Authors:

Abstract

Introduction Currently, single incision laparoscopic cholecystectomy, which is being proposed as an alternative to standard four port laparoscopic cholecystectomy, has not been embraced universally as the procedure of choice for removal of the gall bladder.

Aim We aimed to evaluate the feasibility of SILS and report our initial experience of undertaking SILS cholecystectomy in a district hospital where laparoscopic cholecystectomy yet remains the standard, despite the limitation in resources.

Methods Six patients underwent SILS cholecystectomy for gall stone cholecystitis as an elective procedure. Except for previous exposure of the surgeon to SILS cholecystectomy, for the rest of the hospital team, the SILS procedure was a new experience. All procedures were performed as standard under general anaesthesia and positive pressure ventilation.

Results Six patients (1 male; 5 female; age range 28 to 42 years) underwent SILS over a twelve month period from 2010 to 2011. The main end points were time taken to complete the SILS cholecystectomy and conversion to 4-port laparoscopic cholecystectomy. In 5 (83%), surgery was completed using SILS and the time taken ranged from 100mins to 180mins (median 120mins). Subjective assessment revealed that SILS was a more difficult procedure compared with laparoscopic cholecystectomy, chiefly due to lack of familiarity of the team and limitation in mobility due to the lack of triangulation that is otherwise available with 4-port laparoscopic cholecystectomy.

Conclusion SILS is feasible in a district hospital with facilities available mostly for laparoscopic 4-port cholecystectomy. Surgical teams may perform better in their initial SILS experience if the entire team is taken through training. The cost efficacy of SILS needs to be addressed.

DOI: http://dx.doi.org/10.4038/sljs.v32i1.6868

The Sri Lanka Journal of Surgery 2014; 32(1): 24-28

Keywords: Single incision, Laparoscopy cholecystectomy, SILS, Patient demography