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Li Z, Ouyang Y, Ding K. Single-Incision Laparoscopic Cholecystectomy in Situs Inversus Totalis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2025; 26:e946523. [PMID: 40388373 PMCID: PMC12101093 DOI: 10.12659/ajcr.946523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Accepted: 02/18/2025] [Indexed: 05/21/2025]
Abstract
BACKGROUND Situs inversus totalis (SIT) is a rare developmental anomaly. For many years, laparoscopic cholecystectomy has been a well-established and effective treatment for patients with cholecystolithiasis. However, when it comes to SIT patients with cholecystolithiasis, this surgery presents unique challenges. Due to its complete mirror inversion of viscera, it is uncomfortable to carry out standard laparoscopic cholecystectomy for some surgeons. Single-incision laparoscopic cholecystectomy (SILC) offers a minimally invasive alternative to traditional laparoscopic cholecystectomy, potentially enhancing aesthetic outcomes and minimizing postoperative discomfort. CASE REPORT A 67-year-old woman was admitted to the hospital due to abdominal pain. After admission, she completed a chest X-ray, electrocardiogram, B-ultrasound, and magnetic resonance cholangiopancreatography. Imaging examination revealed SIT and cholecystolithiasis. The laboratory examination results were normal. All contraindications to surgery were ruled out, and then SILC was performed under general anesthesia on January 22, 2024. The surgeon and assistant stood on the right side of the patient, and the abdominal SILC port with 3 operation channels was placed through a 2-cm traumatic incision. We used electric hooks and separating forceps to dissect the Calot triangle and gallbladder of the patient, and the gallbladder was successfully removed. The patient recovered well after the surgery. CONCLUSIONS For SIT patients with cholecystolithiasis, SILC is a safe and effective minimally invasive treatment option which has fewer surgical incisions and less postoperative pain. However, it demands experienced SILC surgeons, thorough preoperative examinations, and close attention to incision conditions after surgery.
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Rudiman R, Hanafi RV, Wijaya A. Single-incision laparoscopic cholecystectomy versus conventional multi-port laparoscopic cholecystectomy: A systematic review, meta-analysis, and meta-regression of randomized controlled trials. F1000Res 2024; 11:754. [PMID: 39931659 PMCID: PMC11809676 DOI: 10.12688/f1000research.122102.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2024] [Indexed: 02/13/2025] Open
Abstract
Background Conventional multi-port laparoscopic cholecystectomy (CMLC) has become the current 'gold standard' technique in gallbladder disease. Single-incision laparoscopic cholecystectomy (SILC) has gained attention due to its benefits in improving patient cosmetic results and pain reduction. We aim to assess the latest evidence on the feasibility, safety and surgical outcomes of SILC and CMLC. Methods We conducted searches for randomized controlled trials (RCTs) in PubMed, PubMed Central (PMC), and Europe PMC between December 2011 and 2021. The latest search was conducted in January 2022. We analyzed several outcomes, including perioperative complications, estimated blood loss, operation time, conversion to open surgery, hospital stay, pain score, cosmesis, and days of return to work. Cochrane Risk of Bias (RoB) 2.0 tool was used to evaluate quality of studies. Mantel-Haenszel's formula and Inverse Variance method were conducted to synthesize results. This study was accomplished in accordance with the PRISMA guidelines. Results A total of 37 studies were eligible, with a total of 2,129 and 2,392 patients who underwent SILC and CMLC. Our study demonstrated a superiority of SILC for the visual analog score (VAS) at six hours post-operation [mean difference (MD) -0.58 (95% CI -1.11, -0.05), p=0.03], cosmesis one-month post-operation [standard MD 2.12 (95% CI 1.10, 3.13), p<0.0001], and cosmesis six months post-operation [standard MD 0.53 (95% CI 0.06, 0.99), p<0.0001]. Meanwhile, SILC showed a longer operation time [MD 10.45 (95% CI 6.74, 14.17), p<0.00001]. In terms of VAS at four time points (4, 8, 12, and 24 hours), perioperative complications, estimated blood loss, conversion to open surgery, hospital stay and days to return to work, SILC did not differ from CMLC. Conclusions SILC is a safe, feasible and favorable procedure in terms of pain reduction and cosmetic results. The option between both procedures is based on surgeon preferences. Registration: PROSPERO ( CRD42022306532; 23 February 2022).
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Affiliation(s)
- Reno Rudiman
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, 40161, Indonesia
| | | | - Alma Wijaya
- Division of Digestive Surgery, Department of General Surgery, School of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, 40161, Indonesia
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3
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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4
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Cadière GB, Himpens J, Poras M, Pau L, Boyer N, Cadière B. First human surgery using a surgical assistance robotics device for laparoscopic cholecystectomies. Surg Endosc 2023; 37:7812-7818. [PMID: 37605013 PMCID: PMC10520184 DOI: 10.1007/s00464-023-10296-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/02/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Over the past 20 years, surgeons involved in soft tissue minimally invasive surgery have experienced the pros and cons of both conventional and tele-robotic laparoscopic approaches. The Maestro System, developed by Moon Surgical (Paris, France) aims to overcome the challenges inherent to both approaches thanks to a new concept that augments the surgeon's performance at the bedside during a laparoscopic procedure. METHODS The current study aims to present the first human experience with laparoscopic cholecystectomy with the Maestro system on 10 patients. RESULTS All ten procedures were completed successfully. No significant complications related to the use of the Maestro system werenoted. CONCLUSION Our preliminary observations appear to support the benefits of the Maestro system in non-emergent laparoscopic cholecystectomies. It goes without saying that further research is necessary to demonstrate the safety of this approach in other procedures.
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Affiliation(s)
| | - Jacques Himpens
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium
| | - Mathilde Poras
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium.
- CHU St Pierre, Brussels, Belgium.
| | - Luca Pau
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium
| | - Nicolas Boyer
- Digestive Surgery, Hôpital Universitaire St Pierre, ULB, Brussels, Belgium
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Hassan I, Hassan L, Alsalameh M, Abdelkarim H, Hassan W. Cost-effective scarless cholecystectomy using a modified endoscopic minimally invasive reduced appliance technique (Emirate). Front Surg 2023; 10:1200973. [PMID: 37181599 PMCID: PMC10169593 DOI: 10.3389/fsurg.2023.1200973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023] Open
Abstract
ABSTRACT The current gold-standard surgical treatment for symptomatic gallstone disease is the conventional four-port laparoscopic cholecystectomy (CLC). In recent years, however, celebrities and social media have altered people's attitudes regarding surgery. Consequently, CLC has undergone several changes to reduce scarring and improve patient satisfaction. In this case-matched control study, the cost-effectiveness of a modified endoscopic minimally invasive reduced appliance technique (Emirate) that uses less equipment and three 5 mm reusable ports only at precisely specified anatomical sites was compared to CLC. METHODS Single-center retrospective matched cohort analysis including 140 consecutive patients treated with Emirate laparoscopic cholecystectomy ("ELC-group"), matched 1:1 by sex, indications for surgery, surgeon expertise, and preop bile duct imaging, with 140 patients receiving CLC in the same period of time ("CLC group"). RESULTS We performed a retrospective case-matched review of 140 patients who had Emirate laparoscopic cholecystectomy for gallstones between January 2019 and December 2022. The groups included 108 females and 32 males with an equal ratio of surgical expertise-115 procedures were performed by consultants and 25 by trainees. In each group, 18 patients had preoperative MRCP or ERCP and 20 had acute cholecystitis as indications for surgery. Preoperative characteristics such as age (39 years in the Emirates group and 38.6 years in the CLC group), BMI (29.3 years in the Emirates group and 30 years in the CLC group), stone size, or liver enzymes showed no statistical difference between the two groups. In both groups, the average hospital stay was 1.5 days, and there was no conversion to open surgery, nor was there any bleeding requiring blood transfusion, bile leakage, stone slippage, bile duct injury, or invasive intervention postoperatively. When compared to the CLC group, the ELC group had significantly faster surgery times (t-test, p = 0.001), lower levels of the bile duct enzyme ALP (p = 0.003), and much lower costs (t-test, p = 0.0001). CONCLUSION The Emirate laparoscopic cholecystectomy method is a safe alternative to the traditional four-port laparoscopic cholecystectomy that is also much faster and less expensive.
