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Lobe TE, Panait L, Dapri G, Denk PM, Pechman D, Milone L, Scholz S, Slater BJ. A SAGES technology and value assessment and pediatric committee evaluation of mini-laparoscopic instrumentation. Surg Endosc 2022; 36:7077-7091. [DOI: 10.1007/s00464-022-09467-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/10/2022] [Indexed: 11/30/2022]
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Perini D, Giordano A, Guagni T, Cantafio S. Minilaparoscopic over conventional laparoscopic cholecystectomy and appendectomy: is it worth it? A case series and review of literature. J Surg Case Rep 2022; 2022:rjac136. [PMID: 35386268 PMCID: PMC8978859 DOI: 10.1093/jscr/rjac136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/14/2022] Open
Abstract
Minilaparoscopic cholecystectomy was proposed with the aim to improve the cosmesis and reduce the impact on the abdominal wall. Our aim was to analyze the knowledge currently available on this topic with a review of literature and with our experience to suggest patient-centered approach over the use of minilaparoscopic cholecystectomies and appendectomies. From January 2021 to October 2021, we performed 21 minilaparoscopic cholecystectomies and 12 minilaparoscopic appendectomies. Within the established 1-month and 3-month follow-up intervals, clinical examination and scar evaluation were assessed and a satisfaction questionnaire was completed by all the patients. No intraoperative or postoperative complications were recorded. Patients' pain decreases significantly during hospital stay and 30 patients (90,1%) were discharged with VAS 0. The same happened with aesthetic score, that was 2,23 the postoperative-day-1, decrease to 1,87 1 week later and was 1,12 at 1- and 3-month follow-up.
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Affiliation(s)
- Davina Perini
- General Surgery Unit, Nuovo Ospedale “S. Stefano”, Azienda ASL Toscana Centro, Prato, Italy
| | - Alessio Giordano
- General Surgery Unit, Nuovo Ospedale “S. Stefano”, Azienda ASL Toscana Centro, Prato, Italy
| | - Tommaso Guagni
- General Surgery Unit, Nuovo Ospedale “S. Stefano”, Azienda ASL Toscana Centro, Prato, Italy
| | - Stefano Cantafio
- General Surgery Unit, Nuovo Ospedale “S. Stefano”, Azienda ASL Toscana Centro, Prato, Italy
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Sassani JC, Clark SG, McGough CE, Shepherd JP, Bonidie M. Sacrocolpopexy experience with a novel robotic surgical platform. Int Urogynecol J 2022; 33:3255-3260. [PMID: 35312804 DOI: 10.1007/s00192-022-05155-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/20/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to describe early experience performing sacrocolpopexy using a novel robotic surgical platform. METHODS This is a case series of all women who underwent robotic-assisted sacrocolpopexy using a new robotics platform (TransEnterix Senhance) between January 2019 and July 2021. All sacrocolpopexies were performed by a single Female Pelvic Medicine and Reconstructive surgeon at a large academic institution. Perioperative information including complications was abstracted from the medical record. Anatomical recurrence was defined as any anatomical point at or past the hymen (≥0). Data are descriptive, with Mann-Whitney U test used for comparison of operative time between the first and second half of the patients. RESULTS A total of 25 sacrocolpopexies were performed using the new robotics platform. Mean age was 62.3 years (±9.2) and mean BMI was 26.5 (±3.8). Ten (40.0%) patients had a prior hysterectomy. Most (n = 21, 84.0%) had stage III or IV prolapse preoperatively. Mean operative time was 210.2 min (±48.6) and median estimated blood loss was 35 ml (IQR 25-50). Mean operative time decreased between the first and second half of the patients (231.7 min vs 190.3 min, p = 0.047). There were no major intraoperative complications. Median follow-up time was 16 weeks (IQR 4-34) and there were no subjective recurrences or retreatments during this period. Two patients (8.0%) had anatomical recurrence without subjective bother. There were two postoperative readmissions (8.0%) within 30 days for small bowel obstruction, one treated surgically and the other with nonsurgical management. CONCLUSIONS Our case series demonstrates feasibility and successful early adoption of a new robotics platform for robotic sacrocolpopexy.
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Affiliation(s)
- Jessica C Sassani
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| | - Stephanie Glass Clark
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Christine E McGough
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jonathan P Shepherd
- Department of Obstetrics & Gynecology, University of Connecticut Health Center, Farmington, CT, USA
| | - Michael Bonidie
- Division of Urogynecology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Shah MY, Somasundaram U, Wilkinson TRVR, Wasnik N. Feasibility and Safety of Three-Port Laparoscopic Cholecystectomy Compared to Four-Port Laparoscopic Cholecystectomy. Cureus 2021; 13:e19979. [PMID: 34984137 PMCID: PMC8714047 DOI: 10.7759/cureus.19979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background The standard four-port laparoscopic cholecystectomy (LC) is the gold standard procedure. The various clinical trials and reports in the literature have suggested that the three-port technique LC can be done safely with acceptable results. Still, that the three-port LC offers any added benefits to the patient is a controversial issue especially in view of safety and feasibility. In this study, we report the experience of three-port LC compared to four-port LC technique, its safety, feasibility and outcomes. Materials and methods A prospective randomized study was conducted between two groups which included 165 cases - 93 patients were included in three-port LC (Group A) and 72 patients in four-port LC (Group B). Operative time, intraoperative complications, postoperative pain, length of hospital stay, analgesics requirement, conversion to open and return to normal activities were parameters of evaluation. Results Demographic data was comparable in both the groups. Three-port LC Group A had lesser post-operative pain and analgesics requirements. The mean postoperative pain visual analogue scale (VAS) score on day 1 was (4.16 and 6.24), on day 7 was (1.26 and 1.81) in three-port group and in four-port LC group, respectively. The mean days of analgesics requirement were 2.56 days and 4.21 days among three-port group and four-port group, respectively Length of hospital stay was less and returning to work was early in three-port group. There was no statistical difference in operative time. The mean operative time among three-port LC group A and four-port LC group B was 36+/-8.6 minutes (30-68) and 39+/-7 minutes (30-90), respectively. The overall outcomes were comparable to four-port LC. Conclusion Three-port LC is a feasible and safe procedure for LC with satisfactory outcomes like lesser postoperative pain, postoperative stay and less scars, when performed by experienced hands, especially in acute cholecystitis. The use of fourth port should be done when required in a difficult situation.
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Zhao JJ, Syn NL, Chong C, Tan HL, Ng JYX, Yap A, Kabir T, Goh BKP. Comparative outcomes of needlescopic, single-incision laparoscopic, standard laparoscopic, mini-laparotomy, and open cholecystectomy: A systematic review and network meta-analysis of 96 randomized controlled trials with 11,083 patients. Surgery 2021; 170:994-1003. [PMID: 34023139 DOI: 10.1016/j.surg.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most randomized trials on minimally invasive cholecystectomy have been conducted with standard (3/4-port) laparoscopic or open cholecystectomy serving as the control group. However, there exists a dearth of head-to-head trials that directly compare different minimally invasive techniques for cholecystectomy (eg, single-incision laparoscopic cholecystectomy versus needlescopic cholecystectomy). Hence, it remains largely unknown how the different minimally invasive cholecystectomy techniques fare up against one another. METHODS To minimize selection and confounding biases, only randomized controlled trials were considered for inclusion. Perioperative outcomes were compared using frequentist network meta-analyses. The interpretation of the results was driven by treatment effects and surface under the cumulative ranking curve values. A sensitivity analysis was also undertaken focusing on a subgroup of randomized controlled trials, which recruited patients with only uncomplicated cholecystitis. RESULTS Ninety-six eligible randomized controlled trials comprising 11,083 patients were identified. Risk of intra-abdominal infection or abscess, bile duct injury, bile leak, and open conversion did not differ significantly between minimally invasive techniques. Needlescopic cholecystectomy was associated with the lowest rates of wound infection (surface under the cumulative ranking curve value = 0.977) with an odds ratio of 0.095 (95% confidence interval: 0.023-0.39), 0.32 (95% confidence interval: 0.11-0.98), 0.33 (95% confidence interval: 0.11-0.99), 0.36 (95% confidence interval: 0.14-0.98) compared to open cholecystectomy, single-incision laparoscopic cholecystectomy, mini-laparotomy, and standard laparoscopic cholecystectomy, respectively. Mini-laparotomy was associated with the shortest operative time (surface under the cumulative ranking curve value = 0.981) by a mean difference of 22.20 (95% confidence interval: 13.79-30.62), 12.17 (95% confidence interval: 1.80-22.54), 9.07 (95% confidence interval: 1.59-16.54), and 8.36 (95% confidence interval: -1.79 to 18.52) minutes when compared to single-incision laparoscopic cholecystectomy, needlescopic cholecystectomy, standard laparoscopic cholecystectomy, and open cholecystectomy, respectively. Needlescopic cholecystectomy appeared to be associated with the shortest hospitalization (surface under the cumulative ranking curve value = 0.717) and lowest postoperative pain (surface under the cumulative ranking curve value = 0.928). CONCLUSION Perioperative outcomes differed across minimally invasive techniques and, in some instances, afforded superior outcomes compared to standard laparoscopic cholecystectomy. These findings suggest that there may be equipoise for exploring further the utility of novel minimally invasive techniques and potentially incorporating them into the general surgery training curriculum.
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Affiliation(s)
- Joseph J Zhao
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Cheryl Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Julia Yu Xin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ashton Yap
- Townsville Hospital, Queensland, Australia
| | - Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Hepatopancreatobiliary Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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Coletta D, Mascioli F, Balla A, Guerra F, Ossola P. Minilaparoscopic Cholecystectomy Versus Conventional Laparoscopic Cholecystectomy: An Endless Debate. J Laparoendosc Adv Surg Tech A 2021; 31:648-656. [PMID: 32833590 DOI: 10.1089/lap.2020.0416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Our systematic review and meta-analysis examine the impact of minilaparoscopic cholecystectomy (MLC) versus conventional laparoscopic cholecystectomy (CLC). Some authors previously compared these surgical approaches without reaching any clear conclusion, since then, further trials have been performed, but an update was needed. Materials and Methods: PubMed, EMBASE, and the CENTRAL were systematically searched for randomized controlled trials comparing MLC versus CLC up to August 2019. The outcome measures used for comparison were operative time (OT), overall morbidity, intra- and postoperative complications, conversion and reintervention rate, length of hospital stay (LOS), postoperative pain (POP), and cosmetic results. A meta-analysis of relevant studies was performed using RevMan 5.3. Results: Fifteen studies, including 863 patients, were considered eligible to collect data and entered the meta-analysis. A total of 415 patients in the MLC group versus 448 in the CLC group were compared. No statistical difference as for overall morbidity, intra- and postoperative complications, conversion and reintervention rate, LOS, and cosmetic results were retrieved among the groups. CLC results faster and MLC shows to be the least painful. Conclusions: According to the available high-level evidence, both surgical approaches resulted substantially equivalent to perform LC, with some advantages of CLC as for OT and of MLC concerning POP. As a consequence, we can conclude that either procedure is superior or inferior to the other one; actually, we are not able to suggest the adoption of any of the two on a routine basis.
