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Objective:
Cholangiography remains an important tool for uncovering the common bile duct (CBD) pathology and biliary anatomy during cholecystectomy. This study examined the feasibility and efficacy of routine IOC during SILC, looking at the addition of operative time and associated complications.
Design:
Prospective study from IRB approved database of single incision laparoscopic surgery (SILS).
Setting:
single surgeon’s experience in a community teaching hospital.
Patients:
137 consecutive patients underwent SILC from November 2008 through March 2012.
Main Outcome Measures:
Patient demographics, cholangiogram success, findings and time for completion, overall SILC operative time, length of stay and peri-operative complications.
Results:
The mean age was 46 years with a mean BMI of 28. 80% were female patients. IOC identified choledocholithiasis in 2 patients. Routine IOC was successfully completed in 97% (n=132) of cases requiring an average 7.3 min in all patients which decreased to 5.6 in the year 2011.There were no surgical complications attributed to attempted or completed cholangiogram. 35 SILC cases (26%) required an additional port(s) for cholecystectomy and two (1.5%) patients had conversion to standard laparoscopy, both not related to IOC. Average time for SILC was 84 minutes. Two (1.5%) patients required hospital admission; one due to choledocholithiasis requiring ERCP, the other for pain management. Outpatient follow up at 2 to 3 weeks post operatively documented a single case of surgical site cellulitis requiring a short course of oral antibiotic treatment. No other peri-operative complications were identified.
Conclusions:
The results presented demonstrate that evaluation of biliary anatomy with IOC during SILC can be routinely and safely accomplished. There were no complications attributed to IOC. The procedure required little additional time which further decreased with the experience.