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Affiliation(s)
- Iyad Hassan
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
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Bianco FM, Dreifuss NH, Chang B, Schlottmann F, Cubisino A, Mangano A, Pavelko Y, Masrur MA, Giulianotti PC. Robotic single-port surgery: Preliminary experience in general surgery. Int J Med Robot 2022; 18:e2453. [PMID: 35962708 PMCID: PMC9788012 DOI: 10.1002/rcs.2453] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND We aim to analyse the safety and feasibility of the DaVinci Single Port (SP) platform in general surgery. METHODS A prospective series of robotic SP transabdominal pre-peritoneal inguinal hernia repairs (SP-TAPP) and cholecystectomies (SP-C) (off-label) were analysed. Primary endpoints were safety and feasibility defined by the need for conversion and incidence of perioperative complications. RESULTS A total of 225 SP procedures were performed; 84 (37.3%) SP-TAPP (70 unilateral, 7 bilateral), and 141 (62.7%) SP-C. There were no conversions or additional ports placed. Mean console time was 17.6, 31.9, and 54 min for SP-C, unilateral, and bilateral SP-TAPP, respectively. There was no mortality, intraoperative or major postoperative complications. Mean LOS was 2.7 h for elective SP-TAPP and 2.3 h for SP-C. CONCLUSION Robotic SP surgery is safe and feasible for two of the most performed general surgery operations. Further experience might allow expanding the applications of robotic single-incision surgery for other procedures.
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Affiliation(s)
- Francesco M. Bianco
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Nicolas H. Dreifuss
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Betty Chang
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Francisco Schlottmann
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Antonio Cubisino
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Alberto Mangano
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Yevhen Pavelko
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Mario A. Masrur
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Pier C. Giulianotti
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
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Suprapubic Cholecystectomy Improves Cosmetic Outcome Compared to Classic Cholecystectomy. J Clin Med 2022; 11:jcm11154579. [PMID: 35956193 PMCID: PMC9369808 DOI: 10.3390/jcm11154579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Currently, cholecystectomy is performed laparoscopically. While the conventional approach (CA) with four access ports persists, other methods seek to reduce trauma or to optimize cosmetic results. In this study, the safety and cosmetic outcome of a suprapubic approach (SA) were evaluated. Between 2015 and 2016, patients undergoing elective cholecystectomy either by CA or by a suprapubic approach (SA) at our institution were included. The cosmetic outcome, postoperative morbidity, operative time and length of stay were evaluated. Pictures of the site of intervention were taken 6−12 months postoperatively and rated on a scale from 1 (unsatisfying aesthetic result) to 5 (excellent aesthetic result). Five “non-medical” and five “medical” raters as well as one board-certified plastic surgeon performed the ratings. A total of 70 patients were included (n = 28 SA, n = 42 CA). The two groups did not differ in baseline characteristics (age, gender, BMI). The SA group showed a significantly better aesthetic outcome compared to the CA group 4.8 (4.8−4.9) vs. 4.2 (3.8−4.4), (p > 0.001). Medical raters: 4.0 (3.8−4.2) vs. 4.8 (4.6−5.0), (p < 0.001); non-medical raters: 4.2 (3.8−4.6) vs. 5.0 (4.8−5.0), (p < 0.001); plastic surgeon: 4.0 (4.0−4.0) vs. 5.0 (5.0−5.0), (p < 0.001). Fair interrater consistency was demonstrated with an ICC of 0.47 (95% CI = 0.38−0.57). No significant difference in the complication rate (1 (3.5%) in SA vs. 6 (14%) in CA, (p = 0.3)), or the operating time 66 (50−86) vs. 70 (65−82) min, (p = 0.3), were observed. Patients stayed for a median of three (3−3) days in the SA group and 3 (3−4) days in the CA group (p = 0.08). This study demonstrated that the suprapubic approach is an appropriate alternative to conventional laparoscopic cholecystectomy, presenting a better cosmetic outcome with a similar complication rate.
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Hayashi Y, Akai K, Fujii S, Ueda T, Maeda I, Takahashi T, Yamashita K, Saito T, Tanaka K, Yamamoto K, Makino T, Kurokawa Y, Eguchi H, Doki Y, Nakajima K. Ultra-thin surgical swab: its development and clinical application. MINIM INVASIV THER 2022; 31:887-893. [DOI: 10.1080/13645706.2021.2025402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yoshinori Hayashi
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | | | | | | | | | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kiyokazu Nakajima
- Department of Next Generation Endoscopic Intervention (Project ENGINE), Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Casaccia M, Ponzano M, Testa T, Martigli SP, Contratto C, De Cian F. Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis. JSLS 2022; 26:e2022.00020. [PMID: 35967963 PMCID: PMC9355797 DOI: 10.4293/jsls.2022.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions. METHODS All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients' charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared. RESULTS Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (P = .001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (P = .442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (P = .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively. CONCLUSION SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Marta Ponzano
- Unit of Clinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgery, San Martino Hospital, Genoa, Italy
| | - Sofia Paola Martigli
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Cecilia Contratto
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
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Cawich SO, Dapri G. Emergency single-incision laparoscopic cholecystectomy for acute cholecystitis: A multi-center study. MEDICINE INTERNATIONAL 2022; 2:21. [PMID: 36699509 PMCID: PMC9829208 DOI: 10.3892/mi.2022.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/17/2022] [Indexed: 01/28/2023]
Abstract
Single-incision laparoscopy is accepted as a safe alternative to multiple port laparoscopy for elective cholecystectomy; however, there are limited data on its use in patients with acute cholecystitis. The present multi-center study evaluated the outcomes of emergency single-incision surgeries for acute cholecystitis in hospitals in Belgium, Jamaica, and Trinidad and Tobago over a 5-year period. Standardized definitions of uncomplicated and complicated acute cholecystitis were used and the data were compared using SPSS software. The results revealed that over the 5-year period, 108 patients with a mean age of 48±15 years and a mean body mass index of 27±4.2 kg/m2 underwent emergency single-incision cholecystectomies. The surgeries were successful in 92.1% of cases without supplemental trocars being used. The overall morbidity rates (9.3%) were also comparable to the historic controls with multiple port cholecystectomy. As was expected, the complicated cholecystitis group required a significantly longer operating time (86.11±30.16 vs. 66.79±16.8; P<0.00194), as well as supplemental trocars (7.9%) vs. 0; P=0.0413). On the whole, the present study demonstrates that emergency single-incision cholecystectomy is a technically feasible and safe procedure for patients with acute cholecystitis. These findings advocate a low threshold to place additional ports to assist with dissection and exposure.
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Affiliation(s)
- Shamir O. Cawich
- Department of Surgery, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago, I-24125 Bergamo, Italy,Correspondence to: Professor Shamir O. Cawich, Department of Surgery, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Giovanni Dapri
- International School of Reduced Scar Laparoscopy, Minimally Invasive General and Oncologic Surgery Center, Humanitas Gavazzeni University Hospital, I-24125 Bergamo, Italy
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11
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Cawich SO, Mohanty SK, Felix O, Dapri G. Single Incision Cholecystectomies for Acute Cholecystitis: A Single Surgeon Series from the Caribbean. Minim Invasive Surg 2022; 2022:6781544. [PMID: 35223097 PMCID: PMC8865982 DOI: 10.1155/2022/6781544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. MATERIALS AND METHODS After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. RESULTS SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). CONCLUSION The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.
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Affiliation(s)
- Shamir O. Cawich
- Department of Surgery, University of the West Indies, St. Augustine Campus, Trinidad, Trinidad and Tobago
| | - Sanjib K. Mohanty
- Department of Surgery, Cayman Islands Hospital, George Town, Cayman Islands
| | - Omar Felix
- Department of Surgery, Cayman Islands Hospital, George Town, Cayman Islands
| | - Giovanni Dapri
- Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium
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12
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Melly C, McGeehan G, O’Connor N, Johnston A, Bass G, Mohseni S, Donohoe C, Bucholc M, Sugrue M. OUP accepted manuscript. BJS Open 2022; 6:6603491. [PMID: 35668711 PMCID: PMC9171002 DOI: 10.1093/bjsopen/zrac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient-reported outcome measures (PROMs) in patients undergoing laparoscopic cholecystectomy. Methods A PROSPERO-registered (registration number CRD42021261707) systematic review was undertaken for all relevant English language articles using PubMed version of MEDLINE, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards and included the keywords: laparoscopic cholecystectomy AND patient outcome OR patient-reported outcome OR patient-reported outcome measure OR PRO OR PROM. Medical Subjects Heading terms were used to search PubMed and Scopus. Articles published from 1 January 2011 to 2 June 2021 were included. Results A total of 4960 individual articles were reviewed in this study, of which 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy and underwent methodological index for non-randomized studies (MINORS) grading. Twenty-one articles spanning 19 countries and four continents met all inclusion criteria and were included in the qualitative data synthesis. There was significant heterogeneity in PROMs identified with eight different comprehensive PROM tools used in the 21 studies. There was wide variation in the time points at which PROMs were recorded. Fourteen of 21 studies recorded PROMs before and after surgery, and 7 of 21 recorded PROMs only after surgery. Follow-up intervals ranged from 3 days to 2 years after surgery. Conclusions This study identified that while post-laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. The EQ-5D™ (EuroQoL Group, Rotterdam, the Netherlands) provides a simple platform for the modern digital era.
