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Minimally Invasive Surgery
Volume 2013 (2013), Article ID 381628, 7 pages
Research Article

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

1Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore 119228
2Division of Biostatistics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228
3Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177 Stockholm, Sweden
4Saw Swee Hock School of Public Health, National University of Singapore, Singapore 117597

Received 13 November 2012; Accepted 11 April 2013

Academic Editor: Peng Hui Wang

Copyright © 2013 Chee Wei Tay et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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.