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129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

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Is It Safe To Perform SIL-Cholecystectomy As A Teaching Procedure?

Meeting Abstract

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  • Katharina Pimpl - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Schirnhofer Jan - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Matthias Biebl - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Christof Mittermair - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Christian Obrist - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Walter Brunner - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Robert Frass - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Nicolas Waldstein - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg
  • Helmut Weiss - Krankenhaus der Barmherzigen Brüder, Allgemeinchirurgie, Salzburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch269

doi: 10.3205/12dgch269, urn:nbn:de:0183-12dgch2697

Published: April 23, 2012

© 2012 Pimpl et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Introduction: While learning single incision transumbilical laparoscopy (SIL), the surgeon is constrained by the intersection of the instruments and the modified angles.

Materials and methods: We report on a comparison of SI-CHE performed by senior surgeons (A, n=20), fellows (B, n=20) or trainees (C, n=20) comparing total procedural time, intraoperative/postoperative complications, and length of umbilical incision. All surgeons had passed preoperative wet-lab training. The procedures were performed in a regular laparoscopic setting. Exposure and dissection of Calot`s triangle was performed using a suspension suture (cystopexia), one articulating instrument, and a 5 mm optical device. Statistical analysis were performed using the Mann-Whitney-U test with significance assumed at p<0.05.

Results: All 60 procedures could be completed laparoscopically. Additional trocars were used for difficult dissection in 5%, 20% and 5% in groups A, B, and C (p< 0.0001 for comparison of group A vs B and B vs C, respectively). Procedural time was 64,1± 30,0 min, 81,4±35,3 min and 76,9±19,4 min (p< 0.0001 for all comparisons). One intraperitoneal hematoma required redo-laparoscopy (1,7%; group C). All other patients were on oral diet and started mobilization at the day of surgery. The follow-up was uneventful in all patients. Incisional length at the navel showed no difference between the groups.

Conclusion: With significant differences in handling and procedural time, SIL-CHE can be proctored safely at least in selected cases, and can thereby be regarded as a teaching procedure.