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Affiliation(s)
| | - Gearoid McGeehan
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- University of Limerick School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall O’Connor
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Alison Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Gary Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery Orebro University Hospital, & School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Claire Donohoe
- Department of Surgery, Trinity College Dublin, St James’ Hospital, Dublin, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
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13
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Kang YH, Kang JS, Cho YS, Kim HS, Lee M, Han Y, Sohn HJ, Kim H, Kwon W, Jang JY, Lee HK. A retrospective multicentre study on the evaluation of perioperative outcomes of single-port robotic cholecystectomy comparing the Xi and SP versions of the da Vinci robotic surgical system. Int J Med Robot 2021; 18:e2345. [PMID: 34676970 DOI: 10.1002/rcs.2345] [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: 05/23/2021] [Revised: 09/26/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Single-incision robotic cholecystectomy (SIRC) is widely performed with both the da Vinci Xi system (Xi) and the da Vinci SP system (SP). But there are limited numbers of studies comparing these platforms. METHODS Patients who underwent SIRC between 2019 and 2020 were enrolled. Patient demographics, intraoperative factors, postoperative complications, postoperative pain were compared using a one-to-one propensity score matching (PSM). RESULTS Overall, 258 patients underwent SIRC with Xi and 72 with SP. After PSM, there were significant differences between the Xi and SP in operation time at console and numeric rating scale for postoperative pain, but no difference in total operation time and postoperative complications. The SP group showed more estimated blood loss. CONCLUSIONS Despite the statistical difference, clinical benefit was not significant. Both platforms can be safe and feasible to perform SIRC, but further investigation including the surgeon's workload and ergonomics is needed as a prospective study.
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Affiliation(s)
- Yoon Hyung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Seung Kang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yo Seok Cho
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Seok Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mirang Lee
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngmin Han
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hee Ju Sohn
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hongbeom Kim
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wooil Kwon
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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14
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Valcarenghi J, Hernigou J, Apicella G, Clegg E, Rousie M, Chasse E. Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study. Acta Chir Belg 2021; 121:320-326. [PMID: 32375576 DOI: 10.1080/00015458.2020.1765673] [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] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). BACKGROUND Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. METHODS Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. RESULTS A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. CONCLUSIONS Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.
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Affiliation(s)
| | - Jacques Hernigou
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Giulia Apicella
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emilie Clegg
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Maxime Rousie
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emmanuel Chasse
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
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15
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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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16
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Cruickshank M, Newlands R, Blazeby J, Ahmed I, Bekheit M, Brazzelli M, Croal B, Innes K, Ramsay C, Gillies K. Identification and categorisation of relevant outcomes for symptomatic uncomplicated gallstone disease: in-depth analysis to inform the development of a core outcome set. BMJ Open 2021; 11:e045568. [PMID: 34168025 PMCID: PMC8231013 DOI: 10.1136/bmjopen-2020-045568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Many completed trials of interventions for uncomplicated gallstone disease are not as helpful as they could be due to lack of standardisation across studies, outcome definition, collection and reporting. This heterogeneity of outcomes across studies hampers useful synthesis of primary studies and ultimately negatively impacts on decision making by all stakeholders. Core outcome sets offer a potential solution to this problem of heterogeneity and concerns over whether the 'right' outcomes are being measured. One of the first steps in core outcome set generation is to identify the range of outcomes reported (in the literature or by patients directly) that are considered important. OBJECTIVES To develop a systematic map that examines the variation in outcome reporting of interventions for uncomplicated symptomatic gallstone disease, and to identify other outcomes of importance to patients with gallstones not previously measured or reported in interventional studies. RESULTS The literature search identified 794 potentially relevant titles and abstracts of which 137 were deemed eligible for inclusion. A total of 129 randomised controlled trials, 4 gallstone disease specific patient-reported outcome measures (PROMs) and 8 qualitative studies were included. This was supplemented with data from 6 individual interviews, 1 focus group (n=5 participants) and analysis of 20 consultations. A total of 386 individual recorded outcomes were identified across the combined evidence: 330 outcomes (which were reported 1147 times) from trials evaluating interventions, 22 outcomes from PROMs, 17 outcomes from existing qualitative studies and 17 outcomes from primary qualitative research. Areas of overlap between the evidence sources existed but also the primary research contributed new, unreported in this context, outcomes. CONCLUSIONS This study took a rigorous approach to catalogue and map the outcomes of importance in gallstone disease to enhance the development of the COS 'long' list. A COS for uncomplicated gallstone disease that considers the views of all relevant stakeholders is needed.
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Affiliation(s)
- Moira Cruickshank
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Rumana Newlands
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Jane Blazeby
- Department of Social Medicine, University of Bristol Department of Social Medicine, Bristol, UK
| | - Irfan Ahmed
- Department of Surgery, NHS Grampian, Aberdeen, UK
| | - Mohamed Bekheit
- Department of Surgery, NHS Grampian, Aberdeen, UK
- Department of Surgery, ElKabbary Hospital, Alexandria, Egypt
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Bernard Croal
- Clinical Biochemistry, Grampian University Hospitals NHS Trust, Aberdeen, UK
| | - Karen Innes
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
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17
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Cawich SO, Burgess PE, Ranglin-Robinson D, Ewing R. Single-Incision Laparoscopic Cholecystectomy: Initial Report From the Turks and Caicos Islands. Cureus 2021; 13:e14891. [PMID: 34109080 PMCID: PMC8180239 DOI: 10.7759/cureus.14891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
There has been no prior report of single-incision laparoscopic surgery (SILS) from the Caribbean island of Turks and Caicos. We report our initial experience with SILS cholecystectomy to show that SILS in this environment is feasible with minimal change to the existing hardware. It is a safe alternative to conventional multi-trocar laparoscopic cholecystectomy in this setting.
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Affiliation(s)
| | | | | | - Rufus Ewing
- Surgery, Cheshire Hall Medical Center, Providenciales, TCA
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18
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Subirana H, Rey FJ, Barri J, Robres J, Parra L, Martín M, Memba R, Mullerat JM, Jorba R. Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial. J Minim Access Surg 2021; 17:311-317. [PMID: 32964868 PMCID: PMC8270025 DOI: 10.4103/jmas.jmas_97_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time. Methods: This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate. Results: In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures. Conclusions: SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.
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Affiliation(s)
- Helena Subirana
- Department of General Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Francisco Javier Rey
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Barri
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Joaquim Robres
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Lourdes Parra
- Department of Anesthesiology, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Montserrat Martín
- Department of Clinical Epidemiology, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Robert Memba
- Department of General Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Josep Maria Mullerat
- Department of General Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Rosa Jorba
- Department of General Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
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Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Single-incision versus conventional multiport laparoscopic cholecystectomy: a current meta-analysis of randomized controlled trials. Surg Endosc 2020; 34:4315-4329. [PMID: 31620914 DOI: 10.1007/s00464-019-07198-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC). METHODS We searched PubMed, Embase, Web of Science, the Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials comparing SILC versus MPLC. We evaluated the pooled outcomes for complications, pain scores, and surgery-related events. This study was performed in accordance with PRISMA guidelines. RESULTS A total of 48 randomized controlled trials involving 2838 patients in the SILC group and 2956 patients in the MPLC group were included in this study. Our results showed that SILC was associated with a higher incidence of incisional hernia (relative risk = 2.51; 95% confidence interval = 1.23-5.12; p = 0.01) and longer operation time (mean difference = 15.27 min; 95% confidence interval = 9.67-20.87; p < 0.00001). There were no significant differences between SILC and MPLC regarding bile duct injury, bile leakage, wound infection, conversion to open surgery, retained common bile duct stones, total complication rate, and estimated blood loss. No difference was observed in postoperative pain assessed by a visual analogue scale between the two groups at four time points (6 h, 8 h, 12 h, and 24 h postprocedure). CONCLUSIONS Based on the current evidence, SILC did not result in better outcomes compared with MPLC and both were equivalent regarding complications. Considering the additional surgical technology and longer operation time, SILC should be chosen with careful consideration.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China.
- Department of General Surgery, Dongyang People's Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China.
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
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20
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Abstract
Laparoscopic surgery performed through a single incision is relatively new. Here, we investigated the importance of radiological anatomical evaluation of the umbilicus prior to such surgery.Umbilical images of 500 patients who underwent computed tomography (CT) in 2019 were evaluated retrospectively, using both transverse and sagittal sections.Spearman rank correlation analysis indicated a significant positive relationship between age and the sagittal and transverse umbilical measurements (all patients: P < .01; men: P = .001; women: P < .01). Mean transverse and sagittal measurements were 5.63 ± 1.9 and 6.2 ± 2.0 mm in women and 5.49 ± 1.9 and 6.2 ± 1.8 mm in men.Umbilical anatomy can be evaluated radiologically as a component of preoperative evaluation.
