BACKGROUND: This past year has borne witness to the acceptance of single-port laparoscopic surgery into mainstream clinical practice. This study describes a surgeon's experience with single-port laparoscopic cholecystectomy and delineates a learning curve for this technically demanding procedure utilizing improvements in operative time as a proxy for technical facility. METHODS: Through a 2-cm vertical transumbilical incision, three 5-mm ports or SILS™ Ports were placed using the Veress technique. One extracorporeal stay suture was utilized to provide cephalad retraction of the gallbladder fundus, and a roticulating instrument was used at the infundibulum for lateral retraction. The hilum was dissected and the cystic duct and artery were clipped and divided. One 5-mm port was removed and another upgraded to one 10-mm port to allow the introduction of a retrieval bag to facilitate the removal of the gallbladder from the abdomen. Patient demographic data, operative time, length of stay, surgical pathology, and complications were recorded. RESULTS: Fifty-two of 54 patients successfully underwent single-port cholecystectomies. Two patients required conversion to either a conventional laparoscopic cholecystectomy or open cholecystectomy. The average age was 41 years and average BMI was 30.2 kg/m(2). Mean operative time was 80 min. Length of stay was 0.3 days. The complication rate was 3/54 (5.5%). When patients were divided into sequential quintiles (n = 10), operative times decreased significantly after the first 10 patients (p = 0.0001) and then remained flat (p = 0.233). Operative times for obese patients (BMI >30) were greater than those for nonobese patients, but these results failed to reach statistical significance (85.3 vs. 69.7 min, p = 0.07). CONCLUSION: The significant improvement in operative times after the first quintile followed by consistent results without subsequent variability suggests that the learning curve for the single-port cholecystectomy, in the hands of a fellowship-trained laparoscopic surgeon, is approximately ten cases.
BACKGROUND: This past year has borne witness to the acceptance of single-port laparoscopic surgery into mainstream clinical practice. This study describes a surgeon's experience with single-port laparoscopic cholecystectomy and delineates a learning curve for this technically demanding procedure utilizing improvements in operative time as a proxy for technical facility. METHODS: Through a 2-cm vertical transumbilical incision, three 5-mm ports or SILS™ Ports were placed using the Veress technique. One extracorporeal stay suture was utilized to provide cephalad retraction of the gallbladder fundus, and a roticulating instrument was used at the infundibulum for lateral retraction. The hilum was dissected and the cystic duct and artery were clipped and divided. One 5-mm port was removed and another upgraded to one 10-mm port to allow the introduction of a retrieval bag to facilitate the removal of the gallbladder from the abdomen. Patient demographic data, operative time, length of stay, surgical pathology, and complications were recorded. RESULTS: Fifty-two of 54 patients successfully underwent single-port cholecystectomies. Two patients required conversion to either a conventional laparoscopic cholecystectomy or open cholecystectomy. The average age was 41 years and average BMI was 30.2 kg/m(2). Mean operative time was 80 min. Length of stay was 0.3 days. The complication rate was 3/54 (5.5%). When patients were divided into sequential quintiles (n = 10), operative times decreased significantly after the first 10 patients (p = 0.0001) and then remained flat (p = 0.233). Operative times for obesepatients (BMI >30) were greater than those for nonobese patients, but these results failed to reach statistical significance (85.3 vs. 69.7 min, p = 0.07). CONCLUSION: The significant improvement in operative times after the first quintile followed by consistent results without subsequent variability suggests that the learning curve for the single-port cholecystectomy, in the hands of a fellowship-trained laparoscopic surgeon, is approximately ten cases.
Authors: Chris Edwards; Alan Bradshaw; Paul Ahearne; Pierre Dematos; Ted Humble; Randy Johnson; David Mauterer; Peeter Soosaar Journal: Surg Endosc Date: 2010-03-03 Impact factor: 4.584
Authors: J H Peters; E C Ellison; J T Innes; J L Liss; K E Nichols; J M Lomano; S R Roby; M E Front; L C Carey Journal: Ann Surg Date: 1991-01 Impact factor: 12.969
Authors: Eun Jung Koo; Soon Hwa Youn; Yang Hyun Baek; Young Hoon Roh; Hong Jo Choi; Young Hoon Kim; Ghap Joong Jung Journal: J Korean Surg Soc Date: 2012-02-27
Authors: Mark Bignell; Andrew Hindmarsh; Haritharan Nageswaran; Bhavani Mothe; Andrew Jenkinson; David Mahon; Michael Rhodes Journal: Surg Endosc Date: 2011-03-18 Impact factor: 4.584
Authors: Stephanie G Wood; Feng Dai; Susan Dabu-Bondoc; Hosni Mikhael; Nalini Vadivelu; Andrew Duffy; Kurt E Roberts Journal: Surg Endosc Date: 2014-10-08 Impact factor: 4.584