SILC for SILC: Single Institution Learning Curve for Single-Incision Laparoscopic Cholecystectomy

Objectives. We report the single-incision laparoscopic cholecystectomy (SILC) learning experience of 2 hepatobiliary surgeons and the factors that could influence the learning curve of SILC. Methods. Patients who underwent SILC by Surgeons A and B were studied retrospectively. Operating time, conversion rate, reason for conversion, identity of first assistants, and their experience with previous laparoscopic cholecystectomy (LC) were analysed. CUSUM analysis is used to identify learning curve. Results. Hundred and nineteen SILC cases were performed by Surgeons A and B, respectively. Eight cases required additional port. In CUSUM analysis, most conversion occurred during the first 19 cases. Operating time was significantly lower (62.5 versus 90.6？min, P = 0.04) after the learning curve has been overcome. Operating time decreases as the experience increases, especially Surgeon B. Most conversions are due to adhesion at Calot’s triangle. Acute cholecystitis, patients’ BMI, and previous surgery do not seem to influence conversion rate. Mean operating times of cases assisted by first assistant with and without LC experience were 48 and 74 minutes, respectively (P = 0.004). Conclusion. Nineteen cases are needed to overcome the learning curve of SILC. Team work, assistant with CLC experience, and appropriate equipment and technique are the important factors in performing SILC. 1. Introduction Single-incision laparoscopic cholecystectomy (SILC) has been increasingly performed for benign gallbladder disease over the last few years with comparable operative results with conventional 4-port laparoscopic cholecystectomy (CLC). With results from randomized controlled trials (RCTs) [1–5] and series of publications [6–9] showing that SILC is equally safe, with no obvious additional scar and potentially have less postoperative pain and earlier return to daily activity [5], more surgeons are embarking on learning the technique. As SILC is a new approach to gallbladder disease, many aspects of this new technique have not been studied in detail. Most surgeons embarking on this technique are concerned with its learning curve, conversions, and potential longer operating time. To date, very limited work has been done to look into this important issue and few publications have looked into learning curve of SILC from conversion point of view. To perform SILC safely and successfully, there may be changes in surgical technique, need of new equipment, and modifications in the role of assistant. In this study, we report an SILC learning experience of a tertiary university hospital