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Affiliation(s)
| | - Ali Er
- Tepecik Training and Research Hospital, Department of Radiology, Izmir, Turkey
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21
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Kang SM, Cho JR, Oh HK, Lee EJ, Kim MH, Kim DW, Kang SB. Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings. Ann Coloproctol 2020; 36:17-21. [PMID: 32146784 PMCID: PMC7069680 DOI: 10.3393/ac.2019.04.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy. Methods Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed. Results Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality. Conclusion Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.
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Affiliation(s)
- Seng-Muk Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Rae Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Ju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Hyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Casaccia M, Palombo D, Razzore A, Firpo E, Gallo F, Fornaro R. Laparoscopic Single-Port Versus Traditional Multi-Port Laparoscopic Cholecystectomy. JSLS 2020; 23:JSLS.2018.00102. [PMID: 31488940 PMCID: PMC6708410 DOI: 10.4293/jsls.2018.00102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives Safety, efficacy, and costs are still debated issues in single-port laparoscopy. The aim of the study was to compare clinical outcomes and hospital costs for conventional 4-port laparoscopic cholecystectomy (4PLC) and single-port laparoscopic cholecystectomy (SPLC) performed at a single institution. Methods A series of 40 SPLC patients operated on from October 2016 to May 2017 were compared to a hystorical series of 40 4PLC patients. Primary endpoints were the operative time, blood loss, postoperative pain, analgesia requirement, length of stay, and morbidity. Secondary endpoints were the operative costs and total hospital costs. Results No patient required surgical conversion in both groups. Duration of surgery was significantly longer in the SPLC group. Length of hospitalization was shorter for patients operated on by SPLC (1.9 ± 0.9 vs 2.3 ± 1.2 days; P = .104). According to visual analogue scale evaluation, the pain profile was similar. Minor postoperative complications were present in 12.5% of the SPLC group and 2.5% in 4PLC group (P = .200). The total hospitalization costs associated with SPLC procedure were lower compared to standard 4PLC procedure. As regards the disposable operating room equipment costs, a statistically significant difference in favor of SPLC technique was found. Conclusion SPLC has shown relevant procedure and postoperative outcomes when compared to traditional 4PLC. The technique has proved to be promising even in cases of acute cholecystitis considered to date a relative contraindication. Further studies are needed to confirm its safety and feasibility in this setting. In contrast with the current evidence of increased costs for the single-port technique, a reduction of material and hospitalization costs was experienced in our study.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Denise Palombo
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Andrea Razzore
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Emma Firpo
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Fabio Gallo
- Section of Biostatistics, Department of Health Sciences (DISSAL), Genoa University, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
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Alhambra-Rodríguez de Guzmán C, Morandeira-Rivas AJ, Herrero-Bogajo ML, Moreno-Sanz C. Incidence and Risk Factors of Incisional Hernia After Single-Incision Endoscopic Surgery. J Laparoendosc Adv Surg Tech A 2019; 30:251-255. [PMID: 31829780 DOI: 10.1089/lap.2019.0728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Abdominal wall complications are one of the most controversial issues regarding single-incision endoscopic surgery. The aim of this study was to analyze the incidence and risk factors of incisional hernia after single-incision endoscopic cholecystectomy. Materials and Methods: An observational retrospective study was performed, on a cohort of patients cholecystectomized laparoscopically through a transumbilical single incision due to gallbladder lithiasis or polyps. Postoperative complications were analyzed, with special interest in the incisional hernia rate, whose results were assessed in the long-term follow-up. Univariate and multivariate analyses were also performed to evaluate possible variables associated with the appearance of incisional hernia. Cumulative sum charts (CUSUM) were used to identify trends in the incisional hernia risk. Results: Some 109 patients were included in the study. With a mean follow-up of nearly 38 months, an incisional hernia incidence of 5.5% was found, with 67% being diagnosed during the first year of follow-up. In the Cox regression analysis, two variables showed an independent association with the emergence of incisional hernia, body mass index (hazard ratio [HR] 1.30; 95% confidence interval [CI 1.053-1.606]; P .015), and wound infection (HR 26.32; [3.186-217.40]; P .002]. CUSUM charts showed a decrease in the risk of incisional hernia after the first 10 cases. Conclusions: Single-incision endoscopic cholecystectomy is associated with a substantially high risk of postoperative incisional hernia (5.5%).
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Affiliation(s)
| | | | | | - Carlos Moreno-Sanz
- General and Digestive Surgery, General Hospital La Mancha Centro, Alcázar de San Juan, Spain
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24
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Lee B, Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, Kim KH, Hyun IG, Han SJ. Solo single incision laparoscopic cholecystectomy using the parallel method; Surgical technique reducing a steep learning curve. Ann Hepatobiliary Pancreat Surg 2019; 23:344-352. [PMID: 31825000 PMCID: PMC6893057 DOI: 10.14701/ahbps.2019.23.4.344] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/14/2019] [Accepted: 07/25/2019] [Indexed: 12/27/2022] Open
Abstract
Backgrounds/Aims To describe the techniques, short-term outcomes, and learning curve of solo single-incision laparoscopic cholecystectomy (Solo-SILC) using a laparoscopic scope holder. Methods A total of 591 patients who underwent Solo-SILC from July 2014 to December 2016 performed by four experienced hepatobiliary surgeons were retrospectively assessed. Solo-SILC was performed using the parallel method using a scope holder. The moving average method was used to investigate the learning curve in terms of operative time. Results In total, 590 Solo-SILC procedures were performed. Very few procedures were converted to multi-port laparoscopic cholecystectomy. There was one case of bile duct injury. The mean operative time (59.93±25.77 min) was shorter than that in other studies of SILC. Three postoperative complications, delaying bile leakage, occurred in the patients treated by one surgeon. These cases were resolved by ultrasound-guided puncture and drainage. The learning curve for surgeons A, B, and C was overcome after 14, 12, and 12 cases. Surgeon D, who had the most experience with SILC, had no obvious learning curve. Conclusions Hepatobiliary surgeons experienced in LC can perform Solo-SILC almost immediately. Solo-SILC using the parallel technique represents a more stable option and is a promising treatment for gallbladder disease.
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Affiliation(s)
- Boram Lee
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Suk-Won Suh
- Department of Surgery, Chung-Ang University, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kil Hwan Kim
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - In Gun Hyun
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sun Jong Han
- Department of Surgery, Seoul National University, College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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25
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Lee SR, Kim HO, Shin JH. Clinical outcomes of single-incision robotic cholecystectomy versus conventional 3-port laparoscopic cholecystectomy. Can J Surg 2019; 62:52-56. [PMID: 30693746 DOI: 10.1503/cjs.000118] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Few studies have compared the surgical results of single-incision robotic cholecystectomy (SIRC) with those of conventional laparoscopic cholecystectomy (CLC). The purpose of this study was to evaluate the relative clinical efficacy of SIRC by comparing the number of postoperative days, pain level and complications between the 2 surgical methods. Methods We retrospectively collected demographic, perioperative and postoperative data for all patients who underwent SIRC or CLC performed by a single surgeon from June 2016 to May 2017. Operative time was recorded, divided into anesthesia
time, docking time, console time and total operation time. Postoperative pain was measured with the Numerical Pain Rating Scale. Results A total of 121 patients underwent cholecystectomy during the study period, of whom 61 had SIRC and 60 had CLC. The mean total operation time of SIRC and CLC was 93.52 (SD 20.27) minutes and 37.67 (SD 19.73) minutes, respectively (p <
0.001). The total operation time excluding console time of SIRC was significantly longer than that of CLC (82.77 [SD 18.27] min v. 37.67 [SD 19.73] min) (p < 0.001). The mean Numerical Pain Rating Scale score was 4.73 (SD 1.23) (SIRC: 4.75
[SD 1.24]; CLC: 4.70 [SD 1.22]) (p = 0.8) within 1 hour after the operation; scores after 6 hours and 1 day decreased in a similar manner in the 2 groups (p = 0.1). Conclusion Postoperative pain, use of an additional port, complication rates, operation time and cost of SIRC were similar to or greater than those of CLC. Large randomized controlled trials are needed to examine the true benefits of SIRC.
