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Single Incision Laparoscopic Surgery (SILS):

Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopy (SPL) is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, a patient’s navel.

Physicians and patients prefer the laparoscopic surgery due to the benefits it offers when compared to the traditional surgery. SILS is the latest and most widely used laparoscopy surgery development since the introduction of the laparoscopic cholecystectomy more than 20 years ago. As a laparoscopic procedure, the SILS further minimizes the discomfort and reduces the recovery time associated with the surgery.

SILS surgery can be technically challenging and often performed by the surgeons already having experience in laparoscopy.

Methods and Procedures:
Under the approval of the Ethics Committee, a retrospective review of SILS cholecystectomies was conducted at the Department of Surgery of the University of Buenos Aires. The procedure began with an incision in the umbilical region approximately 2 cms length, and then the abdominal cavity is insufflated using a Veress needle followed by a dissection of the surrounded subcutaneous tissue, 10mm trocar placement and two 5mm trocars, one flexible on the right and one rigid on the left (Mickey Mouse Technique), having the freedom to have the 10mm trocar either in the upper or lower vertex. After this, the scope is introduced through the 5mm trocar based on the better visualization and comfort with the external manipulation of the instruments. Pulling the gallbladder fundus with 3-0 nylon suture using a percutaneous straight needle and neck retraction with articulated grasping forceps, introduced by trocar flexible. Cholecystectomy similar to that made by conventional laparoscopy, with the search for the “critical view of safety” and performing cholangiography selectively. Using forceps 10 mm clipper reusable. Extraction with ad hoc clamp 10 mm trocar.

Results:
Two hundred-fifty cholecystectomies were performed between January 2009 and December 2011, the mean patient age was 35 years (range 20-56), and an average BMI of 24 (range 18-28). 242 (96.8 %) completed successfully with the proposed technique, the remaining cases were converted to laparoscopic approach due to adhesions. One case required a laparotomy through a previous kocher incision looking for bleeding of the liver. Systematic assessments prove adequate healing of the umbilical access with no local complications. Follow-up averaged 6 months (range 1-12).

Conclusions:
This study demonstrates the feasibility, safety and reproducibility of an standardized technique for the performance of a single umbilical incision cholecystectomy. Our initial experience found that complications are similar to the previous reported in conventional cholecystectomy technique with 4 trocars.

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