These results selleckchem Crizotinib however, include a limited number of surgeons and are applicable only to patients with programmed cholecystectomies without any foreseeable factors aggravating dissection of Calot’s triangle as out of the 58 patients only 3 were diagnosed with acute cholecystitis, thereby limiting their applicability. In a matched pair analysis that took place over 26 months, Gangl et al. [20] compared operating time, postoperative pain using the visual analogous scale (VAS) at 24 and 48hrs, use of analgesics, length of hospital stay, and complications [20]. They performed the SILC/LESS patient data gathering prospectively, comparing them to matched controls from a group of 163 LC which were performed in the same time period, with no significant differences in age, gender, BMI, ASA classification, diagnosis of acute cholecystitis, or previous abdominal surgery.

They reported a SILC/LESS cholecystectomy completion rate of 85.1%, with conversion to LC in 9 patients and open cholecystectomy in 1 patient due to inadequate visualization of the anatomy, versus a 100% completion rate in the LC group, with no significant difference with regard to postoperative pain, analgesic use, length of stay or complications. The only significant difference was the length of surgery with a longer operating time in the SILC/LESS cholecystectomy group (75min versus 63min). They conclude that SILC/LESS even though associated with a longer operating time is comparable to LC [20]. The incidence of biliary injury during standard LC varies from 0.5 to 0.8% [37].

In order to identify biliary injury the use of intraoperative cholangiogram is now considered a standard procedure to evaluate anatomy of the biliary tree. The possibility of carrying out a transoperative cholangiogram in SILC/LESS was recently evaluated by Yeo et al. [38]. They were able to observe that in the 55 patients in which a successful SILC was carried out, 53 received a transoperative cholangiogram out of which 48 were normal with 1 patient requiring endoscopic removal of a biliary stone [38]. This is the largest series of SILC/LESS which reports the routine evaluation of biliary anatomy with a cholangiogram performed through an umbilical port, however, whether these results are reproducible or not, requires further studies. A more pressing issue regarding biliary injury and SILC/LESS is an adequate exposure of Calot’s triangle or ��the Strasberg critical view.

�� As described above, in order to achieve the ��critical view,�� the use of transparietal sutures or magnetic forceps that allow extra corporeal traction on the gallbladder fundus can be carried out [6, 21, 29]. It is interesting to note that in the study carried out by Antoniou et al. [6], the two most common reasons for conversion Carfilzomib from SILC/LESS to standard LC were: Inflammation/adhesions/unclear anatomy (47.