Single-incision laparoscopic cholecystectomy in a resource-poor setting: improving safety during the learning curve

Background:  Single Incision Laparoscopic Cholecystectomy is becoming a widely performed operation with various techniques and special instruments having been developed for the procedure. However, these tend to increase the cost of the operation and hence are not always feasible options in smaller centres with poor patients. We describe a safe, low cost operation that involves the same equipment and instruments as the conventional laparoscopic cholecystectomy and draw conclusions on the steps to improve safety during the learning curve. Methods: The study was conducted on 35 patients who underwent Single Incision Laparoscopic Cholecystectomy out of 212 who underwent laparoscopic cholecystectomy at a secondary level charitable hospital in Shillong, Meghalaya, India from November 2009 to March 2011. Results:  With careful case selection, single incision laparoscopic cholecystectomy was safely performed on 35 patients. 2 tall patients required an additional port in the epigastrium since the instruments were not long enough to comfortably reach the Calot’s triangle. One patient developed a wound infection after 3 weeks and there were no other reported complications or incidence of hernia after 4 years. Conclusions:  With wise patient selection, proficiency in 3-port cholecystectomy, demonstration of the critical view of safety, proper placement of the ports and utilisation of standard laparoscopic instruments, single incision laparoscopic cholecystectomy can be safely performed without major complications and at no increased cost even in smaller hospitals without specialised training in the procedure.