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Evolution of the Konyang Standard Method for single incision laparoscopic cholecystectomy: the result from a thousand case of a single center experience

Annals of Surgical Treatment and Research 2018년 95권 2호 p.80 ~ 86
KMID : 0371420180950020080
 ( Kim Min-Kyu ) - Konyang University Hospital Department of Surgery

 ( Choi In-Seok ) - Konyang University Hospital Department of Surgery
 ( Moon Ju-Ik ) - Konyang University Hospital Department of Surgery
 ( Lee Sang-Eok ) - Konyang University Hospital Department of Surgery
 ( Yoon Dae-Sung ) - Konyang University Hospital Department of Surgery
 ( Kwon Seong-Uk ) - Konyang University Hospital Department of Surgery
 ( Choi Won-Jun ) - Konyang University Hospital Department of Surgery
 ( Sung Nak-Song ) - Konyang University Hospital Department of Surgery
 ( Park Si-Min ) - Konyang University Hospital Department of Surgery

Abstract

Purpose: Single incision laparoscopic cholecystectomy (SILC) is increasingly performed worldwide. Accordingly, the Konyang Standard Method (KSM) for SILC has been developed over the past 6 years. We report the outcomes of our procedures.

Methods: Between April 2010 and December 2016, 1,005 patients underwent SILC at Konyang University Hospital. Initially 3-channel SILC with KSM was changed to 4-channel SILC using a modified technique with a snake retractor for exposure of Calot triangle; we called this a modified KSM (mKSM). Recently, we have used a commercial 4-channel (Glove) port for simplicity.

Results: SILC was performed in 323 patients with the KSM, in 645 with the mKSM, and in 37 with the commercial 4-channel port. Age was not significantly different between the 3 groups (P = 0.942). The postoperative hospital days (P = 0.051), operative time (P < 0.001) and intraoperative bleeding volume (P < 0.001) were significantly improved in the 3 groups. Drain insertion (P = 0.214), additional port insertion (P = 0.639), and postoperative complications (P = 0.608) were not significantly different in all groups. Postoperative complications were evaluated with the Clavien-Dindo classification. There were 3 cases (0.9%) over grade IIIb (bile duct injury, incisional hernia, duodenal perforation, or small bowel injury) with KSM and 3 (0.5%) with mKSM.

Conclusion: We evaluated the evolution of the KSM for SILC. The use of the mKSM with a commercial 4-channel port may be the safest and most effective method for SILC.
KeyWords

Laparoscopic cholecystectomy, Single-incision, Laparoscopy
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