Since then, LC has become the standard procedure for the treatment of gallstones, cholecystitis, or gallbladder polyps. Traditionally, LC has involved four customer reviews ports. Many laparoscopic techniques have been developed using this 4-port LC, and it has become possible to perform these techniques safely. Now, having established the safety of LC, our interest focused on reducing the invasiveness and scarring caused by the procedure. Cuesta et al. reported single-incision laparoscopic cholecystectomy (SILC), in which two 5mm ports were introduced through the umbilicus, and a Kirschner wire hook was introduced through the right subcostal area to pull in an upright direction in order to visualize Calot’s triangle [2]. Several surgeons have described performing SILC using three 5mm ports from the umbilicus [3, 4].
Meanwhile, Merchant et al. also performed SILC by inserting a Gelport (Applied Medical, Rancho Santa Margarita, CA, USA) to stretch the umbilical fascia incision for easy access with instruments into the abdominal cavity [5]. Furthermore, a technique involving several transumbilical-placed ports for single-incision laparoscopic surgery was newly developed, and SILC by means of the ASC Triport (Advanced Surgical Concepts, Wicklow, Ireland) has been described successively [6�C8]. On the other hand, an interesting new instrument named SPIDER (TransEnterix, Inc., Research Triangle Park, NC) for use in single-incision surgery was developed, and its use in SILC in an animal experiment has been reported [9]. As a result of these clinical studies, the use of SILC has spread rapidly.
Various ports and instruments are available, and various surgical methods used in performing SILC are available in many institutions; however, it is necessary to develop an excellent procedure that can be performed safely like the conventional 4-port LC, and it is also necessary to balance safety, operativity, and economy in this new technique. We herein describe the experience with SILC in our institute, focusing on the technical problems and the advances made to overcome these problems. 2. SILS Port Procedures In performing SILC, we first selected the SILS Port (Covidien, Inc., Norwalk, CT, USA) (Figure 1). This port was developed for use in single-incision laparoscopic surgery, and it has contributed to the global spread of SILC. The approximate operative procedures using this SILS Port are as follows.
Under general anesthesia, an approximately 25mm vertical skin incision was made through the center of the umbilicus, the peritoneal cavity was entered with the open method, and then the SILS Port was inserted. Three exclusive 5mm ports were inserted through GSK-3 the SILS Port, and one 5mm port was changeable to an exclusive 12mm port. The pneumoperitoneum was set at 8mmHg, and a 5mm flexible scope (Olympus, Tokyo, Japan) was used for the intra-abdominal visualization.
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