More Bile Duct Injuries With Single-Incision Laparoscopic Cholecystectomy
Medscape recently published an interesting health article. It is a reproduction of a report published by Reuters Health (click here for the full article).
This article basically highlighted the findings of a recent publication in the June edition of the Annals of Surgery - a high impact surgical journal. The paper was titled "Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution" (Ann Surg 2012 Jul; 256:1-6)
Single-incision lapaproscopic surgery is one of the new fab in minimally invasive surgery. It is also called "scarless" surgery or "single port surgery". The concept is to make a larger wound right in the umbilicus, one large enough to allow the insertion of 2 or more instruments to perfrom the operation. Because the cut is made in the umbilcus, when the wound heals, it will be hidden within the belly-button, and hence appears as "scarless". Because of this promise of superior cosmesis, and other touted benefits like less pain, faster recovery and so on, single-incision operations have become more prevalent. One of the first surgical procedure that adopted this technique is the removal of the gallbladder (cholecystectomy).
The main observation made by this review of 45 published reports, covering the surgical outcomes of 2626 patients was that single-incision laparoscopic cholecystectomy was associated with a higher bile duct injury rate, when compared to the conventional 4-port laparoscopic cholecystectomy. Bile duct injury is one of the most devastating complications of this surgery. Sometimes, surgical repair is required if the injury is severe. A cut bile duct during laparoscopic cholecystectomy often results in litigation.
Besides a higher incidence of bile duct injury, other important findings are:
- potentially more long-term wound complications
- post-operative pain may be similar or even more than conventional laparoscopic cholecystectomy
- the cosmetic benefits may be minimal
The conclusion of the study?
For Nexus Surgical Laparoscopic and MIS Centre, we are very careful in selecting our patients who request for single-incision laparoscopic surgery. We will also ensure that these patients are aware of the risks and benefits.
If cosmesis is the main motivation why patients choose single-incision laparoscopic surgery, we will offer them needle-scopic or minilaparoscopic surgery as an alternatve to consider. This technqiue preserves the safety of conventional laparoscopic cholecystectomy while reducing the scars, by using miniaturized instruments.
Do contact Nexus Surgical Laparoscopic and MIS Centre if you require more clarifications.