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Affiliation(s)
- Diego Coletta
- Emergency Department-Emergency and Trauma Surgery Unit, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
- Hepatopancreatobiliary Surgery, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Mascioli
- Department of General Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Balla
- Department of General Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
| | - Francesco Guerra
- Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Paolo Ossola
- Department of General Surgery, Umberto I University Hospital, Sapienza University of Rome, Rome, Italy
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Single-Port Laparoscopic Surgery Is Feasible and Safe for Hepatic Left Lateral Sectionectomy for Benign Liver Lesions. Gastroenterol Res Pract 2019; 2019:1570796. [PMID: 31354806 PMCID: PMC6636576 DOI: 10.1155/2019/1570796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 04/02/2019] [Indexed: 01/18/2023] Open
Abstract
Background and Objectives The feasibility and safety of single-port laparoscopic surgery for left lateral liver lobectomy are largely unknown. This study is aimed at comparing the effectiveness and safety between single-port laparoscopic (SPL) and conventional multiport laparoscopic (CL) surgeries for hepatic left lateral sectionectomy. Methods A total of 65 patients receiving laparoscopic hepatic left lateral sectionectomy between January 2008 and July 2015 were included and divided into the SPL group (n = 40) and the CL group (n = 25). Results There was no significant difference in the operative time, estimated intraoperative blood loss, length of hospital stay, and incidences of postoperative complications (biliary leakage, hemorrhage, and contusion at incision) between groups (all P > 0.05). However, the SPL group had a significantly lower VAS pain score (at 24 h but not 7 days postoperation) and higher cosmetic satisfaction scores (at both 2 months and 6 months postoperation) than the CL group (all P < 0.01). Moreover, multivariate linear regression analysis further confirmed the superior pain score and cosmetic outcome in the SPL group. Conclusions Single-port laparoscopic hepatic left lateral sectionectomy is a safe and feasible treatment for patients with lesions in the left hepatic lobe. Patients with benign lesions in the left hepatic lobe are more suitable to receive single-port laparoscopic hepatic left lateral sectionectomy than those with malignancies.
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Tsamalaidze L, Permenter SL, Stauffer JA. Subcostal Trocar Approach Using Four 5-mm with Exclusive Removal (STAUFFER): An Efficient and Useful Technique for Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2018; 28:311-319. [DOI: 10.1089/lap.2017.0554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
| | - Samantha L. Permenter
- Mayo Clinic School of Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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Umemura A, Suto T, Nakamura S, Fujiwara H, Endo F, Nitta H, Takahara T, Sasaki A. Comparison of Single-Incision Laparoscopic Cholecystectomy versus Needlescopic Cholecystectomy: A Single Institutional Randomized Clinical Trial. Dig Surg 2018; 36:53-58. [PMID: 29393173 DOI: 10.1159/000486455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Both single-incision laparoscopic cholecystectomy (SILC) and needlescopic cholecystectomy (NSC) are superior to conventional laparoscopic cholecystectomy in terms of cosmetic outcome and incisional pain. We conducted a prospective, randomized clinical trial to evaluate the surgical outcome, postoperative pain, and cosmetic outcome for SILC and NSC procedures. METHODS In this trial, 105 patients were enrolled (52 in the SILC group; 53 in the NSC group). A visual analogue scale (VAS) was used to evaluate the cosmetic outcome and incisional pain for patients. Logistic regression analyses were used to evaluate the operative difficulty that was present for both procedures. RESULTS There were no significant differences in patient characteristics or surgical outcomes, including operative time and blood loss. The mean VAS scores for cosmetic satisfaction were similar in both groups. There were significant differences in the mean VAS scores for incisional pain on postoperative day 1 (p = 0.009), and analgesics were required within 12 h of surgery (p = 0.007). Obesity (body mass index ≥25 kg/m2) was the only significant influential factor for operating time over 100 min (p = 0.031). CONCLUSION NSC is superior to SILC in terms of short-term incisional pain. Experienced laparoscopic surgeons can perform both SILC and NSC without an increase in operative time.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, .,Department of Surgery, Morioka Municipal Hospital, Morioka,
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Seika Nakamura
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | | | - Fumitaka Endo
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | | | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
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Rosales-Velderrain A, Alkhoury F. Single-Port Robotic Cholecystectomy in Pediatric Patients: Single Institution Experience. J Laparoendosc Adv Surg Tech A 2017; 27:434-437. [DOI: 10.1089/lap.2016.0484] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
| | - Fuad Alkhoury
- Department of Pediatric Surgery, Nicklaus Children's Hospital, Miami, Florida
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Lin CJ, Cheng CF, Chen HJ, Wu KY. Training Performance of Laparoscopic Surgery in Two- and Three-Dimensional Displays. Surg Innov 2017; 24:162-170. [PMID: 28190372 DOI: 10.1177/1553350617692638] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This research investigated differences in the effects of a state-of-art stereoscopic 3-dimensional (3D) display and a traditional 2-dimensional (2D) display in simulated laparoscopic surgery over a longer duration than in previous publications and studied the learning effects of the 2 display systems on novices. METHODS A randomized experiment with 2 factors, image dimensions and image sequence, was conducted to investigate differences in the mean movement time, the mean error frequency, NASA-TLX cognitive workload, and visual fatigue in pegboard and circle-tracing tasks. RESULTS The stereoscopic 3D display had advantages in mean movement time ( P < .001 and P = .002) and mean error frequency ( P = .010 and P = .008) in both the tasks. There were no significant differences in the objective visual fatigue ( P = .729 and P = .422) and in the NASA-TLX ( P = .605 and P = .937) cognitive workload between the 3D and the 2D displays on both the tasks. For the learning effect, participants who used the stereoscopic 3D display first had shorter mean movement time in the 2D display environment on both the pegboard ( P = .011) and the circle-tracing ( P = .017) tasks. CONCLUSIONS The results of this research suggest that a stereoscopic system would not result in higher objective visual fatigue and cognitive workload than a 2D system, and it might reduce the performance time and increase the precision of surgical operations. In addition, learning efficiency of the stereoscopic system on the novices in this study demonstrated its value for training and education in laparoscopic surgery.
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Affiliation(s)
- Chiuhsiang Joe Lin
- 1 National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
| | - Chih-Feng Cheng
- 1 National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
| | - Hung-Jen Chen
- 1 National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
| | - Kuan-Ying Wu
- 1 National Taiwan University of Science and Technology, Taipei, Taiwan, ROC
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Shaikh HR, Abbas A, Aleem S, Lakhani MR. Is mini-laparoscopic cholecystectomy any better than the gold standard?: A comparative study. J Minim Access Surg 2017; 13:42-46. [PMID: 27251827 PMCID: PMC5206838 DOI: 10.4103/0972-9941.181368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: Mini-laparoscopic cholecystectomy (MLC) has widened the horizons of modern laparoscopic surgery. Standard four port laparoscopic cholecystectomy (SLC), which has long been established as the “Gold Standard” for gall bladder diseases, is under reconsideration following the advent of further minimally-invasive procedures including MLC. Our study aims to provide a comparison between MLC and SLC and assesses whether MLC has any added benefits. MATERIALS AND METHODS: Patients with symptomatic gall bladder disease undergoing MLC or SLC during the 2.5-month period were included in the study. Thirty-two patients underwent MLC while SLC was performed on 40 patients by the same surgeon. Data was collected prospectively and analysed retrospectively using a predesigned questionnaire. RESULTS: In our study, both the groups had similar age, body mass index (BMI) and gender distribution. No cases of MLC required insertion of additional ports. The mean operative time for MLC was 38.2 min (33-61 min), which is longer than SLC; but it was not statistically significant. There was no significant difference in mean operative blood loss, postoperative pain, analgesia requirement and mobilization. Patients who underwent MLC were able to return to normal activity earlier than patients undergoing SLC (P < 0.01). CONCLUSION: Our experience suggests that MLC can safely be used as an alternative to SLC. Compared to SLC, it has the added benefit of an early return to work along with excellent cosmetic results. Further large scale trials are required to prove any additional benefit of MLC.
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Affiliation(s)
- Haris R Shaikh
- Department of Surgery, Ziauddin University Hospital, Nazimabad, Karachi, Pakistan
| | - Asad Abbas
- Department of Surgery, Ziauddin University Hospital, Nazimabad, Karachi, Pakistan
| | - Salik Aleem
- Department of Surgery, Ziauddin University Hospital, Nazimabad, Karachi, Pakistan
| | - Miqdad R Lakhani
- Department of Surgery, Ziauddin University Hospital, Nazimabad, Karachi, Pakistan
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Peretti V, Chereau E, Lambaudie E, Greco F, Butarelli M, Jauffret C, Rua-Ribeiro S, Houvenaeghel G. [Single-port versus mini-laparoscopy in benign adnexal surgery: Results of a not randomized pilot study]. ACTA ACUST UNITED AC 2016; 44:620-628. [PMID: 27751747 DOI: 10.1016/j.gyobfe.2016.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/05/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Carry out a preliminary study comparing postoperative pain and intraoperative and postoperative complications between micro-laparoscopy and laparoscopic monotrocart non-oncological adnexal surgery. METHODS All patients should benefit from a benign adnexal surgery were included prospectively from February to May 2014. The insufflation pressure, infiltration of trocar holes with a local anesthetic, postoperative analgesics were prescribed standardized. Operative and postoperative complications, type and length of hospital stay as well as EVA and analgesic consumption were recorded. RESULTS Nine patients were included in monotrocart group versus 7 in the micro-laparoscopy group. There were no differences in operative and postoperative complications, the type and length of hospital stay, as well as cosmetics satisfaction. However, there was a significant difference in the VAS to D2 (2.15 vs. 4.08, P=0.04) and analgesic consumption at D0 (P=0.04), D1 (P=0.04), D2 (P=0.02) and D3 (P=0.01), for the benefit of micro-laparoscopy. DISCUSSION AND CONCLUSION Despite an enrollment of patients low, micro-laparoscopy appears to have a significant advantage over the monotrocart laparoscopy for postoperative pain in benign adnexal surgery.
