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Single-fulcrum laparoscopic cholecystectomy: a single-incision and multi-port technique

Authors

  • Sung Hoon Choi,

    1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine
    2. Pancreatobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System and
    3. Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
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  • Ho Kyoung Hwang,

    1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine
    2. Pancreatobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System and
    3. Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
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  • Chang Moo Kang,

    Corresponding author
    1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine
    2. Pancreatobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System and
    3. Young Yonsei Pancreatic Tumor Study Group, Seoul, Korea
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  • Woo Jung Lee

    1. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine
    2. Pancreatobiliary Cancer Clinic, Institute of Gastroenterology, Yonsei University Health System and
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  • S. H. Choi MD; H. K. Hwang MD; C. M. Kang MD; W. J. Lee PhD.

A/Prof. Chang Moo Kang, Department of Surgery, Yonsei University College of Medicine, Ludlow Faculty Research Building #204, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea. Email: cmkang@yuhs.ac

Abstract

Background:  Single-incision laparoscopic cholecystectomy (LC) is still technically demanding and usually requires specially designed instruments. This article describes our own technique, a single-fulcrum LC using only standard ports and instruments.

Methods:  Between March 2009 and December 2010, 130 consecutive patients, all scheduled to undergo elective LC, underwent this single-fulcrum LC for benign gallbladder disease. Perioperative surgical outcomes were retrospectively evaluated.

Results:  One hundred and ten patients (84.6%) underwent successful single-fulcrum LC, and 20 patients (15.4%) were converted to conventional surgery (n= 18) or required additional trocars (n= 2) during the procedure because of umbilical hernia (n= 3), severe inflammation or adhesion (n= 9), impacted cystic duct stone (n= 3), anatomical anomaly (n= 3) and iatrogenic injury (n= 2). Two intraoperative complications (iatrogenic injury) were securely managed using additional trocars and there was no post-operative morbidity or mortality. This single-fulcrum LC could be performed with comparable cost to conventional LC, and the sequential operative time showed reasonable learning curve.

Conclusion:  Single-fulcrum LC is feasible, safe and quite reproducible. The surgical wound can be dramatically reduced at a similar cost to conventional LC. It may be an alternative procedure for most uncomplicated benign gallbladder disease.

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