Two-Trocar Cholecystectomy by Strategic Laparoscopy for Improved Cosmesis (SLIC)

BACKGROUND AND OBJECTIVES: Until the advent of single-incision laparoscopic surgery, few advances were aimed at improving cosmesis with laparoscopic cholecystectomy. Criticisms of the single-incision laparoscopic surgery technique include a larger incision and increased incidence of wound-related complications. We present our initial experience with a novel technique aimed at performing strategic laparoscopy for improved cosmesis (SLIC) for cholecystectomy. METHODS: Twenty-five patients with biliary symptoms were selected for SLIC cholecystectomy. Access to the abdomen was obtained with a 5-mm optical trocar in the left upper quadrant and a 5-mm trocar in the umbilicus. Retraction was performed by a transabdominal suture in the dome of the gallbladder and a needlescopic grasper. Age, American Society of Anesthesiologists score, body mass index, operative time, length of stay, pathology results, and short-term complications at follow-up were prospectively recorded. RESULTS: The 25 female patients had a mean age of 34.3 years and mean body mass index of 24 kg/m(2). American Society of Anesthesiologists scores ranged from 1 to 3. The mean operative time was 51.3 minutes. Pathology revealed chronic cholecystitis in all patients. All procedures were performed on an outpatient basis. The only complication was one ultrasonography-documented deep vein thrombosis. All 25 planned SLIC cholecystectomies were successfully completed. CONCLUSIONS: SLIC cholecystectomy is feasible and safe. This technique decreases the cumulative incision length, as well as the number of incisions, leading to very desirable cosmetic results in patients with a favorable body habitus and surgical history.