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Affiliation(s)
- V Peretti
- Centre hospitalier de Salon-de-Provence, 207, avenue Julien-Fabre, 13300 Salon-de-Provence, France.
| | - E Chereau
- Hôpital Saint-Joseph, 26, boulevard Louvain, 13285 Marseille cedex 08, France
| | - E Lambaudie
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - F Greco
- CHU Nord, chemin des Bourrely, 13015 Marseille, France
| | - M Butarelli
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - C Jauffret
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - S Rua-Ribeiro
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - G Houvenaeghel
- Institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
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Impact of miniport laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy on recovery of physical activity: a randomized trial. Surg Endosc 2016; 31:2299-2309. [PMID: 27655375 DOI: 10.1007/s00464-016-5232-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 08/30/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION We conducted a randomized trial comparing minilaparoscopic cholecystectomy (MLC) to conventional laparoscopic cholecystectomy (CLC) to determine whether MLC accelerated recovery of physical activity after elective surgery (NCT01397565). METHODS A total of 115 patients scheduled for elective cholecystectomy were randomized to either CLC or MLC. Both procedures used a 10-mm umbilical port, but the three upper abdominal ports were 5 mm in CLC and 3 mm in MLC. Primary outcome was self-reported physical activity 1 month after surgery as estimated by Community Health Activities Model Program for Seniors questionnaire (kcal/kg/week). Secondary outcomes were umbilical pain, abdominal pain, nausea and fatigue (VAS, 1-10), and cosmetic result at one and 3 months. Patients received identical surgical dressings for 1 week, and assessors were blinded to group allocation. RESULTS Forty-two patients randomized to CLC group and 33 patients randomized to MLC remained in the trial and were analyzed. Both groups were similar at baseline characteristics. In the MLC group, at least one 5-mm port was used in 17 (51.5 %) mainly due to unavailability of ML equipment. Median (IQR) physical activity for the CLC and MLC groups was similar at baseline (23.4 [13.1, 44.6] vs 23.6 [14.2, 66.9] kcal/kg/week, p = 0.35) and at 1 month (20 [7.9, 52.5] vs 16.8 [11.8, 28.6] kcal/kg/week, p = 0.90). One month post-op, umbilical pain and abdominal pain were similar, but the CLC group reported higher fatigue (4 [1-5] vs 1 [0-4], p = 0.05) and worse scar appearance scores (4 [3, 4] vs 4.5 [4, 5], p = 0.009). At 3 months, the CLC group had worse scar appearance (4 [3-5] vs 5 [4-5], p = 0.02) and lower scar satisfaction scores (4 [3, 4] vs 4 [3.5-4], p = 0.04). CONCLUSION Recovery of physical activity was similar after MLC and CLC. MLC resulted in less fatigue and better scar appearance and satisfaction. These benefits were seen despite the need to upsize one or more ports in more than half of patients related to availability of the miniature instruments.
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Caron JP. Single incision mesh incisional hernioplasty in the horse: Significant clinical benefits? EQUINE VET EDUC 2016. [DOI: 10.1111/eve.12565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. P. Caron
- Department of Large Animal Clinical Sciences; College of Veterinary Medicine; Michigan State University; East Lansing USA
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16
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Bingener J, Skaran P, McConico A, Novotny P, Wettstein P, Sletten DM, Park M, Low P, Sloan J. A Double-Blinded Randomized Trial to Compare the Effectiveness of Minimally Invasive Procedures Using Patient-Reported Outcomes. J Am Coll Surg 2015; 221:111-21. [PMID: 26095558 DOI: 10.1016/j.jamcollsurg.2015.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Institute of Medicine has included the comparison of minimally invasive surgical techniques in its research agenda. This study seeks to evaluate a model for the comparison of minimally invasive procedures using patient-reported outcomes. STUDY DESIGN A double-blinded randomized controlled trial (NCT01489436) was conducted. Baseline data were obtained, standardized anesthesia was induced, and patients were randomized to single-port (SP) or 4-port (FP) laparoscopic cholecystectomy. Perioperative care was standardized. The outcomes were pain (Visual Analog Scale) on postoperative day 1 (primary) and quality of life (Patient-Reported Outcomes Measures Information System and Linear Analog Self-Assessment), serum cytokines, and heart rate variability (secondary). Analysis was intention to treat. Using identical occlusive dressings, patients and the outcomes assessor remained blinded until postoperative day 2. RESULTS Fifty-five patients were randomized to each arm. There was no difference in demographics. Visual Analog Scale pain score on postoperative day 1 was significantly different from baseline in each group (SP: 1.6 ± 1.9 to 4.2 ± 2.4 vs FP: 1.8 ± 2.3 to 4.2 ± 2.2), but not different from each other (p = 0.83). Patients in the FP arm reported significantly less fatigue on postoperative day 7 than patients in the SP group (3.1 ± 2.1 vs 4.2 ± 2.2; p = 0.009). Fewer patients in the FP group required postoperative oral narcotics before discharge (40% vs 60%; p = 0.056). Cytokines levels and heart rate variability were similar between arms. In patients followed for >1 year, no difference in umbilical hernia rates was noted. CONCLUSIONS Early postoperative quality of life data captured differences in fatigue, indicating improved recovery after FP within a controlled trial. Physiologic measures were similar, suggesting that the differences between SP and FP are minimal.
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Affiliation(s)
| | - Pam Skaran
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Paul Novotny
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Peter Wettstein
- Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | | | - Myung Park
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Philip Low
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Jeff Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Andrási L, Ábrahám S, Lázár G. [Mini-laparoscopic cholecystectomy as an innovative method in minimally invasive abdominal surgery]. Magy Seb 2014; 67:334-339. [PMID: 25500640 DOI: 10.1556/maseb.67.2014.6.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
INTRODUCTION In our study, we applied a mini-laparosopic approach during laparoscopic cholecystectomy (LC) (using the minimum size of trocars with the simultaneous intention to reduce their number). The advantages and disadvantages of the mini-LC approach were compared with those of traditional LC. PATIENTS AND METHODS During mini-LC procedures, we used 3 ports (11 mm, 5 mm, 3.5 mm). Mini-LC was performed in 10 patients, and the results were compared with those of 10 cases of traditional LCs. The two groups were homogenous in terms of gender, age, BMI and ASA classification. Comparison criteria included operative time, the need to use an extra port, conversion rate, oral analgesic requirement, early/late complications and cosmetic results. RESULTS There were no significant differences in terms of operative time, blood loss, hospital stay and complications. Cumulative size of incisions was 19.5 mm with mini-LC- and 41 mm in the LC group, respectively, and the tissue injury was 124.2 mm(2) and 448.2 mm(2). Cosmetic results of mini-LC were highly improved by these values. Increased oral analgetic requirements were detected in LC group. CONCLUSION Mini-LC is a safe procedure with outstanding cosmetic results accompanied by less oral analgetic requirements. In selected patients, it can be recommended as an alternative method of traditional LC.
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Affiliation(s)
- László Andrási
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika 6720 Szeged Szőkefalvi-Nagy Béla u. 6
| | - Szabolcs Ábrahám
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika 6720 Szeged Szőkefalvi-Nagy Béla u. 6
| | - György Lázár
- Szegedi Tudományegyetem, Általános Orvostudományi Kar Sebészeti Klinika 6720 Szeged Szőkefalvi-Nagy Béla u. 6
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Sreenivas S, Mohil RS, Singh GJ, Arora JK, Kandwal V, Chouhan J. Two-port mini laparoscopic cholecystectomy compared to standard four-port laparoscopic cholecystectomy. J Minim Access Surg 2014; 10:190-6. [PMID: 25336819 PMCID: PMC4204262 DOI: 10.4103/0972-9941.141517] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/10/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION: Two-port mini laparoscopic cholecystectomy (LC) has been proposed as a safe and feasible technique. However, there are limited studies to evaluate the effectiveness of the procedure. This study is a prospective randomised trial to compare the standard four-port LC with two-port mini LC. MATERIALS AND METHODS: A total of 116 consecutive patients undergoing LC were randomised to four-port/two-port mini LC. In two-port mini LC, a 10-mm umbilical and a 5-mm epigastric port were used. Outcomes measured were duration and difficulty of operation, post-operative pain, analgesia requirements, post-operative stay, complications and cosmetic score at 30 days. RESULTS: Out of 116 patients, the ratio of M:F was 11:92, with mean age 40.79 ± 12.6 years. Twelve patients (nine in four-port group and three in two-port group) were lost to follow-up. The mean operative time were similar (P = 0.727). Post-operative pain was significantly low in the two-port group at up to 24 hrs (P = 0.023). The overall analgesia requirements (P = 0.003) and return to daily activity (P = 0.00) were significantly lower in two-port group. The cosmesis score of the two-port group was better than four-port group (P = 0.00). However, the length of hospital stay (P = 0.760) and complications (P = 0.247) were similar between the two groups. CONCLUSION: Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared to that in four-port LC. Thus, it can be recommended in selected patients.
