Laparoscopic cholecystectomy has been performed since 1985, and throughout the next two decades this procedure became the standard of care for gallbladder disease [1]. Laparoscopic cholecystectomy has traditionally been performed using multiple small incisions/port sites. Single-incision, or single-site, laparoscopic surgery has emerged as an alternative technique to improve cosmesis and minimize complications associated with multiple incisions. The first published report of a single skin incision laparoscopic cholecystectomy was by Navarra in 1997 [2]. Since that time, the idea of “scarless” surgery has gained increasing popularity among patients as well as surgeons.

Set up

A tertiary care hospital-based study in the department of General Surgery, IGMC, Shimla

Study Period

One-year w.e.f.1st July 2018 to 30th June 2019

Setting

This study was done in a single unit of the Department of General Surgery at Indira Gandhi Medical College and Hospital, Shimla w.e.f July 2018 to June 2019 on patients admitted for surgery

Study Design

Observational study

Selection of Cases

Inclusion criteria

• Age less than 70 years 

• ASA 1 & 2 

• Patient should be staying within 1hour of travelling distance from the hospital with adequate motivational level

• Has telephone access 

• Living with a responsible adult

• Able to reach the hospital on their own with or without depending on Emergency Medical Services (EMS)

• Able to understand discharge instructions

• Agrees to do the procedure as an outpatient, (informed consent)

• Has symptomatic uncomplicated gall bladder disease (gall bladder stones or polyps)

Exclusion criteria

• Patients with extreme obesity and co-morbid conditions like poorly controlled diabetes, hypertension, and coronary artery disease or ischaemic heart disease

• Attacks of acute pancreatitis

• Choledocholithiasis with cholelithiasis

• Acute cholecystitis

• BMI > 40 kg/m2 

• ASA grade more than II

• Lack of written informed consent

• Patients on warfarin

• Bleeding disorder

• Previous upper abdominal surgery

Self-reported data related to demographic characteristics and history was recorded as per structured data recording format. This was followed by anthropometric measurement using validated tools. BMI was calculated as ratio of weight in kilograms divided by height in square metres (kg/m2).

The present study was aimed to evaluate the feasibility and safety of SILC as a day care procedure. A total of 30 patients were included in the study over the period of one year at Department of General Surgery, Indira Gandhi Medical College, Shimla. Results of the study have been described below:

Out of 30 patients 29 were female and 1 was male

• Mean age of the study participants was 33.83 years. 

• 47% of the patients aged between 31 and 40 years while 40% of the patients aged below 30 years. 

• Only 3% of the patients aged more than 50 years

Table 1: Duration of surgery

Mean duration of surgery was 48.57 minutes. 20% patients’ duration of surgery more than 50 minutes.

Duration of surgery in our study ranged between 30 to 80 min with mean duration of 48.57 minutes. Karim et al., had mean operating time of SILC to be 75 minutes [3]. Hajong et al., conducted a comparative study of SILC and FPLC (four port laparoscopic cholecystectomy) and observed that mean operating time for SILC was higher than for FPLC (69± 4.00 min vs 38.53±4.00 minutes). This comparison was significant with a p value of <0.05 [4].     

However, Cinar et al., in their study on 144 patients compared 43 patients undergoing SILC with 102 patients Duration of surgery in our study ranged between 30 to 80 min with mean duration of 48.57 minutes. Karim et al., had mean operating time of SILC to be 75 minutes [3]. Hajong et al., conducted a comparative study of SILC and FPLC (four port laparoscopic cholecystectomy) and observed that mean operating time for SILC was higher than for FPLC (69± 4.00 min vs 38.53±4.00 minutes). This comparison was significant with a p value of <0.05 [4].     

However, Cinar et al., in their study on 144 patients compared 43 patients undergoing SILC with 102 patients 
of FPLC. They found that mean operative time for SILC was higher than FPLC but it was not statistically significant [5].

Increased duration of surgery is because of lack of triangulation, mindset of surgeon, altered ergonomics, clashing of instruments at very narrow umbilical fulcrum and the required meticulous closure of the umbilical port. Operating time decreases once learning curve is over, but still remains to be higher than that for FPLC. More number of adhesions in SILC patients increased the duration of surgery further.

Linden et al., had a significantly shorter operating time for SILC (n=79) than CLC (conventional laparoscopic cholecystectomy) (n=71). Mean operating time in SILC was 45 min compared to that of 59 min in the CLC group (P < 0.05) [6].

We conclude that most of patients’ duration of surgery was 30-50 mint.

1. Reynolds, W. Jr. “The First Laparoscopic Cholecystectomy.” JSLS: Journal of the Society of Laparoendoscopic Surgeons, vol. 5, no. 1, 2001, pp. 89–94.

2. Navarra, G., Pozza, E., Occhionorelli, S., Carcoforo, P., and I. Donini. “One-Wound Laparoscopic Cholecystectomy.” Journal of British Surgery, vol. 84, no. 5, May 1997, p. 695.

3. Karim, M.A., Ahmed, J., Mansour, M., and A. Ali. “Single Incision vs. Conventional Multiport Laparoscopic Cholecystectomy: A Comparison of Two Approaches.” International Journal of Surgery, vol. 10, no. 7, 2012, pp. 368–372.

4. Hajong, R., Hajong, D., Natung, T., Anand, M., and G. Sharma. “A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy.” Journal of Clinical and Diagnostic Research: JCDR, vol. 10, no. 10, Oct. 2016, pp. PC06–PC09.

5. Cinar, H., Topgul, K., Malazgirt, Z., Yuruker, S., Buyukakincak, S., Kesicioglu, T., Tarim, İ.A., Koc, Z., and Z. Saglam. “Early Results of Single-Incision Laparoscopic Cholecystectomy in Comparison with the Conventional: Does It Have Any Impact on Quality of Life?” Annals of Medicine and Surgery, vol. 32, Aug. 2018, pp. 1–5.

6. van der Linden, Y.T., Bosscha, K., Prins, H.A., and D.J. Lips. “Single-Port Laparoscopic Cholecystectomy vs. Standard Laparoscopic Cholecystectomy: A Non-Randomized, Age-Matched Single Center Trial.” World Journal of Gastrointestinal Surgery, vol. 7, no. 8, Aug. 2015, pp. 145–150.