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Affiliation(s)
- Sung Ryol Lee
- From the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyung Ook Kim
- From the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jun Ho Shin
- From the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Ohira M, Shibuya K, Uemura K, Takahashi H, Ito Y. Correlation between port-to-target distance and procedural difficulty in single-incision laparoscopic cholecystectomy: An observational study. Asian J Endosc Surg 2019; 12:255-263. [PMID: 30259708 DOI: 10.1111/ases.12652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 08/22/2018] [Accepted: 08/23/2018] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) is more challenging than conventional (multiport) laparoscopic cholecystectomy (CLC) because of the increased likelihood of instrument collision and the limited surgical workspace. In SILC, procedural difficulties may increase when the port-to-target distance is long. We aimed to assess the correlation between port-to-target distance and procedural difficulty. METHODS Thirty-six consecutive patients who underwent SILC at our hospital were included in this study. The umbilicus-to-Calot's triangle distance (UCD) was measured intraoperatively. The correlations between the UCD and operative time were analyzed, and for comparison, CLC cases during the same period (n = 28) were similarly analyzed. Moreover, UCD was estimated from preoperative CT (UCD-CT), and the usefulness of UCD-CT was assessed during SILC and CLC. RESULTS Thirty-four patients successfully underwent SILC. There were positive correlations between the UCD and pneumoperitoneum time. Multivariate linear regression analysis, including BMI and height, which were previously reported to have a correlation with longer operative time in SILC, showed that UCD is an independent predictive factor for prolonged operative duration. However, BMI and height were not independent predictive factors. UCD and UCD-CT had a very strong positive correlation; therefore, UCD was estimated from CT. UCD-CT had a strong positive correlation with operative time in SILC, but not in CLC. CONCLUSIONS A longer UCD is an important predictive factor for difficult cases of SILC, but this finding is not applicable in CLC. The usefulness of UCD is specific to SILC.
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Affiliation(s)
- Masafumi Ohira
- Department of Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.,Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuaki Shibuya
- Department of Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan.,Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuhito Uemura
- Department of Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Hiroaki Takahashi
- Department of Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Yoshio Ito
- Department of Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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Qu JW, Xin C, Wang GY, Yuan ZQ, Li KW. Feasibility and safety of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy in an ambulatory setting. Hepatobiliary Pancreat Dis Int 2019; 18:273-277. [PMID: 31056482 DOI: 10.1016/j.hbpd.2019.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy (LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) versus conventional LC in an ambulatory setting. METHODS Ninety-one patients were randomized to SILC (n = 49) or LC (n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. RESULTS There were significant differences in the operative time (46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC; P < 0.001). As compared with LC, SILC was associated with lower total costs (8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB; P < 0.001) and better cosmetic satisfaction (4.94 ± 0.24 vs. 4.74 ± 0.54; P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting (P > 0.05). CONCLUSIONS Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
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Affiliation(s)
- Jun-Wen Qu
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai 200127, China
| | - Cheng Xin
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai 200127, China
| | - Gui-Yang Wang
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai 200127, China
| | - Zhi-Qing Yuan
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai 200127, China
| | - Ke-Wei Li
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Shanghai 200127, China.
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Daliya P, Gemmill EH, Lobo DN, Parsons SL. A systematic review of patient reported outcome measures (PROMs) and quality of life reporting in patients undergoing laparoscopic cholecystectomy. Hepatobiliary Surg Nutr 2019; 8:228-245. [PMID: 31245403 PMCID: PMC6561890 DOI: 10.21037/hbsn.2019.03.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/22/2018] [Indexed: 12/12/2022]
Abstract
Patient reported outcome measures (PROMs) provide a valuable means of measuring outcomes subjectively from a patient's perspective, facilitating the assessment of service quality across healthcare providers, and assisting patients and clinicians in shared decision making. The primary aim of this systematic review was to critically appraise all historic studies evaluating patient reported quality of life, in adult patients undergoing laparoscopic cholecystectomy for symptomatic gallstones. The secondary aim was to perform a quality assessment of cholecystectomy-specific PROM-validation studies. A literature review was performed in PubMed, Google ScholarTM, the Cochrane Library, Medline, CINAHL, EMBASE and PsychINFO databases up to September 2017. Study characteristics, PROM-specific details and a bias assessment were summarised for non-validation studies. A COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) analysis was performed to assess the methodological quality of identified PROM-validation studies. Fifty one studies were found to evaluate health-related quality of life (HRQoL) after laparoscopic cholecystectomy. Although 94.1% of these studies included PROMs as a primary outcome measure, <20% provided level 1 evidence through randomised controlled trials (RCTs). There was significant variation in the selection and reporting of PROMs, with no studies declaring patient involvement in PROM selection, and 88.2% of studies failing to document the management of missing data points, or non-returned surveys (33.3%). In the 6 PROM-validation studies identified, only 5 psychometric properties were evaluated, the findings of which were limited due to the small number of studies. This systematic review identifies a lack in consistency of study design and PRO reporting in clinical trials. Whilst an increasing number of studies are being performed to evaluate PROs, a lack of adherence to existing PRO administration and reporting guidelines is continuing to negatively affect study quality. We recommend that future clinical trials utilizing PROs should adhere to established comprehensive guidelines as described.
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Affiliation(s)
- Prita Daliya
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
| | - Elizabeth H. Gemmill
- Department of General Surgery, Sherwood Forest Hospitals NHS Trust, King’s Mill Hospital, Sutton-in-Ashfield NG17 4JL, UK
| | - Dileep N. Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- MRC/ARUK Centre for Musculoskeletal Ageing Research, School of Life Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UK, UK
| | - Simon L. Parsons
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2UH, UK
- Trent Oesophago-Gastric Unit, City Hospital Campus, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
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Cawich SO, FaSiOen P, Singh Y, Francis W, Mohanty SK, Naraynsingh V, Dapri G. Single incision laparoscopic surgery from a caribbean perspective. Int J Surg 2019; 72S:13-18. [PMID: 31132463 DOI: 10.1016/j.ijsu.2019.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/16/2019] [Indexed: 12/20/2022]
Abstract
Conventional laparoscopy with multiple ports has recently gained a strong foothold in the Caribbean, but single incision laparoscopic surgery (SILS) has lagged behind. In this paper, we compare the data on SILS and conventional multi-port laparoscopy in the English-speaking Caribbean.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago.
| | - Patrick FaSiOen
- Department of Surgery, St Elizabeth Hospital, Dutch Caribbean, Curacao
| | - Yardesh Singh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Wesley Francis
- Department of Surgery, Princess Margaret Hosptial, Nassau, Bahamas
| | - Sanjib K Mohanty
- Department of Surgery, Cayman Islands Hospital, West Indies, Cayman Islands
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St. Augustine, West Indies, Trinidad and Tobago
| | - Giovanni Dapri
- Department of Surgery, Saint Pierre University Hospital, Brussels, Belgium
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30
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Gurusamy KS, Davidson BR. Gallstone Disease. EVIDENCE‐BASED GASTROENTEROLOGY AND HEPATOLOGY 4E 2019:342-352. [DOI: 10.1002/9781119211419.ch22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
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Stabilization of Single-incision Laparoscopic Cholecystectomy by Needle Puncture and Bendable Retractor. Surg Laparosc Endosc Percutan Tech 2018; 28:375-379. [DOI: 10.1097/sle.0000000000000539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ito E, Takai A, Imai Y, Otani H, Onishi Y, Yamamoto Y, Ogawa K, Tohyama T, Fukuhara S, Takada Y. Quality of life after single-incision laparoscopic cholecystectomy: A randomized, clinical trial. Surgery 2018; 165:353-359. [PMID: 30314725 DOI: 10.1016/j.surg.2018.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Controversy continues as to whether single-incision laparoscopic cholecystectomy, with the somewhat larger incision at the umbilicus, may lead to a worse postoperative quality of life and more pain compared with the more classic 4-port laparoscopic cholecystectomy. The aim of this study was to compare single-incision and 4-port laparoscopic cholecystectomy from the perspective of quality of life. METHODS This study was a multicenter, parallel-group, open-label, randomized clinical trial. A total of 120 patients who were scheduled to undergo elective cholecystectomy were randomly assigned 1:1 into the single-incision laparoscopic cholecystectomy or the 4-port laparoscopic cholecystectomy group and then assessed continuously for 2 weeks during the postoperative period. The primary outcome was quality of life, defined as the time to resume normal daily activities. Postoperative pain was also assessed. To explore the heterogeneity of treatment effects, we assessed the interactions of sex, age, and working status on recovery time. RESULTS A total of 58 patients in the single-incision group and 53 in the 4-port group (n = 111, 47 male, mean age 57 years) were analyzed. The mean time to resume daily activities was 10.2 days and 8.8 days, respectively, for single-incision and 4-port laparoscopic cholecystectomy (95% confidence interval -0.4 to 3.2, P = .12). Similarly, the time to relief from postoperative pain did not differ significantly between the groups. Statistically insignificant but qualitative interactions were noted; in the subgroups of women, full-time workers, and patients younger than 60 years, recovery tended to be slower after single-incision laparoscopic cholecystectomy. CONCLUSION Postoperative quality of life did not differ substantially between single-incision laparoscopic cholecystectomy and 4-port laparoscopic cholecystectomy. Patients younger than 60 years, women, and full-time workers tended to have a somewhat slower recovery after single-incision laparoscopic cholecystectomy.
