Vivek Chitre
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Scarless Clolecystectomy

single incision lap chole.jpg

About the study

Laparoscopic (key-hole) cholecystectomy is now the established method of removing gall bladders. This is performed by introducing 4 'ports' (5 & 10 mm diameter cannulas through which instruments & the camera enter the abdomen) using tiny cuts.

Single-incision laparoscopic cholecystectomy represents a further refinement of the key-hole technique. In it, a single port is used instead of the 4 ports that are currently needed. The single port has multiple channels that allow the insertion of the viewing camera and working instruments alongside each other.

This technique has been made possible by the development of curved laparoscopic instruments, which approach the target organ at different angles. This is a young technique, and the evidence base is currently limited to case series. In response to the growing popularity of this technique, NICE has published guidance in May 2010. The guidance approves the use of this technique, if several stringent safety and clinical governance criteria are met. The available evidence shows that this technique is safe and effective. However, this method is technically challenging & NICE has therefore recommended that only suitably trained surgeons should develop the evidence base further. Having performed Norfolk’s first single-incision laparoscopic cholecystectomy, I prospectively audited this procedure. I found that it was safe to perform in my hands & patient-satisfaction was very high; however I concluded that the operation needed advanced laparoscopic skills and a specialised laparoscopic theatre team, making it a niche operation for those with a special interest, rather than an operation that NHS Consultants could uniformly provide.

The benefits are still being assessed. NICE acknowledges that the main benefit is cosmetic. This is because the single incision is made deep within the umbilicus, such that it is not visible after the operation. Other potential benefits include a reduced incidence of wound infection (because there is only one wound), reduced postoperative pain and enhanced recovery. The latter two benefits are unlikely to be very significant in the case of cholecystectomy, because the standard laparoscopic cholecystectomy itself is a good operation.