Single-Operator Multi-Port Cholecystectomy (SOMP) – Technique, Safety, and Efficacy

Abstract Background: The Standard technique of laparoscopic cholecystectomy requires four ports and at least two operators (surgeon and assistant). The Single-Operator Multi-Port (SOMP) technique, wherein the surgeon independently manipulates all four ports using self-retaining retractors, remains poorly characterized in the literature. Aim: To describe the SOMP cholecystectomy technique and evaluate its feasibility, safety, and efficacy through analysis of surgical outcomes. Methods: We performed a retrospective review of consecutive laparoscopic cholecystectomies from July 2022 to April 2025, by a single surgeon who routinely uses the SOMP technique except when self-retaining retractors are unavailable. Patient demographics, surgical indications, operative time, estimated blood loss, conversion to open surgery, reoperation rate, 30-day readmission, and 30-day mortality were evaluated. Results: Among 124 consecutive laparoscopic cholecystectomies, 92 cases (74.2%) used the SOMP technique. In the SOMP cohort, the median age was 48, and 67 (72.8%) were female. Thirty-three procedures (35.9%) were elective. Surgical indications included symptomatic cholelithiasis (n=69), chronic cholecystitis (n=39), choledocholithiasis (n=25), biliary pancreatitis (n=16), and acute cholecystitis (n=14). Additional port placement for better retraction was needed in eight patients (8.7%). Median operative time was 75 minutes, with a median estimated blood loss of 25 mL. Four patients (4.3%) required readmission within 30 days. There were no reoperations or mortalities within 30 days. Multivariate analysis demonstrated that the SOMP technique was an independent factor associated with lower operative time (β for MOMP =41.2, p<0.001) and conversion rate to open approach (OR for MOMP = 20.4, p<0.001). Conclusion: The SOMP technique using self-retaining retractors is a safe and efficient approach to laparoscopic cholecystectomy, with possible benefits in improved ergonomics, reduced costs, and staffing needs. Trial Registration (Clinical trial details): not applicable