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Affiliation(s)
- S Sreenivas
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Ravindra Singh Mohil
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Gulshan Jit Singh
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Jainendra K Arora
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Vipul Kandwal
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
| | - Jitendra Chouhan
- Department of Surgery, V. M. Medical College and Safdarjang Hospital, New Delhi, India
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Milsom JW, Trencheva K, Ezell P, Maggiori L, Pavoor R, Vitellaro M, Zhuo C, Makino T, Lee SW, Shukla PJ. Feasibility and Safety of Laparoscopic Colon Surgery Performed Under Intravenous Sedation and Local Anesthesia Using Microinvasive (<3 mm) Instruments: An Acute and Survival Study on Porcine Model. Surg Innov 2014; 22:131-6. [PMID: 24902688 DOI: 10.1177/1553350614535854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of the study was to evaluate the feasibility and safety of performing laparoscopic intestinal surgery using local anesthesia and intravenous sedation with instruments <3 mm in diameter. METHODS Porcine model with acute (n = 2) and the survival studies (n = 8): all female pigs, weight (median 36.4 kg, range 33.2-38.4 kg). Surgeries were performed using only intravenous sedation with ketamine-midazolam and local anesthetic infiltration at the sites of trocar insertion, with airway protection. CO2 pneumoperitoneum was maintained using pressure of 3 to 5 mm Hg. Commercially available instruments, sizes <3 mm in diameter were used. Surgical steps were as follows: (a) exploration of all quadrants of the abdomen and pelvis, (b) "running" the entire length of small bowel, (c) dissection of bowel attachments to the peritoneal sidewall, and (d) creating a 2.5 cm enterotomy in the colon and suture repair of this defect. RESULTS All 10 surgeries were completed successfully. Animals tolerated the procedure well, with no requirement of intubation. There were no decrements in vital signs during pneumoperitoneum or surgery. Despite spontaneous respiration movements, all planned surgical maneuvers were feasible. The median length of operations was 74 minutes (range 56-165 minutes). All survival animals had an uneventful recovery; there were no infectious complications, oral intake and bowel function returned within 24 hours. CONCLUSIONS It appears feasible and safe to perform simple laparoscopic intestinal procedures using instruments <3 mm in diameter and low CO2 insufflation pressure under local anesthesia and intravenous sedation. This methodology holds promise in the development of new approaches to intestinal surgery and disease diagnosis.
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Affiliation(s)
| | | | - Paula Ezell
- Medical University of South Carolina, Charleston, SC, USA
| | | | | | | | - Changhua Zhuo
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | - Sang W Lee
- Weill Cornell Medical College, New York, NY, USA
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Li L, Tian J, Tian H, Sun R, Wang Q, Yang K. The efficacy and safety of different kinds of laparoscopic cholecystectomy: a network meta analysis of 43 randomized controlled trials. PLoS One 2014; 9:e90313. [PMID: 24587319 PMCID: PMC3938681 DOI: 10.1371/journal.pone.0090313] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE We conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]). METHODS PubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC. RESULTS We included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC. CONCLUSION The rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.
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Affiliation(s)
- Lun Li
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hongliang Tian
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Rao Sun
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Quan Wang
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Gurusamy KS, Vaughan J, Ramamoorthy R, Fusai G, Davidson BR. Miniports versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2013; 2013:CD006804. [PMID: 23908012 PMCID: PMC11747961 DOI: 10.1002/14651858.cd006804.pub3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND In conventional (standard) port laparoscopic cholecystectomy, four abdominal ports (two of 10 mm diameter and two of 5 mm diameter) are used. Recently, use of smaller ports, miniports, have been reported. OBJECTIVES To assess the benefits and harms of miniport (defined as ports smaller than the standard ports) laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013 to identify randomised clinical trials of relevance to this review. SELECTION CRITERIA Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing miniport versus standard port laparoscopic cholecystectomy were considered for the review. DATA COLLECTION AND ANALYSIS Two review authors collected the data independently. We analysed the data with both fixed-effect and random-effects models using RevMan analysis. For each outcome we calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI). MAIN RESULTS We included 12 trials with 734 patients randomised to miniport laparoscopic cholecystectomy (380 patients) versus standard laparoscopic cholecystectomy (351 patients). Only one trial which included 70 patients was of low risk of bias. Miniport laparoscopic cholecystectomy could be completed successfully in more than 80% of patients in most trials. The remaining patients were mostly converted to standard port laparoscopic cholecystectomy but some were also converted to open cholecystectomy. These patients were included for the outcome conversion to open cholecystectomy but excluded from other outcomes. Accordingly, the results of the other outcomes are on 343 patients in the miniport laparoscopic cholecystectomy group and 351 patients in the standard port laparoscopic cholecystectomy group, and therefore the results have to be interpreted with extreme caution.There was no mortality in the seven trials that reported mortality (0/194 patients in miniport laparoscopic cholecystectomy versus 0/203 patients in standard port laparoscopic cholecystectomy). There were no significant differences between miniport laparoscopic cholecystectomy and standard laparoscopic cholecystectomy in the proportion of patients who developed serious adverse events (eight trials; 460 patients; RR 0.33; 95% CI 0.04 to 3.08) (miniport laparoscopic cholecystectomy: 1/226 (adjusted proportion 0.4%) versus standard laparoscopic cholecystectomy: 3/234 (1.3%); quality of life at 10 days after surgery (one trial; 70 patients; SMD -0.20; 95% CI -0.68 to 0.27); or in whom the laparoscopic operation had to be converted to open cholecystectomy (11 trials; 670 patients; RR 1.23; 95% CI 0.44 to 3.45) (miniport laparoscopic cholecystectomy: 8/351 (adjusted proportion 2.3%) versus standard laparoscopic cholecystectomy 6/319 (1.9%)). Miniport laparoscopic cholecystectomy took five minutes longer to complete than standard laparoscopic cholecystectomy (12 trials; 695 patients; MD 4.91 minutes; 95% CI 2.38 to 7.44). There were no significant differences between miniport laparoscopic cholecystectomy and standard laparoscopic cholecystectomy in the length of hospital stay (six trials; 351 patients; MD -0.00 days; 95% CI -0.12 to 0.11); the time taken to return to activity (one trial; 52 patients; MD 0.00 days; 95% CI -0.31 to 0.31); or in the time taken for the patient to return to work (two trials; 187 patients; MD 0.28 days; 95% CI -0.44 to 0.99) between the groups. There was no significant difference in the cosmesis scores at six months to 12 months after surgery between the two groups (two trials; 152 patients; SMD 0.13; 95% CI -0.19 to 0.46). AUTHORS' CONCLUSIONS Miniport laparoscopic cholecystectomy can be completed successfully in more than 80% of patients. There appears to be no advantage of miniport laparoscopic cholecystectomy in terms of decreasing mortality, morbidity, hospital stay, return to activity, return to work, or improving cosmesis. On the other hand, there is a modest increase in operating time after miniport laparoscopic cholecystectomy compared with standard port laparoscopic cholecystectomy and the safety of miniport laparoscopic cholecystectomy is yet to be established. Miniport laparoscopic cholecystectomy cannot be recommended routinely outside well-designed randomised clinical trials. Further trials of low risks of bias and low risks of random errors are necessary.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free Hospital,Rowland Hill StreetLondonUKNW3 2PF
| | - Jessica Vaughan
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free Hospital,Rowland Hill StreetLondonUKNW3 2PF
| | - Rajarajan Ramamoorthy
- Royal Free Hospital and University College School of MedicineUniversity Department of Surgery9th Floor, Royal Free HospitalPond StreetLondonUKNW3 2QG
| | - Giuseppe Fusai
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free Hospital,Rowland Hill StreetLondonUKNW3 2PF
| | - Brian R Davidson
- Royal Free Campus, UCL Medical SchoolDepartment of SurgeryRoyal Free Hospital,Rowland Hill StreetLondonUKNW3 2PF
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Cheng Y, Jiang ZS, Xu XP, Zhang Z, Xu TC, Zhou CJ, Qin JS, He GL, Gao Y, Pan MX. Laparoendoscopic single-site cholecystectomy vs three-port laparoscopic cholecystectomy: A large-scale retrospective study. World J Gastroenterol 2013; 19:4209-4213. [PMID: 23864785 PMCID: PMC3710424 DOI: 10.3748/wjg.v19.i26.4209] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 05/08/2013] [Accepted: 05/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To perform a large-scale retrospective comparison of laparoendoscopic single-site cholecystectomy (LESSC) and three-port laparoscopic cholecystectomy (TPLC) in a single institution.
METHODS: Data were collected from 366 patients undergoing LESSC between January 2005 and July 2008 and were compared with the data from 355 patients undergoing TPLC between August 2008 and November 2011 in our department. Patients with body mass index greater than 35 kg/m2, a history of major upper abdominal surgery, signs of acute cholecystitis, such as fever, right upper quadrant tenderness with or without Murphy’s sign, elevated white blood cell count, imaging findings suggestive of pericholecystic fluid, gallbladder wall thickening > 4 mm, and gallstones > 3 cm, were excluded to avoid bias.
RESULTS: Altogether, 298 LESSC and 315 TPLC patients met the inclusion criteria. The groups were well matched with regard to demographic data. There were no significant differences in terms of postoperative complications (contusion: 19 vs 25 and hematoma at incision: 11 vs 19), hospital stay (mean ± SD, 1.4 ± 0.2 d vs 1.4 ± 0.7 d) and visual analogue pain score (mean ± SD, 8 h after surgery: 2.3 ± 1.4 vs 2.3 ± 1.3 and at day 1: 1.2 ± 0.4 vs 1.3 ± 1.2) between the LESSC and TPLC patients. Four patients required the addition of extra ports and 2 patients were converted to open surgery in the LESSC group, which was not significantly different when compared with TPLC patients converted to laparotomy (2 vs 2). LESSC resulted in a longer operating time (mean ± SD, 54.8 ± 11.0 min vs 33.5 ± 9.0 min), a higher incidence of intraoperative gallbladder perforation (56 vs 6) and higher operating cost (mean ± SD, 1933.7 ± 64.4 USD vs 1874.7 ± 46.2 USD) than TPLC. No significant differences in operating time (mean ± SD, 34.3 ± 6.0 min vs 32.7 ± 8.7 min) and total cost (mean ± SD, 1881.3 ± 32.8 USD vs 1876.2 ± 33.4 USD) were found when the last 100 cases in the two groups were compared. A correlation was observed between reduced operating time of LESSC and increased experience (Spearman rank correlation coefficient, -0.28). More patients in the LESSC group expressed satisfaction with the cosmetic result (98% vs 85%).
CONCLUSION: LESSC is a safe and feasible procedure in selected patients with benign gallbladder diseases, with the significant advantage of cosmesis.
