Todd A. Ponsky, MD; Scott Boulanger, MD, PhD
Cholecystectomy is performed in approximately 28,000 children per year in United States and most are performed laparoscopically. Typical trocar placement for laparoscopic cholecystectomy involves a 10 mm trocar in the umbilicus, 5 mm trocar in the epigastrium and two 5 mm ports on the right side. A single port cholecystectomy has been described in adults, whereby a single fascial incision is made in the umbilicus. Here we describe a single port cholecystectomy in a child.
The patient shown is a 12 year old boy with symptomatic cholelithiasis. He has no other medical problems and no prior operations. The operation was performed through one 1.5 cm incision in the umbilicus. Three 5 mm trocars and one 2 mm grasper were inserted through the umbilical fascia. Using a long 50 cm laparoscope and flexible, reticulating hand instruments, the gallbladder was removed through the umbilicus.
This particular cholecystectomy was performed in 38 minutes and there were no complications.
A total of 15 single site cholecystectomies have been performed in children at our institution. There has been one conversion to 4 port laparoscopy and no complications. Single site surgery may be cosmetically superior to and be less painful than traditional laparoscopy cholecystectomy and it is safe and effective.