Single-incision laparoscopic cholecystectomy: the first 100 outpatients

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Abstract
Single-incision laparoscopic surgery (SILS) is a well-described technique for many general surgical procedures. The SILS techniques applied to cholecystectomy vary, and reporting has been sparse. Because most cholecystectomies are outpatient procedures performed by busy, practicing general surgeons, the authors report their initial experience adopting this technique. From March, 2008 to January, 2009, SILS was performed for 100 consecutive outpatients needing cholecystectomy. All the patients underwent a single-incision, multiport laparoscopic (SIMPL) technique using existing instrumentation. The patients were followed postoperatively for at least 6 months. Of the 100 patients, 98 underwent SIMPL cholecystectomy and 2 required conversion to the standard laparoscopic technique because of bleeding from the cystic artery. No major postoperative complications occurred, including infections and hernias. The findings show SIMPL cholecystectomy to be safe in the outpatient setting. It is an excellent alternative to traditional three- or four-port cholecystectomy for the ideal candidate with a lower body mass index (BMI), early disease, and no previous abdominal surgery. The authors' initial outpatient experience shows that it can be performed using existing instrumentation without increasing costs by a reproducible technique that can be adopted by any practicing general surgeon.