Initial Experience of Single Incision Laparoscopic Cholecystectomy (With Video)
Bibliographic record
Abstract
OBJECTIVE: Single incision laparoscopic cholecystectomy (SILC) is a rapidly evolving field because of the reduced incisional morbidity, better cosmetic result, shorter hospital stay, and quicker return to activity. We report a technique and retrospectively reviewed our initial experience on SILC. To evaluate the feasibility and safety of the SILC using standard laparoscopic instruments and complying with the conventional surgical principle and technique of minimally invasive cholecystectomy. MATERIALS AND METHODS: From October 2008 to March 2009, 40 patients underwent SILC for the treatment of cholelithiasis at Taipei Medical University Hospital, Taipei, Taiwan. All these patients scheduled for an elective surgery underwent clinical evaluation and appropriate investigations. The exclusion criteria for SILC were acute cholecystitis, concomitant common bile duct stone, obstructive jaundice, previous upper abdominal surgery, and body mass index greater than 35 kg/m. The operation was completed laparoscopically through single 1.5 cm subumbilical incision, through which 3 separate fascitomies were made in triangular form and introduced three 5 mm trocars. A 5-mm 30-degree laparoscope was inserted through the trocar for visualization of the target area. A 5-mm clip was applied to ligate the cystic duct and artery through the others 2 ports alternatively after dissection. Finally, the gallbladder was taken out through the umbilicus and the fascial defect was closed with a direct suturing technique. RESULTS: SILC was performed in 40 patients, 22 (55%) females and 18 (45%) males with a mean age of 46.9+/-10.9 years (range: 28 to 76 y), the mean operative time was 54+/-21.2 minutes (range: 30 to 125 min), and the mean hospital stay was 1.85+/-0.72 days (range: 1.0 to 2.5 d); the mean dosage of the meperidine hydrochloride (Pethidine) was 0.23+/-0.4 mg/kg, the mean pain intensity (Universal Pain Assessment Tool) is mild at 8 hours after surgery, and no pain at 24 hours, the conversion rate for additional incision was 5% (2 of 40).There was no perioperative and postoperative complication. There was no mortality in this study. CONCLUSIONS: The results of our initial experience in SILC showed that it is technically feasible and safe. No additional incisions were used and virtually no scar remained. The established procedure shows that initially learning curve by experienced and well-trained team can be easily overcome by reduced operative duration, postoperative complications, and conversion rate.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".