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Affiliation(s)
- Eitaro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
| | - Akihiro Takai
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Yoshinori Imai
- Department of Gastrointestinal Surgery, Uwajima City Hospital, Uwajima, Ehime, Japan
| | - Hiromi Otani
- Department of Gastrointestinal Surgery, Ehime Prefectural Central Hospital, Matsuyama, Ehime, Japan
| | - Yoshihiro Onishi
- Institute for Health Outcomes & Process Evaluation Research (iHope International), Nakagyo-ku, Kyoto, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Taiji Tohyama
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Sakyo-ku, Kyoto, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan
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Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, Kehlet H, Schug S, Van de Velde M, Vercauteren M, Lirk P, Rawal N, Bonnet F, Lavand'homme P, Beloeil H, Raeder J, Pogatzki-Zahn E. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018; 121:787-803. [DOI: 10.1016/j.bja.2018.06.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
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Asakuma M, Komeda K, Yamamoto M, Shimizu T, Iida R, Taniguchi K, Inoue Y, Hirokawa F, Hayashi M, Okuda J, Kondo Y, Uchiyama K. A Concealed “Natural Orifice”: Umbilicus Anatomy for Minimally Invasive Surgery. Surg Innov 2018; 26:46-49. [DOI: 10.1177/1553350618797619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. A recent development in minimally invasive surgery (MIS) is single-port surgery, where a single large multiport trocar is placed in the umbilicus. All medical schools require that students complete an anatomy course as part of the medical curriculum. However, there is limited instruction regarding the detailed parts of the “umbilicus.” In several famous anatomy atlases, the umbilicus is not dissected at all and is merely represented as a button. Until now, the true nature of the umbilicus has not been anatomically demonstrated. Methods. Five cadavers were obtained from the Osaka Medical College medical student anatomy class. The umbilicus was dissected in the anatomy laboratory, to demonstrate all the layers. A detailed dissection was performed, focusing on the exact center of the umbilicus, in order to ascertain whether there exists a “natural orifice” or a fascial defect. Results. In all cadavers, a small defect of fascia was identified just below the center of the umbilicus. Yellow fatty tissue was present just below the skin in the exact center of the umbilicus. A probe placed exactly in the middle of this defect passes easily through into the abdominal cavity. Conclusions. With the widespread use of MIS, umbilical incision is commonly used to reduce pain and improve cosmetic results. This study consistently revealed a natural defect of fascia in the center of the umbilicus. Therefore, the umbilicus can be called a concealed “natural orifice.” It is important to recognize and utilize this defect effectively to minimize unnecessary tissue trauma during MIS.
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Affiliation(s)
| | | | | | | | - Ryo Iida
- Osaka Medical College, Osaka, Japan
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Migliore M, Arezzo A, Arolfo S, Passera R, Morino M. Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review. Surg Endosc 2018; 32:4716-4727. [PMID: 29943057 DOI: 10.1007/s00464-018-6300-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiport laparoscopic cholecystectomy (MLC) is the gold standard technique for cholecystectomy. In order to reduce postoperative pain and improve cosmetic results, the application of the single-incision laparoscopic cholecystectomy (SILC) technique was introduced, leading surgeons to face important challenges. Robotic technology has been proposed to overcome some of these limitations. The purpose of this review is to assess the safety of single-incision robotic cholecystectomy (SIRC) for benign disease. METHODS An Embase and Pubmed literature search was performed in February 2017. Randomized controlled trial and prospective observational studies were selected and assessed using PRISMA recommendations. Primary outcome was overall postoperative complication rate. Secondary outcomes were postoperative bile leak rate, total conversion rate, operative time, wound complication rate, postoperative hospital stay, and port site hernia rate. The outcomes were analyzed in Forest plots based on fixed and random effects model. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 13 studies provided data about 1010 patients who underwent to SIRC for benign disease of gallbladder. Overall postoperative complications rate was 11.6% but only 4/1010 (0.4%) patients required further surgery. A postoperative bile leak was reported in 3/950 patients (0.3%). Conversion occurred in 4.2% of patients. Mean operative time was 86.7 min including an average of 42 min should be added as for robotic console time. Wound complications occurred in 3.7% of patients. Median postoperative hospital stay was 1 day. Port site hernia at the latest follow-up available was reported in 5.2% of patients. CONCLUSIONS The use of the Da Vinci robot in single-port cholecystectomy seems to have similar results in terms of incidence and grade of complications compared to standard laparoscopy. In addition, it seems affected by the same limitations of single-port surgery, consisting of an increased operative time and incidence of port site hernia.
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Affiliation(s)
- Marco Migliore
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
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Cinar H, Topgul K, Malazgirt Z, Yuruker S, Buyukakincak S, Kesicioglu T, Tarim İA, Koc Z, Saglam Z. Early results of single-incision laparoscopic cholecystectomy in comparison with the conventional: Does it have any impact on quality of life? Ann Med Surg (Lond) 2018; 32:1-5. [PMID: 29928499 PMCID: PMC6008501 DOI: 10.1016/j.amsu.2018.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/10/2018] [Indexed: 02/08/2023] Open
Abstract
Background Laparoscopic cholecystectomy is the standard treatment for gallbladder diseases. In recent times, single-incision laparoscopic cholecystectomy(SILC) has developed as a less invasive alternative technique to conventional laparoscopy. In the literature, many studies have compared SILC and conventional laparoscopic cholecystectomy (CLC) procedures but a limited number of studies have compared the two techniques with regard to quality of life (QOL). The choice of surgical procedure was effected by QOL of the patients. The effects of SILC on QOL remain unclear. In this study, we aimed to compare the effects of conventional laparoscopic cholecystectomy (CLC) and single-incision laparoscopic cholecystectomy (SILC) procedures on the clinical outcomes and quality of life of patients by short-term follow-up evaluation. Material and methods In this study, 142 patients who underwent cholecystectomy operations with either technique underwent SILC and CLC were evaluated. The quality of life index in the patients was measured with short form 36 (SF 36) test. Results The results of mean operative time, length of stay and complication rate for SILC and CLC were similar. The postoperative health-related quality of life (HRQOL) scores were not significantly different between the SILC and CLC patients but only physical functioning score were higher in SILC patients. Conclusions SILC is a safe and effective alternative to CLC. To detect the effects of SILC on HRQOL, we need long-term prospective comparative studies.
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Affiliation(s)
- Hamza Cinar
- Ordu University Medical Faculty, Department of General Surgery, Ordu, Turkey
| | - Koray Topgul
- Anadolu Medical Center, General Surgery Department, Kocaeli, Turkey
| | - Zafer Malazgirt
- Medical Park Hospital, General Surgery Department, Samsun, Turkey
| | - Savas Yuruker
- Ondokuz Mayis University Medical Faculty, Department of General Surgery, Samsun, Turkey
| | - Sercan Buyukakincak
- Akçaabat Haçkalı Baba Public Hospital, Department of General Surgery, Trabzon, Turkey
| | - Tugrul Kesicioglu
- Giresun University Medical Faculty, Department of General Surgery, Giresun, Turkey
| | - İsmail Alper Tarim
- Ondokuz Mayis University Medical Faculty, Department of General Surgery, Samsun, Turkey
| | - Zeliha Koc
- Ondokuz Mayıs University, Health Science Faculty, Samsun, Turkey
| | - Zeynep Saglam
- Ondokuz Mayıs University, Health Science Faculty, Samsun, Turkey
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Matsui Y, Yamaki S, Hirooka S, Yamamoto T, Yanagimoto H, Satoi S, Kon M. Evaluation of relative criteria for single-incision laparoscopic cholecystectomy. Asian J Surg 2018; 41:216-221. [DOI: 10.1016/j.asjsur.2016.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/13/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022] Open
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Arezzo A, Passera R, Forcignanò E, Rapetti L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc 2018. [PMID: 29523982 DOI: 10.1007/s00464-018-6143-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the last decade, single-incision laparoscopic cholecystectomy (SLC) has gained popularity, although it is not evident if benefits of this procedure overcome the potential increased risk. Aim of the study is to compare the outcome of SLC with conventional multi-incision laparoscopic cholecystectomy (MLC) in a meta-analysis of randomized controlled trials only. METHODS A systematic Medline, Embase, and Cochrane Central Register of Controlled Trials literature search of articles on SLC and MLC for any indication was performed in June 2017. The main outcomes measured were overall adverse events, pain score (VAS), cosmetic results, quality of life, and incisional hernias. Linear regression was used to model the effect of each procedure on the different outcomes. RESULTS Forty-six trials were included and data from 5141 participants were analysed; 2444 underwent SLC and 2697 MLC, respectively. Mortality reported was nil in both treatment groups. Overall adverse events were higher in the SLC group (RR 1.41; p < 0.001) compared to MLC group, as well severe adverse events (RR 2.06; p < 0.001) and even mild adverse events (RR 1.23; p = 0.041). This was confirmed also when only trials including 4-port techniques (RR 1.37, p = 0.004) or 3-port techniques were considered (RR 1.89, p = 0.020). The pain score showed a standardized mean difference (SMD) of - 0.36 (p < 0.001) in favour of SLC. Cosmetic outcome by time point scored a SMD of 1.49 (p < 0.001) in favour of SLC. Incisional hernias occurred more frequently (RR 2.97, p = 0.005) in the SLC group. CONCLUSIONS Despite SLC offers a better cosmetic outcome and reduction of pain, the consistent higher rate of adverse events, both severe and mild, together with the higher rate of incisional hernias, should suggest to reconsider the application of single incision techniques when performing cholecystectomy with the existing technology.