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A prospective, randomized, single-blind trial of 5-mm versus 3-mm ports for laparoscopic cholecystectomy: is smaller better? Surg Endosc 2013; 27:3616-21. [PMID: 23588709 DOI: 10.1007/s00464-013-2933-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) is said to provide improved cosmesis with a reduction in postoperative pain, but SILC involves a change in operative technique. A single-blind, randomized controlled trial compared cosmetic outcomes and postoperative pain between 3- and 5-mm ports used for laparoscopic cholecystectomy (LC). METHODS For this study, 80 patients with symptomatic gallstones were recruited from a single center and randomized to a LC using either a 5-mm port and three 3-mm ports (group A) or a 10-mm port and three 5-mm ports (group B). Operative details; pain scores at 1 h, 6 h, and 1 week; and analgesia required during the first week were collected. Cosmetic outcome was assessed at 6 months using a validated questionnaire. RESULTS For each group, 40 patients were recruited. The two groups were well matched except for sex. Group A had 11 males, and Group B had 4 males. The mean operative time was 49 ± 12 min (range, 24-120 min) in the 3-mm group versus 46 ± 19 min (range, 21-124 min) in the control group (p = 0.40). The two groups did not differ statistically in the day case rate. The pain scores in Group A were 2.5 ± 2.1 at 1 h, 3.2 ± 2.2 at 6 h, and 0.8 ± 2.2 at 1 week versus 4.2 ± 2.9 at 1 h, 3.3 ± 2.4 at 6 h, and 2.1 ± 2.4 at 1 week in Group B (p = 0.003, 0.63, and 0.002, respectively). No difference in the analgesia consumption was observed during the first postoperative week. The patients in Group A had significantly better cosmetic outcome scores at 6 months. CONCLUSION The use of 3-mm ports is technically feasible in patients undergoing LC for gallstones. The operating times are comparable with those for conventional LC, whereas the pain scores are reduced, and the cosmetic outcome is better.
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de Carvalho LFA, Fierens K, Kint M. Mini-Laparoscopic Versus Conventional Laparoscopic Cholecystectomy: A Randomized Controlled Trial. J Laparoendosc Adv Surg Tech A 2013; 23:109-16. [DOI: 10.1089/lap.2012.0349] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Kjell Fierens
- Department of General Surgery, Sint-Lucas Hospital, Ghent, Belgium
| | - Marc Kint
- Department of General Surgery, Sint-Lucas Hospital, Ghent, Belgium
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Zhong X, Rui YY, Zhou ZG. Laparoendoscopic single-site versus traditional laparoscopic surgery in patients with cholecystectomy: a meta-analysis. J Laparoendosc Adv Surg Tech A 2012; 22:449-55. [PMID: 22670637 DOI: 10.1089/lap.2011.0521] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To evaluate the primary outcomes of traditional laparoscopic cholecystectomy (TLC) compared with laparoendoscopic single-site cholecystectomy (LESSC). SUBJECTS AND METHODS Randomized controlled trials (RCTs) comparing TLC with LESSC were included by a systematic literature research. The inclusion and extraction of the data were completed by two authors independently. Meta-analysis was performed using Review Manager version 5.1.4 software. The clinical outcomes were evaluated by odds ratio (OR) and standard mean difference (SMD) according to the different types of data. Sensitivity and heterogeneity analyses were used to account for rationality of pooling data and sources of heterogeneity. RESULTS Seven RCTs involving 611 patients met the predefined inclusion criteria. The cosmetic score of the LESSC group was significantly higher at 1 week (SMD = 0.48; 95% confidence intervals [CI] 0.24, 0.73; P = .0001), 2 weeks (SMD = 0.87; 95% CI 0.61, 1.13; P < .00001), and 1 month (SMD = 0.88; 95% CI 0.62, 1.44; P<.00001) postoperatively. However, LESSC showed a lesser physical quality of life (PQOL) score at 3 days (SMD = -0.28; 95% CI -0.52, -0.44; P = .02), 1 week (SMD = -0.31; 95% CI -0.55, 0.06; P = .01), and 2 weeks (SMD = -0.30; 95% CI -0.55, -0.05; P = .02) postoperatively. There was no significant difference between the two groups in operating time, perioperative complication, intraoperative blood loss, postoperative hospital stay, Visual Analog Scale pain score, and PQOL on 1 day, 5 days, and 1 month postoperatively. CONCLUSION LESSC is associated with a higher cosmetic score and a lesser short-term PQOL score compared with TLC.
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Affiliation(s)
- Xi Zhong
- Department of Gastrointestinal Surgery and Institute of Digestive Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Fiori C, Morra I, Bertolo R, Mele F, Chiarissi ML, Porpiglia F. Standard vs mini-laparoscopic pyeloplasty: perioperative outcomes and cosmetic results. BJU Int 2012; 111:E121-6. [DOI: 10.1111/j.1464-410x.2012.11376.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Does single-port access (SPA) laparoscopy mean reduced pain? A retrospective cohort analysis between SPA and conventional laparoscopy. Eur J Obstet Gynecol Reprod Biol 2012; 162:71-4. [DOI: 10.1016/j.ejogrb.2012.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 12/01/2011] [Accepted: 01/12/2012] [Indexed: 11/20/2022]
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Tagaya N, Abe A, Kubota K. Needlescopic surgery for liver, gallbladder and spleen diseases. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2011; 18:516-24. [PMID: 21584706 DOI: 10.1007/s00534-011-0398-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We propose that needlescopic surgery (NS) should be considered as a way of improving the esthetic result and post-operative quality of life of patients and of reducing costs and stress on surgeons, and we have evaluated the results of NS. METHODS We used NS in 157 patients between May 1998 and December 2010: cholecystectomy in 150 patients, marsupialization of splenic and hepatic cysts in 4 and splenectomy in 3, respectively. Under general anesthesia, one 12-mm and two or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved from the 12-mm wound using a plastic bag. RESULTS The procedures were successfully completed in all patients without conversion to an open procedure. In eight (5.3%) of 150 cholecystectomies a change to 5-mm instruments was required. The mean operation times and postoperative hospital stays for cholecystectomy, splenectomy, and marsupialization of splenic and hepatic cysts were 80.2 min and 3.2 days, 167 min and 5.6 days, 170 min and 7 days, and 120 min and 7 days, respectively. There were a few perioperative complications. The most important factor for reducing operation time and achieving a low conversion rate is the use of at least one 3- or 5-mm port for the grasping instruments in cholecystectomy. We recognized a residual cyst requiring splenectomy 62 months after marsupialization in one case. Technical points for performing safe procedures on solid organs were: no direct organ mobilization to avoid organ injuries, the rotation of the operating table and the utilization of organ gravity to create a better operative field, the minimum use of the needlescope to perform a safe maneuver and the improvement of bi-manual technique. CONCLUSIONS NS is a safe and feasible procedure for achieving minimal invasive surgery. We should consider NS as a first choice to treat operable diseases in this laparoscopic era.
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Affiliation(s)
- Nobumi Tagaya
- Second Department of Surgery, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
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Agresta F, Bedin N. Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons' last five years experience over 932 cases. Updates Surg 2011; 64:31-6. [PMID: 22076602 DOI: 10.1007/s13304-011-0123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Accepted: 11/05/2011] [Indexed: 11/26/2022]
Abstract
Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth-5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.
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Tagaya N, Kubota K. Reevaluation of needlescopic surgery. Surg Endosc 2011; 26:137-43. [PMID: 21789640 DOI: 10.1007/s00464-011-1839-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 06/22/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the use of single-incision laparoscopic surgery (SILS) has spread rapidly, most procedures employ additional needlescopic instruments to ensure safety and shorten the operation time. Therefore, on the basis of results obtained in our department, the present study was conducted to reevaluate the current state of needlescopic surgery (NS) to improve the cosmetic results and postoperative quality of life of patients and to reduce cost and degree of stress on surgeons. METHODS Between May 1998 and February 2011, we performed NS in 202 patients. The diagnoses included gallbladder diseases in 151 patients, spontaneous pneumothorax in 11, thyroid tumor and axillary lymph node metastases in 10 patients each, splenic cyst and appendicitis in 4 patients each, idiopathic thrombocytopenic purpura and postoperative abdominal wall hernia in 3 patients each, primary aldosteronism and hepatic cyst in 2 patients each, and adhesional bowel obstruction and gastric stromal tumor in 1 patient each. Under general anesthesia, one 12-mm and tow or three 2- or 3-mm ports were introduced into the operative field. The specimen was retrieved via the 12-mm wound using a plastic bag. RESULTS The operations were completed in all patients without the need to convert to an open procedure. In 8 (5.3%) of the 151 cholecystectomies, a change to 5-mm instruments was required. There were no perioperative complications. Pertinent technical points included avoidance of direct organ mobilization to minimize injury, rotation of the operating table and utilization of organ gravity to create a better operative field, minimum use of needlescope to ensure safe maneuvering, and improvement of the bi-hand technique. CONCLUSIONS NS is a safe and feasible procedure that allows experienced surgeons to achieve minimally invasive surgery with low morbidity, without the need to convert to a conventional or open procedure.
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Affiliation(s)
- Nobumi Tagaya
- First Department of Surgery, Dokkyo Medical University Koshigaya Hospital, 2-1-50 Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan.
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Minilaparoscopic versus conventional laparoscopic cholecystectomy a systematic review and meta-analysis. Ann Surg 2011; 253:244-58. [PMID: 21183848 DOI: 10.1097/sla.0b013e318207bf52] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This review broadly examines the impact of minilaparoscopic versus conventional laparoscopic cholecystectomy. The primary outcome was failure of surgical technique. The secondary outcomes were to examine adverse events, cosmesis, length of time to return to activity, quality of life, and length of operation. METHODS Five databases, 2 conference proceedings, reference lists of retrieved articles, and a Web-based trial registry were searched to identify eligible studies. Experts in the field of laparoscopic surgery were also contacted to provide information for the review.This systematic review and meta-analysis were conducted in accordance with the QUORUM guidelines. RESULTS Eighteen studies met eligibility criteria. Methodologic quality was unclear in most trials. Patients having a minilaparoscopic technique had higher conversion rates than patients having a conventional laparoscopic technique [OR 2.25 (1.18-4.30)]. Although minilaparoscopic surgeries were converted, more often there was not a trend toward increased conversion to an open technique. There was a trend toward fewer adverse events using a minilaparoscopic technique [0.57 (0.31-1.04)], however it was not significant. Cosmesis was improved in minilaparoscopic patients at 1 month [mean difference −0.74(−1.09 to −0.38)]. Patients receiving minilaparoscopic procedures returned to activity quicker [mean difference −0.74 (−1.23–0.25)]. CONCLUSIONS Further randomized trials are needed to determine whether minilaparoscopic techniques truly offer any advantages. Important patient outcomes such as failure of technique, adverse events, cosmesis, and quality of life should be emphasized to determine whether there is any benefit over conventional laparoscopic cholecystectomy.
