Department of General Surgery, Theodore Bilharz Research Institute, P.O. Box 30, Imbaba, 12411 Giza, Egypt.
Int J Surg. 2012;10(9):514-7. doi: 10.1016/j.ijsu.2012.07.012. Epub 2012 Aug 11.
Since the implement of laparoscopic cholecystectomy as the gold standard treatment for gall bladder stones, there has been a trend toward minimizing the required number and size of ports to reduce postoperative pain with better cosmetic results. We conducted this study to evaluate the feasibility, safety, advantages and complications of single incision laparoscopic cholecystectomy using the conventional laparoscopic instruments.
Eighty patients (68 females and 12 males) with uncomplicated symptomatic gall bladder stones underwent elective laparoscopic cholecystectomy via single trans-umbilical incision using the conventional laparoscopic instruments.
The mean operative time was 61.75 min (range: 40-105 min) and the mean estimated blood loss was 17.21 ml (range: 5-90 ml). Gall bladder perforation occurred in five cases (6.25%) with calculi spillage in four of them. It was managed by using laparoscopic stone removal forceps. Troublesome cystic artery bleeding occurred in 2 cases (2.5%) while gall bladder bed bleeding happened in one case (1.25%) with liver cirrhosis and managed by argon beam coagulation. An intraoperative cholangiography was performed in 3 cases and a drain was inserted in one case. There was no conversion to the open technique in any of the cases. 49 patients (94.2%) discharged on the 1st postoperative day and 3 patients (5.8%) discharged on the 2nd postoperative day. The average wound length measured on 3rd postoperative month was 1.58 cm (range, 1.3-2.1 mm); while average score of patient satisfaction of the surgery was of 9.32 (range, 7-10).
In uncomplicated gall bladder disease; single incision laparoscopic cholecystectomy is feasible and safe. It has an excellent esthetic results and high grade of patient satisfaction. It could be performed with the conventional laparoscopic instruments and its scale of application could be widened once enough experience attained.
自从腹腔镜胆囊切除术成为胆囊结石的金标准治疗方法以来，人们一直致力于通过减少所需的端口数量和大小来减轻术后疼痛，同时获得更好的美容效果。我们进行这项研究是为了评估使用传统腹腔镜器械进行单切口腹腔镜胆囊切除术的可行性、安全性、优势和并发症。
80 例（68 名女性和 12 名男性）患有单纯症状性胆囊结石的患者接受了经单一脐部切口的选择性腹腔镜胆囊切除术，使用传统腹腔镜器械。
平均手术时间为 61.75 分钟（范围：40-105 分钟），平均估计出血量为 17.21 毫升（范围：5-90 毫升）。五例（6.25%）发生胆囊穿孔，其中四例有结石溢出，用腹腔镜取石钳处理。两例（2.5%）发生棘手的胆囊动脉出血，一例（1.25%）有肝硬化的胆囊床出血，用氩束凝固器处理。三例进行了术中胆管造影，一例放置了引流管。没有一例转为开放手术。49 例（94.2%）患者在术后第 1 天出院，3 例（5.8%）患者在术后第 2 天出院。术后第 3 个月测量的平均切口长度为 1.58 厘米（范围，1.3-2.1 毫米）；患者对手术满意度的平均评分为 9.32（范围，7-10）。
在不复杂的胆囊疾病中；单切口腹腔镜胆囊切除术是可行和安全的。它具有极好的美容效果和高度的患者满意度。它可以使用传统的腹腔镜器械进行，一旦获得足够的经验，其应用范围可以扩大。
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