar-less operation can be achieved by making a skin incision at the umbilicus. However, the safety of this procedure for acute cholecystitis has not been established. We reported 100 consecutive cases of SILC for acute cholecystitis and their surgical outcomes. SILC was safely performed in approximately 80% of cases in this series. We believe that the results of this study indicate the feasibility of SILC for acute cholecystitis.