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Redwan AA. Single-working-instrument, double-trocar, clipless cholecystectomy using harmonic scalpel: a feasible, safe, and less invasive technique. J Laparoendosc Adv Surg Tech A 2011; 20:597-603. [PMID: 20629516 DOI: 10.1089/lap.2009.0375] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIM The aim of this study was to evaluate the safety and efficacy of the Harmonic scalpel (Ethicon Endo-Surgery, Cincinnati, OH) in the closure/division of the cystic duct and artery, and bladder dissection in laparoscopic cholecystectomy as a single working instrument, with the use of a two-working-trocar technique, compared with the regular laparoscopic clip/cautery, three-trocar technique. METHODS This prospective study included 160 patients with symptomatic gallstone disease who were randomly assigned for laparoscopic cholecystectomy by either Harmonic shear as a single working instrument, with the two-trocar technique (group 1 = 80 patients) or group 2 (regular clip/cautery, three-trocar technique) comprising 80 patients. RESULTS No significant complications were encountered in either group; however, 1 case in the regular laparoscopy group suffered mild leakage that was treated conservatively. Intraoperative bile spillage was insignificantly comparable in both groups (10 versus 13%; P = 0.46). The median operative time was statistically significantly shorter in the Harmonic group (20 versus 45 minutes; P = 0.0001). Also, hospital stay was significantly shorter in the Harmonic group (1 versus 1.5 days, respectively; P = 0.001), but no statistically significant difference was found in the incidence of postoperative complications. The overall cosmetic results and patient satisfaction was better in the Harmonic group. CONCLUSIONS The Harmonic shear is as safe and effective as the clip/cautery technique in laparoscopic cholecystectomy in achieving hemobiliary stasis, with shorter operative time, especially if used solely as a working instrument. The two-trocar technique is safe, feasible, and provides better cosmetic results and patient satisfaction.
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Affiliation(s)
- Alaa A Redwan
- General Surgery Department, Assuit University Hospitals, Faculty of Medicine, Assuit University , Assuit, Egypt.
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Yim GW, Jung YW, Paek J, Lee SH, Kwon HY, Nam EJ, Kim S, Kim JH, Kim YT, Kim SW. Transumbilical single-port access versus conventional total laparoscopic hysterectomy: surgical outcomes. Am J Obstet Gynecol 2010; 203:26.e1-6. [PMID: 20417481 DOI: 10.1016/j.ajog.2010.02.026] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 11/03/2009] [Accepted: 02/10/2010] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The objective of the study was to compare surgical outcomes and postoperative pain between transumbilical single-port access total laparoscopic hysterectomy (SPA-TLH) and conventional 4-port total laparoscopic hysterectomy (TLH). STUDY DESIGN We retrospectively reviewed 157 patients who underwent SPA-TLH (n = 52) or conventional TLH (n = 105). A single-port access system consisted of a wound retractor, surgical glove, 2 5 mm trocars, and 1 10/11 mm trocar. RESULTS The SPA-TLH group had less intraoperative blood loss (P < .001), shorter hospital stay (P = .001), and earlier diet intake (P < .001) compared with the conventional TLH group. There was no difference in perioperative complications. Immediate postoperative pain score was lower in the SPA-TLH group (P < .001). Postoperative pain after 6 and 24 hours was lower in SPA-TLH with marginal statistical significance. CONCLUSION SPA-TLH is a feasible method for hysterectomy with lower immediate postoperative pain and better surgical outcomes with respect to recovery time compared with conventional TLH.
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Affiliation(s)
- Ga Won Yim
- Women's Cancer Clinic, Severance Hospital, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Seoul, Korea
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Sari V, Nieboer TE, Vierhout ME, Stegeman DF, Kluivers KB. The operation room as a hostile environment for surgeons: physical complaints during and after laparoscopy. MINIM INVASIV THER 2010; 19:105-9. [PMID: 20158410 DOI: 10.3109/13645701003643972] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Due to suboptimal ergonomic conditions during laparoscopic procedures, surgeons are exposed to physical strain on the upper extremity. The primary objective of this study was to assess the prevalence of physical complaints among laparoscopic surgeons and to assess the factors that influence these complaints. A questionnaire was distributed in a university hospital to all surgeons who perform laparoscopic procedures. Participants were asked to answer questions related to experience, physical complaints during or after laparoscopic procedures and the possible causes of their complaints. Fifty-five out of 92 (60%) surgeons completed the questionnaire. In this group, 40 surgeons (73%) reported physical complaints during or after laparoscopic procedures, mainly involving neck, lower back, shoulders and thumbs. Significantly more surgeons reported complaints in the dominant upper extremity compared to the non-dominant side. Poor table height adjustment, bad monitor positioning and suboptimal design of instrument handles were reported as important causes of complaints. Physical complaints of the dominant upper extremity are common among laparoscopic surgeons, especially less experienced surgeons. The dominant upper extremity appears to be more involved than the non-dominant side. More awareness and implementation of ergonomic guidelines is needed.
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Affiliation(s)
- Vicdan Sari
- Radboud University Nijmegen Medical Centre, Department of Obstetrics & Gynaecology, Nijmegen, the Netherlands
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Gurusamy KS, Samraj K, Ramamoorthy R, Farouk M, Fusai G, Davidson BR. Miniport versus standard ports for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2010:CD006804. [PMID: 20238350 DOI: 10.1002/14651858.cd006804.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND In conventional (standard) laparoscopic cholecystectomy, four abdominal ports (two of 10 mm diameter and two of 5 mm diameter) are used. Recently, use of smaller ports have been reported. OBJECTIVES To assess the benefits and harms of miniport (defined as ports smaller than conventional ports) laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy. SEARCH STRATEGY We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until September 2009 for identifying the randomised trials. SELECTION CRITERIA Only randomised clinical trials (irrespective of language, blinding, or publication status) comparing miniport versus standard ports laparoscopic cholecystectomy were considered for the review. DATA COLLECTION AND ANALYSIS Two authors collected the data independently. We analysed the data with both the fixed-effect and the random-effects models using RevMan Analysis. For each outcome we calculated the risk ratio (RR), mean difference (MD), or standardised mean difference (SMD) with 95% confidence intervals (CI). MAIN RESULTS We included thirteen trials with 803 patients randomised to miniport (n = 416) versus standard ports laparoscopic cholecystectomy (n = 387). In twelve trials, four ports were used. In one trial, three ports were used. The bias risk of all trials was high. Miniport laparoscopic cholecystectomy could be completed successfully in 87% of patients. The remaining patients were mostly converted to standard laparoscopic cholecystectomy but some were also converted to open cholecystectomy. Further information about these patients who underwent conversion to open cholecystectomy was not available in most trials. In the patients on whom information was available, there was no mortality reported; and there was no significant difference in the surgery-related morbidity or conversion to open cholecystectomy. Most trials excluded the patients who were converted to standard laparoscopic cholecystectomy. In patients who underwent successful miniport laparoscopic cholecystectomy, the pain was significantly lower in the miniport group than in the standard port at various time points. AUTHORS' CONCLUSIONS Miniport laparoscopic cholecystectomy can be completed successfully in more than 85% of patients. Patients, in whom elective miniport laparoscopic cholecystectomy was completed successfully, had lower pain than those who underwent standard laparoscopic cholecystectomy. However, because of the lack of information on its safety, miniport laparoscopic cholecystectomy cannot be recommended outside well-designed, randomised clinical trials.
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Affiliation(s)
- Kurinchi Selvan Gurusamy
- University Department of Surgery, Royal Free Hospital and University College School of Medicine, 9th Floor, Royal Free Hospital, Pond Street, London, UK, NW3 2QG
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Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 2010; 24:1842-8. [PMID: 20174950 DOI: 10.1007/s00464-010-0887-3] [Citation(s) in RCA: 264] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Accepted: 09/10/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The attempt to further reduce operative trauma in laparoscopic cholecystectomy has led to new techniques such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS). These new techniques are considered to be painless procedures, but no published studies investigate the possibility of different pain scores in these new techniques versus classic laparoscopic cholecystectomy. In this randomized control study, we investigated pain scores in SILS cholecystectomy versus classic laparoscopic cholecystectomy. PATIENTS AND METHODS Forty patients (34 women and 6 men) were randomly assigned to two groups. In group A (n = 20) four-port classic laparoscopic cholecystectomy was performed. Patients in group B (n = 20) underwent SILS cholecystectomy. In all patients, preincisional local infiltration of ropivacaine around the trocar wounds was performed. Infusion of ropivacaine solution in the right subdiaphragmatic area at the beginning of the procedure plus normal saline infusion in the same area at the end of the procedure was performed in all patients as well. Shoulder tip and abdominal pain were registered at 2, 6, 12, 24, 48, and 72 h postoperatively using visual analog scale (VAS). RESULTS Significantly lower pain scores were observed in the SILS group versus the classic laparoscopic cholecystectomy group after the first 12 h for abdominal pain, and after the first 6 h for shoulder pain. Total pain after the first 24 h was nonexistent in the SILS group. Also, requests for analgesics were significantly less in the SILS group, while no difference was observed in incidence of nausea and vomiting between the two groups. CONCLUSION SILS cholecystectomy, as well as the invisible scar, has significantly lower abdominal and shoulder pain scores, especially after the first 24 h postoperatively, when this pain is nonexistent. (Registration Clinical Trial number: NTC00872287, www.clinicaltrials.gov ).
