HMC Offers Single-incision Laparoscopic Gallbladder Surgery

HOLYOKE — Gallbladder surgery used to be a major surgical procedure, involving a four- to seven-inch incision and several weeks of recovery time. This all changed with the development of laparoscopy, which allowed physicians to remove the gallbladder via three or four tiny incisions using state-of-the art technology.

Now, however, an even more recent development in laparoscopic techniques gives doctors the ability to perform the operation through one incision, right where there is already scar tissue that everyone has: the navel. Dr. L. Willis Roberts recently became the first surgeon at Holyoke Medical Center to do this operation.

One out of 10 people in the U.S. will develop gallstones, and one out of 10 people with gallstones will develop problems with these stones. About a half-million Americans undergo gallbladder surgery each year, making it one of the most common procedures in modern medicine.

To perform this single-incision procedure, Roberts inserts the laparoscopic tools through a small incision in the bellybutton. These tools include a flexible camera and an instrument to cut and suture. Minimally invasive laparoscopic procedures such as this usually require three or four small incisions for separate insertion of the instrumentation, but new techniques, which Roberts studied recently, have made this operation even less invasive.

Roberts noted that this single-incision procedure is not the result of any new technology, but rather newer techniques.

“There are now instruments that curve to allow us greater angles of vision to look around organs,” he said. “And there have been improvements and modifications to the scopes we use, but the main thing is the technique of doing it in a way where all the instruments come from one spot.”

Roberts said that the main advantage of doing a single-incision procedure is mostly cosmetic, but that is very important to some patients. While the multiple-incision gallbladder laparoscopy only leaves very small marks, some patients prefer having no scarring at all. Roberts underwent training for this procedure because he wanted to offer it to his patients as an option. But he stressed that he only did so after considering all the factors.

“We don’t ever want to change a procedure if it will potentially cause more complications,” he said. “We wouldn’t do it if that were the case.”

Debbie Barker, the patient who underwent this first single-incision gallbladder operation at Holyoke Medical Center, was thrilled with the entire process. She was able to go home the same day, and was basically back to a normal routine within two days.

“He did a fantastic job,” Barker said. “My husband had to help me the first night I was home, but by the next day I was OK. I highly recommend Dr. Roberts to anyone. I have no scars, and I am very happy with the whole procedure.”

Barker meant what she said, as her husband underwent surgery with Roberts a few days later.

Some physicians also believe that there is less post-operative discomfort from a single-incision procedure, but Roberts said the jury is still out on that aspect.

“At the conferences I went to, there was some debate about that,” he said. “There may be less pain, but with laparoscopy, there isn’t a lot of pain to start with, so I’d say it’s probably about the same.”

While this type of procedure has been around for a decade or so, it has not been used often, but is now gaining popularity. Roberts also noted that single-incision laparoscopies are now being employed for such procedures as hysterectomies, appendectomies, and several other operations.