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. 2009 Oct-Dec;13(4):528-35.
doi: 10.4293/108680809X12589998404245.

Single port access (SPA) cholecystectomy: two year follow-up

Erica R Podolsky  1 , Steven J Rottman, Paul G Curcillo 2nd
Affiliations

Single port access (SPA) cholecystectomy: two year follow-up

Erica R Podolsky et al. JSLS. 2009 Oct-Dec.

Abstract

Introduction: Laparoscopy is a constantly evolving field of surgery. New technology, applications, and benefits prompt continual improvement. We have developed a Single Port Access (SPA) surgical technique that allows for the entire cholecystectomy to be performed through a single incision within the umbilicus while maintaining safe standard dissection and retraction techniques of currently performed multiport laparoscopic cholecystectomy.

Methods: Fifteen consecutive patients underwent SPA cholecystectomy. Indications were cholelithiasis, cholecystitis, CBD stones, and biliary akinesia. The entire procedure was performed through a single umbilical incision measuring <1.8 cm within the umbilicus. Three trocars and a rigid grasper were inserted through separate fascial sites within the same skin incision. The cholecystectomy procedures are then performed in the standard fashion described in multi-port cholecystectomy.

Results: Fifteen patients successfully underwent Single Port Access cholecystectomy. One patient required a second 5-mm port site secondary to difficulty with retraction of a large liver. Operative times averaged 107 minutes. Blood loss, patient recovery, and outcomes have been comparable to those of standard multi-port procedures. No umbilical hernias have been seen at 2 years of follow-up.

Conclusion: We present the SPA cholecystectomy as an alternative to multi-port cholecystectomy. In the first 2 years, SPA surgery has evolved into a technique easily taught and performed without the restrictions of new equipment or added cost.

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Figures

Figure 1.
Figure 1.
Initial skin incision.
Figure 2.
Figure 2.
Creation of skin flaps.
Figure 3.
Figure 3.
(A) SPA Circle of Entry; (B) SPA Circle of Entry.
Figure 4.
Figure 4.
Visualization on entry.
Figure 5.
Figure 5.
Fundal retracting instrument.
Figure 6.
Figure 6.
(A) SPA schematic setup; (B) Final SPA setup.
Figure 7.
Figure 7.
Long scope.
Figure 8.
Figure 8.
Fundal retraction.
Figure 9.
Figure 9.
Closure.
Figure 10.
Figure 10.
(A) Lack of critical view; (B) Critical view.
Figure 11.
Figure 11.
Final skin incision.
See this image and copyright information in PMC

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