Background
Single-incision laparoscopic surgeries (SILS) promised improved cosmetic results and less postoperative pain, allowing early return to work, and although the first single-incision laparoscopic cholecystectomy (SILC) was described in 1997 by Navarra and colleagues this technique has spread slowly and its adoption was met with reluctance. One of the main problems was concern about its safety, for example, as regards common bile duct injuries in cholecystectomy.
Aim
Evaluation of feasibility, safety, and benefits of SILC and splenectomy.
Patients and methods
As regards cholecystectomy, 40 consecutive patients with gallbladder disease were included. Twenty patients were subjected to SILC and 20 controls were subjected to conventional laparoscopic cholecystectomy. As regards splenectomy, 26 consecutive patients with indication for splenectomy were included. Thirteen patients were subjected to single-port laparoscopic splenectomy and 13 control patients were subjected to conventional laparoscopic splenectomy. All cases were performed at Cairo University, Cairo, Egypt. We compared those techniques for feasibility, safety, operative time, technical difficulties, complications, conversion rates, postoperative pain, duration of hospital stay, and finally, the aesthetic satisfaction.
Results
In the first cholecystectomies, no mortality was reported. Operative time of SILC was considerably longer (100.56 ± 44.8 min) compared with multi-incision laparoscopic cholecystectomy (MILC) (72.21 ± 32.2 min) and it inflicted a physical and mental toll on the operating surgeon. Concerning technical difficulties, gas leak was a problem with SILC occurring in 40% of our cases. Common bile duct injury occurred in one case with SILC and right hepatic artery injury in another case. One case was converted from SILC to MILC and another from SILC to open laparotomy. Pain in SILC was lower than in MILC, and this had resulted in a shorter hospital stay. The men hospital stay was 1.8 days in SILC and in MILC it was of 2.4 days. Port-site hernia was reported in one case in the SILC group. Patient satisfaction was highest in the SILC group. For single-port laparoscopic splenectomy, no mortality was reported. Mean operative time was 145.76 min. Two cases required an additional assisting port. Average hospital stay was 4 days. Patient satisfaction was also very high.
Conclusion
SILS was found to be very demanding, inflicting a huge physical and mental toll on the operating surgeon. The SILS specialized instruments helped but did not solve the problem and increased the cost of practice. On the other hand, the technique do offer better aesthetic results and causes less postoperative pain, which reflects in a shorter hospital stay. More importantly, we believe that SILS will pave the way for the next step in the evolution of scarless surgery.