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Affiliation(s)
- A Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
| | - R Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Forcignanò
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Rapetti
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - M Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
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Abaid RA, Zilberstein B. Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way. J Laparoendosc Adv Surg Tech A 2018; 28:7-12. [PMID: 28514179 DOI: 10.1089/lap.2017.0163] [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: 11/13/2022] Open
Abstract
BACKGROUND About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health. OBJECTIVE To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time. MATERIALS AND METHODS A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium. RESULTS A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery. CONCLUSIONS TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.
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Affiliation(s)
- Rafael Antoniazzi Abaid
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
| | - Bruno Zilberstein
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine , Sao Paulo, Brazil
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Obuchi T, Kameyama N, Tomita M, Mitsuhashi H, Miyata R, Baba S. Impact of obesity on surgical outcome after single-incision laparoscopic cholecystectomy. J Minim Access Surg 2018; 14:99-104. [PMID: 28695876 PMCID: PMC5869987 DOI: 10.4103/jmas.jmas_13_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Single-incision laparoscopic cholecystectomy (SILC) is widely used as a treatment option for gallbladder disease. However, obesity has been considered a relative contraindication to this approach due to more advanced technical difficulties. The aim of this report was to review our experience with SILC to evaluate the impact of body mass index (BMI) on the surgical outcome. Patients and Methods: Between May 2009 and February 2013, 237 patients underwent SILC at our institute. Pre- and post-operative data of the 17 obese patients (O-group) (BMI ≥30 kg/m2) and 220 non-obese patients (NO-group) (BMI <29.9 kg/m2) were compared retrospectively. SILC was performed under general anaesthesia, using glove technique. Indications for surgery included benign gallbladder disease, except for emergent surgeries. Results: Mean age of patients was significantly higher in the NO-group than O-group (58.9 ± 13.5 years vs. 50.8 ± 14.0 years, P = 0.025). SILC was successfully completed in 233 patients (98.3%). Four patients (1.7%) in the NO-group required an additional port, and one patient was converted to an open procedure. The median operative time was 70 ± 25 min in the NO-group and 75.2 ± 18.3 min in the O-group. All complications were minor, except for one case in the NO-group that suffered with leakage of the cystic duct stump, for which endoscopic nasobiliary drainage was need. Conclusion: Our findings show that obesity, intended as a BMI ≥30 kg/m2, does not have an adverse impact on the technical difficulty and post-operative outcomes of SILC. Obesity-related comorbidities did not increase the risks for SILC.
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Affiliation(s)
- Toru Obuchi
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Noriaki Kameyama
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Masato Tomita
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | | | - Ryohei Miyata
- Department of Surgery, International Goodwill Hospital, Yokohama, Japan
| | - Shigeaki Baba
- Department of Surgery, School of Medicine, Iwate Medical University, Iwate, Japan
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Byun GY, Lee SR, Koo BH. Safety of single-incision laparoscopic cholecystectomy for acute cholecystitis. ANZ J Surg 2017; 88:755-759. [PMID: 29124860 DOI: 10.1111/ans.14246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis. METHODS Patients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow-up. RESULTS In total, 1435 patients were included in this study: 220 (15.3%) in the acute group and 1215 (84.7%) in the chronic group. The mean operative time was longer in the acute group than in the chronic group (44.7 ± 21.6 versus 32.8 ± 9.8 min; P < 0.001). Insertion of additional ports was performed in 17 patients: six in the acute group and 11 in the chronic group. Conversion to abdominal laparotomy was performed in eight patients: one in the acute group and seven in the chronic group. The mean post-operative hospital stay was 31.7 ± 20.4 h in the acute group and 27.7 ± 13.7 h in the chronic group. The complication rate was similar between the acute (n = 8, 3.6%) and chronic (n = 33, 2.7%) groups. CONCLUSION SILC does not increase the complication rate and is a safe and feasible technique for both chronic and acute cholecystitis.
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Affiliation(s)
| | - Sung Ryul Lee
- Department of Surgery, Damsoyu Hospital, Seoul, Korea
| | - Bum Hwan Koo
- Department of Surgery, Damsoyu Hospital, Seoul, Korea
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Haueter R, Schütz T, Raptis DA, Clavien PA, Zuber M. Meta-analysis of single-port versus conventional laparoscopic cholecystectomy comparing body image and cosmesis. Br J Surg 2017; 104:1141-1159. [PMID: 28569406 DOI: 10.1002/bjs.10574] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/29/2016] [Accepted: 03/29/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate improvements in cosmetic results and postoperative morbidity for single-incision laparoscopic cholecystectomy (SILC) in comparison with multiport laparoscopic cholecystectomy (MLC). METHODS A literature search was undertaken for RCTs comparing SILC with MLC in adult patients with benign gallbladder disease. Primary outcomes were body image and cosmesis scores at different time points. Secondary outcomes included intraoperative and postoperative complications, postoperative pain and frequency of port-site hernia. RESULTS Thirty-seven RCTs were included, with a total of 3051 patients. The body image score favoured SILC at all time points (short term: mean difference (MD) -2·09, P < 0·001; mid term: MD -1·33, P < 0·001), as did the cosmesis score (short term: MD 3·20, P < 0·001; mid term: MD 4·03, P < 0·001; long-term: MD 4·87, P = 0·05) and the wound satisfaction score (short term: MD 1·19, P = 0·03; mid term: MD 1·38, P < 0·001; long-term: MD 1·19, P = 0·02). Duration of operation was longer for SILC (MD 13·56 min; P < 0·001) and SILC required more additional ports (odds ratio (OR) 6·78; P < 0·001). Postoperative pain assessed by a visual analogue scale (VAS) was lower for SILC at 12 h after operation (MD in VAS score -0·80; P = 0·007). The incisional hernia rate was higher after SILC (OR 2·50, P = 0·03). All other outcomes were similar for both groups. CONCLUSION SILC is associated with better outcomes in terms of cosmesis, body image and postoperative pain. The risk of incisional hernia is four times higher after SILC than after MLC.