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Sajid MS, Khan MA, Ray K, Cheek E, Baig MK. Needlescopic versus laparoscopic cholecystectomy: a meta-analysis. ANZ J Surg 2009; 79:437-42. [PMID: 19566866 DOI: 10.1111/j.1445-2197.2009.04945.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis. METHODS A systematic review of the literature was undertaken. Clinical trials on NC versus LC were selected according to specific criteria and analyzed to generate summative data expressed in standardized mean difference. RESULTS Sixteen trials on NC versus LC encompassing 1549 patients were retrieved from electronic databases. Only six randomized controlled trials on 317 patients qualified for the meta-analysis according to inclusion criteria. NC was associated with longer operative time and higher conversion rate as compared with LC. There was statistically significant heterogeneity among trials. Intraoperative complications, postoperative complications and total stay in hospital were not significantly different. NC was superior to LC in terms of less post-operative pain and better cosmetic outcomes. CONCLUSION NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post-operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate.
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Affiliation(s)
- Muhammad S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK.
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Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery. ACTA ACUST UNITED AC 2009; 16:633-8. [PMID: 19373428 DOI: 10.1007/s00534-009-0108-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 02/19/2009] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVE The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC. METHODS Five pigs were subjected to SPEC. An endoscope was inserted through a 12-mm port placed in the right upper abdomen. After grasping and retracting the gallbladder using a 2-mm retractor that was directly introduced into the peritoneal cavity, gallbladder excision with ligation of the cystic artery and duct using endoclips was carried out. RESULTS A complete gallbladder excision was carried out easily and safely in all cases. No major adverse events occurred. The mean operating time was 67 min (range 52-84 min). CONCLUSIONS SPEC is a technically feasible procedure. It is simpler, easier, and safer than NOTES cholecystectomy. SPEC could be a less invasive alternative to the conventional four-port laparoscopic cholecystectomy.
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Petrotos AC, Molinelli BM. Single-incision multiport laparoendoscopic (SIMPLE) surgery: early evaluation of SIMPLE cholecystectomy in a community setting. Surg Endosc 2009; 23:2631-4. [PMID: 19266233 DOI: 10.1007/s00464-009-0369-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2008] [Revised: 12/10/2008] [Accepted: 01/12/2009] [Indexed: 11/27/2022]
Abstract
BACKGROUND Conventional Laparoscopic Cholecystectomy (LC) is a safe, established procedure for gallbladder disease. This is usually performed through three to four small incisions. Although postoperative pain is minimal, there still exists some discomfort from multiple incisions. In theory, fewer incisions or incisionless surgery may decrease postoperative morbidity more than that already exists. Reports of microport instrumentation as well as normal orifice translumenal endosurgery (NOTES) cholecystectomy transvaginally, transcolonically, or transgastrically have recently surfaced. However, these require a different skill set and new technology, which is still in its developmental infancy. Single incision surgery has recently entered the minimally invasive arena. METHODS Ten consecutive patients requiring laparoscopic cholecystectomy were performed with a single incision multiport technique as described below. RESULTS All ten patients had a successful completion of a single incision multiport laparoendoscopic cholecystectomy without need for conversion to two, three, or four incisions. There were no complications and the recovery was comparable to a conventional LC. CONCLUSION We describe here a single incision multiport laparoendoscopic cholecystectomy (SIMPLE cholecystectomy) technique that is safe for the patient, reproducible, easy to learn, and uses commonly available instruments already in most operating rooms. Conversion, if required, is placement of the remaining two to three ports for a more conventional LC.
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Transumbilical single-port laparoscopic cholecystectomy : scarless cholecystectomy. Surg Endosc 2009; 23:1393-7. [PMID: 19118436 DOI: 10.1007/s00464-008-0252-y] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2008] [Revised: 10/20/2008] [Accepted: 11/15/2008] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many laparoscopic surgeons have been attempting to reduce incisional morbidity and improve cosmetic outcomes by using fewer and smaller ports. We performed transumbilical single-port laparoscopic cholecystectomy (TUSPLC) in 15 patients with cholelithiasis by using a special "single-port" with virtually no scar. METHODS We used an extra-small wound retractor and a surgical glove as the "single-port." The wound retractor was set up through the small umbilical incision and the surgical glove attached with one trocar and two pipes was then fixed to the outer ring of the wound retractor. The commonly used trocar and two slim pipes attached to the surgical glove served as three working channels. Using this single-port and conventional laparoscopic instruments, such as a straight 5-mm dissector, grasper, scissors, and a 30-degree 5-mm rigid laparoscope, we performed TUSPLC in 15 patients with cholelithiasis. The overall procedure was similar to three-port laparoscopic cholecystectomy. RESULTS Fifteen well-selected patients with cholelithiasis underwent TUSPLC (4 males and 11 females; mean age, 39 (range, 29-63) years). Body mass index ranged from 20 to 34 (mean, 25.2). No case required extra-umbilical skin incisions or conversion to standard laparoscopy. The mean operative time was 79 (range, 35-165) min. Blood loss was minimal in all cases. The mean postoperative hospital stay was 1.6 (range, 1.0-2.5) days. No postoperative complications were observed. CONCLUSIONS The results of our initial experience of TUSPLC in 15 well-selected patients with cholelithiasis are encouraging. All procedures were completed successfully within a reasonable time. No extra-umbilical incisions were used and virtually no scar remained. TUSPLC could be a promising alternative method for the treatment of some patients with symptomatic gallstone disease as scarless abdominal surgery.
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McCloy R, Randall D, Schug SA, Kehlet H, Simanski C, Bonnet F, Camu F, Fischer B, Joshi G, Rawal N, Neugebauer EAM. Is smaller necessarily better? A systematic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patient outcomes. Surg Endosc 2008; 22:2541-53. [PMID: 18810546 DOI: 10.1007/s00464-008-0055-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 06/05/2008] [Accepted: 06/15/2008] [Indexed: 12/11/2022]
Abstract
BACKGROUND In recent years, minilaparoscopic cholecystectomy (MLC; total size of trocar incision < 25 mm) has been increasingly advocated for the removal of the gallbladder, due to potentially better surgical outcomes (e.g., better cosmetic result, reduced pain, shorter hospital stay, quicker return to activity), but an evidence-based approach has been lacking. The current systematic review was undertaken to evaluate the importance of total size of trocar incision in improving surgical outcomes in adult laparoscopic cholecystectomy (LC). METHODS The literature was systematically reviewed using MEDLINE and EmBASE. Only randomized controlled trials in English, investigating minilaparoscopic versus conventional LC (total size of trocar incision > or = 25 mm) and reporting pain scores were included. Quantitative analyses (meta-analyses) were performed on postoperative pain scores and other patient outcomes from more than one study where feasible and appropriate. Qualitative analyses consisted of assessing the number of studies showing a significant difference between the techniques. RESULTS Thirteen trials met the inclusion criteria. There was a trend towards reduced pain with MLC compared with conventional LC, without reduction in opioid use. Patients in the MLC group had slightly reduced length of hospital stay, but there were no significant differences for return to activity. The two interventions were also similar in terms of operating times and adverse events, but MLC was associated with better cosmetic result (largely patient rated). There was a significantly greater likelihood of conversion to conventional LC or to open cholecystectomy in the MLC group than there was of conversion to open cholecystectomy in the conventional LC group [OR 4.71 (95% confidence interval 2.67-8.31), p < 0.00001]. CONCLUSIONS The data included in this review suggest that reducing the size of trocar incision results in some limited improvements in surgical outcomes after LC. However, it carries a higher risk of conversion to conventional LC or open cholecystectomy.
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Affiliation(s)
- Rory McCloy
- North of England Wolfson Centre for Minimally Invasive Therapies, Lancashire Teaching Hospitals NHS Foundation Trust, Lancashire, UK
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Is Local Anesthesia or Oral Analgesics Necessary After Mini-laparoscopic Functional Surgery in Children and Young Adults? Surg Laparosc Endosc Percutan Tech 2008; 18:344-7. [DOI: 10.1097/sle.0b013e318172ab33] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Needlescopic Cholecystectomy Versus Needlescope-assisted Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2008; 17:375-9. [PMID: 18049395 DOI: 10.1097/sle.0b013e31806db58b] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This clinical study was performed to compare the feasibility, safety, and best use of the needlescope and needlescopic instruments. Needlescopic cholecystectomy (NC) or needlescope-assisted cholecystectomy (NAC) was performed in 40 cases of gallbladder (GB) stone or polyp. There were 12 men and 28 women, with a mean age of 51.8 years (range, 27 to 79 y). The port sites consisted of three 2-mm ports at the right upper quadrant and one 12-mm port at the umbilicus. To evaluate the feasibility and safety of the needlescope, the time taken to perform each operative step was compared for NC and NAC. Operation time was divided into: (1) skin incision to insertion of the 4 ports; (2) insertion of the 4 ports to cannulation into the cystic duct; (3) time of intraoperative cholangiography (IOC); (4) skin incision to cutting of the cystic duct without IOC; (5) cutting the cystic duct to dissection of the GB; (6) dissection of the GB to removal of the GB; (7) removal of the GB to skin closure; and (8) total operation time. IOC was performed successfully in 10 cases of NC and 10 cases of NAC. Respective mean times of the 8 steps were 5.4 versus 5.3 minutes, 34.2 versus 32.2 minutes, 20.1 versus 18.4 minutes, 33.9 versus 31.3 minutes, 19.6 versus 18.9 minutes, 3.1 versus 2.9 minutes, 10.0 versus 10.2 minutes and 82.5 versus 77.8 minutes for NC versus NAC, respectively. There were no significant differences in any of the factors related to surgical procedures between the 2 groups, and there were no perioperative complications. The use of a needlescope and needlescopic instruments was feasible and safe for laparoscopic cholecystectomy in both surgical laparoscopic procedures for highly selected patients.
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Laurence JM, Lam VWT, Langcake ME, Hollands MJ, Crawford MD, Pleass HCC. Laparoscopic hepatectomy, a systematic review. ANZ J Surg 2008; 77:948-53. [PMID: 17931255 DOI: 10.1111/j.1445-2197.2007.04288.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This systematic review was undertaken to assess the published evidence for the safety, feasibility and reproducibility of laparoscopic liver resection. A computerized search of the Medline and Embase databases identified 28 non-duplicated studies including 703 patients in whom laparoscopic hepatectomy was attempted. Pooled data were examined for information on the patients, lesions, complications and outcome. The most common procedures were wedge resection (35.1%), segmentectomy (21.7%) and left lateral segmentectomy (20.9%). Formal right hepatectomy constituted less than 4% of the reported resections. The conversion and complication rates were 8.1% and 17.6%, respectively. The mortality rate over all these studies was 0.8% and the median (range) hospital stay 7.8 days (2-15.3 days). Eight case-control studies were analysed and although some identified significant reductions in-hospital stay, time to first ambulation after surgery and blood loss, none showed a reduction in complication or mortality rate for laparoscopically carried out resections. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by appropriately skilled surgeons. Further work is needed to determine whether these conclusions can be generalized to include formal right hepatectomy.
