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Correlation between port-to-target distance and procedural difficulty in single-incision laparoscopic cholecystectomy : An observational study

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Title: Correlation between port-to-target distance and procedural difficulty in single-incision laparoscopic cholecystectomy : An observational study
Authors: Ohira, Masafumi Browse this author
Shibuya, Kazuaki Browse this author
Uemura, Kazuhito Browse this author
Takahashi, Hiroaki Browse this author
Ito, Yoshio Browse this author
Keywords: Port-to-target distance
procedural difficulty
single-incision laparoscopic cholecystectomy
Issue Date: 4-Jul-2019
Publisher: John Wiley & Sons
Journal Title: Asian journal of endoscopic surgery
Volume: 12
Issue: 3
Start Page: 255
End Page: 263
Publisher DOI: 10.1111/ases.12652
PMID: 30259708
Abstract: Introduction Single-incision laparoscopic cholecystectomy (SILC) is more challenging than conventional (multiport) laparoscopic cholecystectomy (CLC) because of the increased likelihood of instrument collision and the limited surgical workspace. In SILC, procedural difficulties may increase when the port-to-target distance is long. We aimed to assess the correlation between port-to-target distance and procedural difficulty. Methods Thirty-six consecutive patients who underwent SILC at our hospital were included in this study. The umbilicus-to-Calot's triangle distance (UCD) was measured intraoperatively. The correlations between the UCD and operative time were analyzed, and for comparison, CLC cases during the same period (n = 28) were similarly analyzed. Moreover, UCD was estimated from preoperative CT (UCD-CT), and the usefulness of UCD-CT was assessed during SILC and CLC. Results Thirty-four patients successfully underwent SILC. There were positive correlations between the UCD and pneumoperitoneum time. Multivariate linear regression analysis, including BMI and height, which were previously reported to have a correlation with longer operative time in SILC, showed that UCD is an independent predictive factor for prolonged operative duration. However, BMI and height were not independent predictive factors. UCD and UCD-CT had a very strong positive correlation; therefore, UCD was estimated from CT. UCD-CT had a strong positive correlation with operative time in SILC, but not in CLC. Conclusions A longer UCD is an important predictive factor for difficult cases of SILC, but this finding is not applicable in CLC. The usefulness of UCD is specific to SILC.
Rights: This is the peer reviewed version of the following article: Asian journal of endoscopic surgery: 12(3): 255-263, which has been published in final form at This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Type: article (author version)
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 大平 将史

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