From multi-incision to single-incision laparoscopic cholecystectomy step-by-step: One surgeons self-taught experience and retrospective analysis

Single-incision laparoscopic cholecystectomy (SILC) is emerging as an alternative to standard four-incision laparoscopic cholecystectomy (4ILC). This study presents one surgeons experience of SILC and a retrospective analysis of the data. Sixty-seven consecutive patients treated by a single surgeon and undergoing laparoscopic cholecystectomy (LC) for benign gallbladder diseases were enrolled. LCs were attempted with conventional instruments as follows: 24 three-incision laparoscopic cholecystectomies (3ILC), 10 two-incision laparoscopic cholecystectomies (2ILC), and 33 SILC. The procedure conversion rate into the SILC, 2ILC, and 3ILC groups was 9.1%, 0%, and 8.3% respectively. Operative time was significantly longer with SILC (111.1 ± 30.34 minutes) compared to 2ILC (79.1 ± 15.74 minutes) and 3ILC (80.2 ± 29.41 minutes) (p < 0.01). Post-operative pethidine dosage was significantly lower in the 2ILC group (0.29 ± 0.358 mg/kg) compared to the 3ILC group (1.02 ± 0.802 mg/kg) (p < 0.05). Length of hospital stay (LOS) was significantly shorter in the SILC group (2.52 ± 0.566 days) compared to the 3ILC group (3.1 ± 1.02 days) (p < 0.05). There were no complications. SILC is a safe and feasible procedure that is comparable to multi-incision laparoscopic cholecystectomy (MILC). We have introduced a recommended step-by-step training program. SILC needed longer operative time than MILC but has potential benefits in terms of LOS and post-operative pain