Gallstones are one of the most common medical problems in people 50 years of age and older. It is also one of the main reasons for visits to the emergency room.
Gallstones affect 10 to 15 percent of the adult population. Most patients are symptom free but 1 to 2 percent will develop symptoms requiring surgical intervention to remove the gallbladder, also known as a cholecystectomy.
The most common symptoms of biliary colic or an inflamed gallbladder (cholecystitis) include right upper quadrant pain that might or might not radiate to the upper back (most often between shoulder blades), nausea, vomiting and-or loss of appetite.
Cholecystitis and gallstones are diagnosed by an abdominal ultrasound or CT scan. Cholecystectomy is one of the most common procedures performed by general surgeons in the U.S. and worldwide.
The practice of surgical removal of the gallbladder started more than a century ago with a large incision in the upper abdomen, usually six inches.
This was the gold standard for the management of gallbladder disease, and remained so until 1987 when the first laparoscopic cholecystectomy was performed.
The laparoscopic approach became the new standard of care in the U.S. by 1992. Now, more than 90 percent of cholecystectomies are done laparoscopically.
As with all things, increasingly advanced technology is helping us improve on the current standard. Single site laparoscopic surgery (SILS) is a recent advance in minimally invasive surgery.
This was started a few years ago with some limitations due to the lack of appropriate instrumentation. These limitations are overcome with new updates using robotic surgical technology.
Robotic surgery was started around 1980 and has improved since with the development of the Da Vinci surgery system. The main advantages of this new system include: superior visualization with magnification and three-dimensional (3-D) imaging; mechanical improvements with less torque and pressure on the abdominal wall; the addition of wristed instruments that allow 7 degrees of freedom similar to the human wrist; stabilization of instruments within the surgical field avoiding amplification and tremor, and finally improved ergonomics for the operating surgeon.
Lately, new developments in robotic instruments have allowed the single site laparoscopic surgery for cholecystectomy to become another option for the treatment of gallbladder disease. This surgery is performed using a one-inch incision that goes through the belly button.
A single specialized port enters through the abdominal wall and allows multiple instruments and a camera to pass into the abdomen to perform the cholecystectomy.
After removing the gallbladder, the port and instruments, a single, small opening is left. The opening is then sutured closed and the patient transported to recovery.
The small incision is, in most cases, hidden in the umbilicus. No other scars will be visible in the upper abdomen.
Other advantages of single site surgery include less postoperative pain, decreased length of stay, less blood loss, and faster return to normal activities.
Dr. Carlos Montenegro is a board certified general surgeon on staff at Coastal Carolina Hospital, where he performs robotic-assisted surgery using the Da Vinci Surgical System.