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Affiliation(s)
- Jerome M Laurence
- Collaborative Transplant Research Group, University of Sydney, and Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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The "invisible cholecystectomy": A transumbilical laparoscopic operation without a scar. Surg Endosc 2007; 22:1211-3. [PMID: 17943370 DOI: 10.1007/s00464-007-9588-y] [Citation(s) in RCA: 182] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2007] [Accepted: 08/04/2007] [Indexed: 01/07/2023]
Abstract
BACKGROUND Looking to further reduce the operative trauma of laparoscopic cholecystectomy, we developed, in patients with no history of cholecystitis and a normal BMI, a scarless operation through the umbilicus. The operative technique, along with the results of the first 10 patients operated in this way, are fully described. METHODS 10 female patients underwent transumbilical scarless laparoscopic cholecystectomy. Through the umbilicus, two trocars of 5 mm were introduced parallel to another with a bridge of fascia between them (one for the 5-mm laparoscope and the other for the grasper). With the help of one 1-mm Kirschner wire, introduced at the subcostal line and bent with a special designed device, the gallbladder was pulled up and the triangle of Callot was dissected free, clipped, cut, and the gallbladder was subsequently resected. Finally the gallbladder was taken out through the umbilicus and the umbilicus reconstructed. RESULTS 10 female patients, mean age 36 years (range: 31-49), mean body mass index (BMI) 23 (range: 20-26), after one attack (six patients) or a second attack (four patients) and cholelithiasis confirmed by ultrasonography with no suspicion of inflammation were included in this preliminary study. Mean operative time was 70 minutes (range: 65-85) with no conversions; hospital stay was less than 24 hours with no complications. CONCLUSION Looking to reduce operative trauma and improve the cosmetic result following laparoscopic cholecystectomy, a transumbilical operative technique has been developed. Results of the operative procedure in a selected group of patients are encouraging with no signs of inflammation and normal BMI. The umbilicus can be developed as a natural port for performing various operative procedures with the help of the traction produced by thin Kirschner wires.
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Hosono S, Osaka H. Minilaparoscopic versus conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Laparoendosc Adv Surg Tech A 2007; 17:191-9. [PMID: 17484646 DOI: 10.1089/lap.2006.0051] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We evaluated reports of minilaparoscopic cholecystectomy as compared to conventional laparoscopic cholecystectomy. MATERIALS AND METHODS We searched the Medline, Embase, and Cochrane library databases for randomized controlled trials reported between January 1996 to December 2005. The outcome measures used were operative time, length of hospital stay, postoperative pain, postoperative analgesic requirement, and cosmetic results. Meta-analysis methods were used to measure the pooled estimate of the effect size. RESULTS Data from 712 patients (352 minilaparoscopic cholecystectomy and 360 conventional laparoscopic cholecystectomy) in 12 randomized controlled trials were analyzed. The statistically significant advantages of minilaparoscopic cholecystectomy were less postoperative pain and better cosmesis. Conventional laparoscopic cholecystectomy showed a trend to shorter operative time that did not reach statistical significance. CONCLUSION Minilaparoscopic cholecystectomy could be a feasible alternative to conventional laparoscopic cholecystectomy in select patients, resulting in less pain and better cosmetic results. Additional well-designed randomized controlled and, if possible, blinded trials, with large sample sizes, are required to confirm this conclusion.
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Affiliation(s)
- Shunsuke Hosono
- Department of Surgery, Yamamoto First Hospital, Osaka, Japan.
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Cala Z, Niksić K, Nesek-Adam V, Klapan D, Soldo I. Cosmetic Laparoscopic Cholecystectomy. J Laparoendosc Adv Surg Tech A 2006; 16:577-81. [PMID: 17243873 DOI: 10.1089/lap.2006.16.577] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The cosmetic outcome and recovery time of laparoscopic cholecystectomy has been improved by modifying the operation technique and reducing the number and size of trocars. The next step to improve cosmetic results is moving two trocars below the pubic hairline. We describe our experience in performing cholecystectomy by a combination of European technique using three trocars and moving two ports below the pubic hairline. MATERIALS AND METHODS The results of 72 patients, ASA physical status I and II, who underwent cosmetic laparoscopic cholecystectomy between January 2002 and May 2005 are presented. RESULTS The median operating time was 33.3 +/- 9.9 min and postoperative hospital stay was 2.2 +/- 0.6 days. No patients required additional trocars or conversion to open cholecystectomy. There were no intraoperative or postoperative complications, and all patients reported satisfaction with their postoperative cosmetic results. CONCLUSION According to our experience, cosmetic laparoscopic cholecystectomy is a safe procedure with good cosmetic results; however, its use should be based on careful evaluation in each individual case.
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Affiliation(s)
- Zoran Cala
- University Department of Surgery, Sveti Duh General Hospital, Zagreb, Croatia.
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Verma GR, Lyngdoh TS, Kaman L, Bala I. Placement of 0.5% bupivacaine-soaked Surgicel in the gallbladder bed is effective for pain after laparoscopic cholecystectomy. Surg Endosc 2006; 20:1560-4. [PMID: 16897291 DOI: 10.1007/s00464-005-0284-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2005] [Accepted: 10/12/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study aimed to determine the character of pain after laparoscopic cholecystectomy and its relief with 0.5% bupivacaine-soaked Surgicel placed in the gallbladder bed. METHODS For this study, 60 patients with chronic cholecystitis were divided into four groups of 15 each: group A (bupivacaine-soaked Surgicel kept in gallbladder bed), group B (bupivacaine infiltrated at trocar sites), group C (bupivacaine infiltrated into the gallbladder bed and at trocar sites, and group D (normal saline in the gallbladder bed and at trocar sites). Postoperatively, the character of pain was noted, and its relief was assessed with visual analog scale (VAS) scoring. RESULTS The findings showed that 78.33% of the patients had visceral pain, 70% experienced parietal, and 23.33% reported shoulder pain after laparoscopic cholecystectomy. The visceral pain was significantly less in the group A patients than in the control subjects (p < 0.05), and none of them experienced shoulder pain. The mean VAS score at 4, 8, and, 24 h in the group A patients also was less than in control group D: 26.37 +/- 16.24 versus 38.30 +/- 9.51, 23.23 +/- 14.28 versus 33.73 +/- 7.96, and 18.36 +/- 13.00 versus 28.60 +/- 9.42, respectively. Trocar-site infiltration alone was not effective in relieving the parietal pain. CONCLUSION Visceral pain is prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine-soaked Surgicel in the gallbladder bed alone. Trocar-site infiltration alone is ineffective.
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Affiliation(s)
- G R Verma
- Department of Surgery and Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jani K, Rajan PS, Sendhilkumar K, Palanivelu C. Twenty years after Erich Muhe: Persisting controversies with the gold standard of laparoscopic cholecystectomy. J Minim Access Surg 2006; 2:49-58. [PMID: 21170235 PMCID: PMC2997273 DOI: 10.4103/0972-9941.26646] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Accepted: 02/15/2006] [Indexed: 12/22/2022] Open
Abstract
This review article is a tribute to the genius of Professor Erich Muhe, a man ahead of his times. We trace the development of laparoscopic cholecystectomy and detail the tribulations faced by Muhe. On the occasion of the twentieth anniversary of the first laparoscopic cholecystectomy, we take another look at some of the controversies surrounding this gold standard in the management of gallbladder disease.
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Affiliation(s)
- Kalpesh Jani
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - P S Rajan
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - K Sendhilkumar
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
| | - C Palanivelu
- Departments of Gem Hospital, 45A, Pankaja Mill Road, Ramanathapuram, Coimbatore - 641045, India
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Ghezzi F, Cromi A, Colombo G, Uccella S, Bergamini V, Serati M, Bolis P. Minimizing ancillary ports size in gynecologic laparoscopy: a randomized trial. J Minim Invasive Gynecol 2005; 12:480-485. [PMID: 16337574 DOI: 10.1016/j.jmig.2005.09.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Accepted: 05/27/2005] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE To evaluate the feasibility, safety, and effect on postoperative pain of laparoscopy for the management of adnexal masses by downsizing ancillary trocars from 5- to 3-mm. DESIGN Randomized, controlled trial (Canadian Task Force classification I). SETTING Gynecologic department of a university hospital PATIENTS A total of 102 women with an adnexal mass scheduled for gynecologic laparoscopic procedures were randomized to undergo laparoscopy using either conventional 5-mm ancillary trocars (n=52) or 3-mm instruments (n=50). Preoperative suspicion of malignancy, deep infiltrating endometriosis, and indications for hysterectomy or myomectomy were considered as exclusion criteria. INTERVENTIONS Laparoscopic procedures for the treatment of benign adnexal masses. MEASUREMENTS AND MAIN RESULTS Both groups were similar in patient age, body mass index, history of abdominal surgery, and type of procedures. Intraoperative complications occurred in no patient (0%) in the 3-mm group and in two patients (3.8%) in the 5-mm group (p=.49). Conversion from 3- to 5-mm instrumentation was necessary in one procedure. No difference was found in the operative time between the 3-mm and the 5-mm groups (54 min [range 15-175 min] vs 50 min [range 20-150 min], p=.89). The severity of incisional pain was evaluated with a 100-mm visual analog scale at 1, 3, and 24 hours after surgery. Postoperative pain was significantly lower in the 3-mm than in the 5-mm group 1 hour after laparoscopy (20 [range 0-60] vs 32.5 [range 0-80], p=.04). The proportion of women requiring analgesia before discharge, the timing of analgesic requirement, and the total amount of medication in the first 24 hours after surgery were similar in the two groups. CONCLUSION Three-millimeter ancillary trocars can safely replace traditional-size equipment for the management of adnexal masses without a negative impact on the surgeon's ability to perform gynecologic laparoscopy and are associated with less immediate postoperative pain.
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Affiliation(s)
- Fabio Ghezzi
- Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy.
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