Health Problem: Bile is made by the body to aid in the digestion of fats. It is stored in the gallbladder, where it can crystallize to form gallstones. Although gallstones are often asymptomatic, they can cause acute cholecystitis with severe pain, inflammation, infection, and scarring of the gallbladder wall, particularly when they block the duct that leads from the gallbladder to the small intestine. In the United States, 10% to 20% of adults have gallstones, and approximately one-third of them develop acute cholecystitis. As a result, cholecystectomy is the most commonly performed surgical procedure, with an estimated 500,000 operations annually.
Technology Description: Cholecystectomy is performed to treat and prevent diseases and conditions affecting the gallbladder. It is typically performed by a laparoscopic surgeon on an outpatient or short-term inpatient basis with the patient under general anesthesia. Conventional laparoscopic procedures, also known as multi-incision laparoscopic surgery (MILS) or multiport surgery, require 2 to 5 small incisions or ports to access the gallbladder. Single-incision laparoscopic surgery (SILS), also known as single-port surgery, is an emerging surgical technique that requires only 1 incision.
Controversy: While SILS is touted to be a scarless surgery with the benefits of less pain and shorter hospital length of stay, it has the disadvantage of limited ability to move and triangulate surgical instruments, a more challenging platform for intracorporeal suturing, and longer operating times, especially during the surgeon’s learning phase.
Key Questions:
- Are SILS procedures effective for treating symptomatic benign gallbladder disease?
- How do SILS procedures compare with conventional MILS procedures for treating symptomatic benign gallbladder disease?
- Are SILS procedures for treating symptomatic benign gallbladder disease safe?
- Have definitive patient selection criteria been identified for the SILS procedure?
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