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Affiliation(s)
- R Haueter
- Department of Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | - T Schütz
- Department of Surgery, Cantonal Hospital Olten, Olten, Switzerland
| | - D A Raptis
- Department of Surgery, Cantonal Hospital Olten, Olten, Switzerland
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - P-A Clavien
- Department of Visceral and Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
| | - M Zuber
- Department of Surgery, Cantonal Hospital Olten, Olten, Switzerland
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Rose JB, Hawkins WG. Diagnosis and management of biliary injuries. Curr Probl Surg 2017; 54:406-435. [DOI: 10.1067/j.cpsurg.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/20/2017] [Indexed: 12/11/2022]
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Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 2017; 32:14-23. [DOI: 10.1007/s00464-017-5717-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/10/2017] [Indexed: 02/07/2023]
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Omar MA, Redwan AA, Mahmoud AG. Single-incision versus 3-port laparoscopic cholecystectomy in symptomatic gallstones: A prospective randomized study. Surgery 2017; 162:96-103. [DOI: 10.1016/j.surg.2017.01.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/30/2016] [Accepted: 01/10/2017] [Indexed: 02/07/2023]
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Xu L, Tan H, Liu L, Si S, Sun Y, Huang J, Atyah M, Yang Z. A randomized controlled trial for evaluation of lower abdominal laparoscopic cholecystectomy. MINIM INVASIV THER 2017; 27:105-112. [PMID: 28537508 DOI: 10.1080/13645706.2017.1327445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To improve minimally invasive outcomes, we designed a new procedure, lower abdominal laparoscopic cholecystectomy (LALC). This study was conducted to evaluate the effects of LALC versus classical (CLC) and single-incision (SILC) laparoscopic cholecystectomy on reducing systemic acute inflammatory response, improving cosmesis, and postoperative pain relief. MATERIAL AND METHODS Beginning from July 2014, 105 patients meeting the inclusion criteria were randomly assigned to three groups: LALC, CLC, and SILC. The primary endpoint was the determination of systemic inflammatory response to the surgery. Other outcome measures included cosmesis, postoperative pain, and perioperative indices. RESULTS Each of the three groups consisted of 35 patients. The duration of the operation was significantly longer in the SILC group (p= .005). The rates of adverse events were similar. Changes in interleukin-6 (p = .001) and tumor-necrosis factor-α (p = .016) measured before and after surgery differed significantly; patients who underwent LALC had the smallest change in inflammatory response. Cosmesis scores at one (p = .002) and 12 (p = .004) weeks after surgery favored LALC and SILC. Significant differences in pain scores at four (p = .011) and 12 h (p = .024) postoperatively were also observed. CONCLUSIONS In selected patients, LALC shows more advantages in terms of lower systemic inflammatory response, improved cosmesis, and a favorable postoperative pain profile when compared with CLC and SILC.
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Affiliation(s)
- Li Xu
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Haidong Tan
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Liguo Liu
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Shuang Si
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Yongliang Sun
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Jia Huang
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Manar Atyah
- b Peking University Health Science Center , Beijing , PR China
| | - Zhiying Yang
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
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Patient Body Image and Satisfaction with Surgical Wound Appearance After Reduced Port Surgery for Colorectal Diseases. World J Surg 2017; 40:1748-54. [PMID: 27094561 DOI: 10.1007/s00268-016-3414-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The use of reduced port surgery (RPS) is increasing in the field of colorectal surgery. It is considered to offer advantages over conventional multiport surgery (MPS) in terms of decreased invasiveness and superior cosmesis. However, to date there has been no study that evaluates patient satisfaction after undergoing RPS for colorectal diseases. Herein, we present a questionnaire-based study to address this issue. METHODS Questionnaires were sent by mail to 216 patients who underwent RPS and 145 who underwent MPS. Patient's satisfaction with cosmesis and body image after colorectal surgery was assessed using a validated Body Image Questionnaire (BIQ) and Photo Series Questionnaire (PSQ). RESULTS A total of 76.9 % (166/216) of the RPS patients and 70.3 % (102/145) of the MPS patients returned the questionnaires. BIQ scores gradually improved after surgery, and were more positive overall in the RPS group compared to the MPS group. RPS patients marked significantly better PSQ scores than MPS patients (P < 0.05). In RPS subset analysis, patients with single port surgery (SPS) rated better PSQ scores than patients with SPS with additional port insertion (P < 0.05). CONCLUSION We find that RPS, especially SPS, enhances patient satisfaction by reducing abdominal wall trauma. This new advantage of RPS may prove valuable in its consideration as an option in laparoscopic colorectal surgery.
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Araki K, Shirabe K, Watanabe A, Kubo N, Sasaki S, Suzuki H, Asao T, Kuwano H. Risk factors for an additional port in single-incision laparoscopic cholecystectomy in patients with cholecystitis. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 64:245-249. [PMID: 28954990 DOI: 10.2152/jmi.64.245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Although single-incision laparoscopic cholecystectomy is now widely performed in patients with cholecystitis, some cases require an additional port to complete the procedure. In this study, we focused on risk factor of additional port in this surgery. We performed single-incision cholecystectomy in 75 patients with acute cholecystitis or after cholecystitis between 2010 and 2014 at Gunma University Hospital. Surgical indications followed the TG13 guidelines. Our standard procedure for single-incision cholecystectomy routinely uses two needlescopic devices. We used logistic regression analysis to identify the risk factors associated with use of an additional full-size port (5 or 10 mm). Surgical outcome was acceptable without biliary injury. Nine patients (12.0%) required an additional port, and one patient (1.3%) required conversion to open cholecystectomy because of severe adhesions around the cystic duct and common bile duct. In multivariate analysis, high C-reactive protein (CRP) values (>7.0 mg/dl) during cholecystitis attacks were significantly correlated with the need for an additional port (P = 0.009), with a sensitivity of 55.6%, specificity of 98.5%, and accuracy of 93.3%. This study indicated that the severe inflammation indicated by high CRP values during cholecystitis attacks predicts the need for an additional port. J. Med. Invest. 64: 245-249, August, 2017.
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Affiliation(s)
- Kenichiro Araki
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
- Department of General Surgical Science, Gunma University Graduate School of Medicine
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
| | - Akira Watanabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
- Department of General Surgical Science, Gunma University Graduate School of Medicine
| | - Norio Kubo
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine
- Department of General Surgical Science, Gunma University Graduate School of Medicine
| | - Shigeru Sasaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine
| | - Hideki Suzuki
- Department of General Surgical Science, Gunma University Graduate School of Medicine
| | - Takayuki Asao
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine
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Guo W, Liu Y, Han W, Liu J, Jin L, Li JS, Zhang ZT. Randomized Trial of Immediate Postoperative Pain Following Single-incision Versus Traditional Laparoscopic Cholecystectomy. Chin Med J (Engl) 2016; 128:3310-6. [PMID: 26668145 PMCID: PMC4797506 DOI: 10.4103/0366-6999.171422] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND We undertook a randomized controlled trial to ascertain if single-incision laparoscopic cholecystectomy (SILC) was more beneficial for reducing postoperative pain than traditional laparoscopic cholecystectomy (TLC). Moreover, the influencing factors of SILC were analyzed. METHODS A total of 552 patients with symptomatic gallstones or polyps were allocated randomly to undergo SILC (n = 138) or TLC (n = 414). Data on postoperative pain score, operative time, complications, procedure conversion, and hospital costs were collected. After a 6-month follow-up, all data were analyzed using the intention-to-treat principle. RESULTS Among SILC group, 4 (2.9%) cases required conversion to TLC. Mean operative time of SILC was significantly longer than that of TLC (58.97 ± 21.56 vs. 43.38 ± 19.02 min, P < 0.001). The two groups showed no significant differences in analgesic dose, duration of hospital stay, or cost. Median pain scores were similar between the two groups 7 days after surgery, but SILC-treated patients had a significantly lower median pain score 6 h after surgery (10-point scale: 3 [2, 4] vs. 4 [3, 5], P = 0.009). Importantly, subgroup analyses of operative time for SILC showed that a longer operative time was associated with greater prevalence of pain score >5 (≥100 min: 5/7 patients vs. <40 min, 3/16 patients, P = 0.015). CONCLUSIONS The primary benefit of SILC appears to be slightly less pain immediately after surgery. Surgeon training seems to be important because the shorter operative time for SILC may elicit less pain immediately after surgery.
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Affiliation(s)
| | | | | | | | | | | | - Zhong-Tao Zhang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University; National Clinical Research Center for Digestive Disease, Beijing Friendship Hospital, Beijing 100050, China
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Alekberzade AV, Lipnitsky EM, Krylov NN, Sundukov IV, Badalov DA. [Single-port laparoscopic cholecystectomy: advantages and disadvantages]. Khirurgiia (Mosk) 2016:19-24. [PMID: 27905368 DOI: 10.17116/hirurgia20161119-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To analyze the outcomes of single-port laparoscopic cholecystectomy. MATERIAL AND METHODS Early and long-term postoperative period has been analyzed in 240 patients who underwent laparoscopic cholecystectomy (LCE) including 120 cases of single-port technique and 120 cases of four-port technique. Both groups were compared in surgical time, pain syndrome severity (visual analog scale), need for analgesics, postoperative complications, hospital-stay, daily activity recovery and return to physical work, patients' satisfaction of surgical results and their aesthetic effect. RESULTS It was revealed that single-port LCE is associated with lower severity of postoperative pain, quick recovery of daily activity and return to physical work, high satisfaction of surgical results and their aesthetic effect compared with four-port LCE. Disadvantages of single-port LCE include longer duration of surgery, high incidence of postoperative umbilical hernia. However hernia was predominantly observed during the period of surgical technique development. CONCLUSION Further studies to standardize, evaluate the safety and benefits of single-port LCE are necessary.
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Affiliation(s)
- A V Alekberzade
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - E M Lipnitsky
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - N N Krylov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - I V Sundukov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
| | - D A Badalov
- Sechenov First Moscow State Medical University, Ministry of Health of the Russian Federation, Moscow, Russia
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