Initial experience of glove port technique in single incision laparoscopic cholecystectomy using conventional laparoscopic instruments

Introduction: Single-incision laparoscopic surgery is an attractive approach for cholecystectomy. However, its widespread application has many limitations. A significant obstacle of application in developing countries is the expensive and non-affordable specialized single port systems and roticulating instruments.

Objective: To evaluate our initial experience of single incision laparoscopic cholecystectomy (SILC) performed by a single surgeon using the glove port technique and the conventional laparoscopic instruments.

Methodology: 45 patients with symptomatic gall bladder stone disease underwent an elective SILC during the period from October 2011 to March 2012at Theodor Bilharz Research Institute. Trans-Umbilical single incision glove port access was used. Patient's demographic data, perioperative outcomes, and early postoperative complications were collected and analyzed.

Results: The mean operative time was 47.75 min and the mean estimated blood loss was 14.5 ml. Intraoperative bile leakage due to gall bladder perforation occurred in 4 cases (8.89%). Troublesome cystic artery bleeding occurred in 2 cases (4.44%). An intra-operative trans cholecystic cholangiogram was performed in 2 cases and a drain was inserted in 3 cases (6.66%). No conversion of the technique occurred except in one case (2.22%) at which additional 5 ml port was used. 41 patients (91.11%) discharged in the first post-operative day and 4 patients in the 2nd day. Post-operative wound seroma was observed in 2 cases and subumbilical wound hematoma in one case. Three months post-operative wound length was an average of 1.59 cm while patient satisfaction of the surgery was an average of 9.41.

Conclusion: On preselected cases; glove port laparoscopic cholecystectomy (GPLC) using the conventional laparoscopic instruments is feasible and safe with excellent aesthetic results and high grade of patient satisfaction. We consider GPLC a cost effective and convenient alternative to single port laparoscopic cholecystectomy and its scale of application could be widened once enough experience is attained.