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A Comparative Study of Needlescopic Grasper Assisted Single Incision versus Three-Port versus Pure Single Incision Laparoscopic Cholecystectomy. THE JOURNAL OF MINIMALLY INVASIVE SURGERY 2019; 22:171-176. [PMID: 35601375 PMCID: PMC8980142 DOI: 10.7602/jmis.2019.22.4.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 07/29/2019] [Accepted: 08/26/2019] [Indexed: 11/16/2022]
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) is a surgical method to treat gallbladder disease designed to reduce postoperative pain and improve cosmetic results. However, pure SILC (pSILC) has several inherent limitations. In this study, we report the surgical outcomes of SILC with needlescopic grasper (nSILC) compared with those of pSILC and conventional three-port laparoscopic cholecystectomy (TPLC). Methods This retrospective study enrolled 103 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease in our hospital between January 2013 and January 2015. Among them, 33 patients underwent pSILC, 35 underwent nSILC, and 35 underwent TPLC. We collected demographic characteristics and operative data to analyze outcomes between groups. Results All procedures were done by laparoscopy and the gallbladder of each patient was completely removed. Women and younger patients were more to undergo SILC than TPLC. Analysis showed that the operation time of the nSILC group was longer than that of the TPLC group, but shorter than that of the pSILC group (skin to skin operation time [pSILC: 65.2±19.1 min, nSILC: 49.7±12.9 min, and TPLC: 43.4±14.7 min, p<0.001], and major procedure time [pSILC: 42.2±18.7 min, nSILC: 25.9±8.9 min, and TPLC: 23.4±12.7 min, p<0.001]). There were no significant differences between the groups for patient visual analogue scale score, length of hospital stay, or intraoperative blood loss. Conclusion nSILC is feasible surgical method in patients with benign gallbladder disease compared to TPLC, and that is an effective procedure to overcome the disadvantage of pSILC.
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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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Feasibility of Single-Port Cholecystectomy With Wound Retractor and a Glove in a Rural Hospital in Mexico. Int Surg 2018. [DOI: 10.9738/intsurg-d-15-00061.1] [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] Open
Abstract
Laparoscopic surgery has been established as the standard therapy for symptomatic cholecystolithiasis. Now, single-port cholecystectomy is a surgical option. Due to the need of special laparoscopic instruments and devices, the cost of the surgery is significantly increased, limiting its popularity in most medical centers in developing countries, especially in rural areas. This paper's objective was to show the safety, reproducibility, and feasibility of single-port laparoscopic cholecystectomy using conventional laparoscopic equipment, a wound retractor, and a sterile glove in a rural hospital in Mexico. A prospective study was carried out from July to October 2014. Patients diagnosed with uncomplicated cholecystolithiasis who agreed to participate were operated with this technique. Complications, operative time, bleeding, evolution, and length of hospital stay were recorded. A total of 24 women went onto surgery under this approach. A mean follow-up of 71 days was completed. No incisional hernias, bile duct injuries, wound infection, nor death was presented. Surgical time and cost were not significantly increased compared to conventional laparoscopic approach. Most patient discharge was done the same day of the surgery. Single-port laparoscopic cholecystectomy is a cost-effective procedure, which can be performed in all hospitals where an Alexis retractor and conventional laparoscopic equipment is available. There was no increase of surgical morbidity. The single-port cholecystectomy is a technically feasible and safe surgical option in selected patients and can be easily performed in rural hospitals at a low cost, providing the benefits of the single incision.
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A promising technique for easier single incision laparoscopic cholecystectomy: needle grasper traction of gallbladder. Wideochir Inne Tech Maloinwazyjne 2018; 13:358-365. [PMID: 30302149 PMCID: PMC6174160 DOI: 10.5114/wiitm.2018.75849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) is the primary treatment method for benign gallbladder diseases. Single incision laparoscopic cholecystectomy (SILC) was reported to be superior in terms of work return, cosmetic results, and post-operative pain, but limited maneuver capacity and overlapping of hand tools are technical difficulties associated with SILC that endanger patient safety. Aim To perform SILC using a needle grasper for gallbladder traction, thus simplifying the dissection of Calot's triangle. Material and methods The files of patients who underwent elective LC for gallbladder stone and polyps in general surgery clinics between December 2013 and December 2014 were analyzed retrospectively. The patients were divided into two groups: needle-grasper-assisted SILC (nSILC) and conventional laparoscopic cholecystectomy (CLC). Age, gender, height, weight, body mass index, visual analog scale (VAS) scores, ASA score, duration of operation, duration of post-operative hospital stay, complications, drain use, conversion to open and conventional technique, and oral feeding beginning time were analyzed. Results There were no per-operative or post-operative complications in either of the groups, and no significant differences were found between the groups in terms of complications. The mean duration of the operation was significantly longer in the nSILC group. There was no difference between the groups in terms of hospital stay. The mean visual analogue scale (VAS) scores in conventional nSILC were significantly lower for all hours. The patient satisfaction in terms of cosmetic results was better in the nSILC group. Conclusions Needle-grasper-assisted SILC reduces the number of tools that need to be held by surgeons; it also provides safe dissection, better cosmetic results, and less post-operative pain in elective cases.
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Kim TS, Kim KH, An CH, Kim JS. Single center experiences of needle-scopic grasper assisted single incision laparoscopic cholecystectomy for gallbladder benign disease: comparison with conventional 3-port laparoscopic cholecystectomy. Ann Surg Treat Res 2016; 91:233-238. [PMID: 27847795 PMCID: PMC5107417 DOI: 10.4174/astr.2016.91.5.233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 07/15/2016] [Accepted: 08/08/2016] [Indexed: 12/30/2022] Open
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) has some technical problems. Our group has performed needlescopic grasper assisted SILC (nSILC) to overcome these problems. In this study, we introduce our technique and evaluate the safety and feasibility of this technique compared with the conventional laparoscopic cholecystectomy (CLC). Methods The medical records of 485 patients who received nSILC and CLC were reviewed retrospectively. Surgical outcomes including operative time, hospital stay, postoperative pain and perioperative complication were compared between the 2 techniques. Results Although wound complications were developed more frequently in nSILC group, there was no significant difference between groups in other surgical outcomes. In subgroup analysis, surgical outcomes of nSILC were similar with those of CLC not only in easy group but also in difficult group. Conclusion It seems that nSILC is safe and feasible not only in selected patients but also in difficult cases such as acute cholecystitis.
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Affiliation(s)
- Tae-Seok Kim
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Kee-Hwan Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Chang-Hyeok An
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
| | - Jeong-Soo Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea
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Escobar-Dominguez JE, Garcia-Quintero P, Hernandez-Murcia C, Verdeja JC. Outcomes in laparoscopic cholecystectomy by single incision with SPIDER surgical system are comparable to conventional multiport technique: one surgeon's experience. Surg Endosc 2016; 30:4793-4799. [PMID: 26932549 DOI: 10.1007/s00464-016-4809-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/03/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy has emerged as an alternative to conventional multiport laparoscopic cholecystectomy (LC). Technical difficulty, prolonged surgical times and increased complication rates have been reported in single-incision laparoscopic surgery. One of the concerns is lack of triangulation of instruments. The SPIDER® surgical system is a single-incision laparoscopic device that utilizes flexible instruments with the purpose of achieving adequate triangulation. The purpose of this study is to compare the outcomes of SPIDER versus LC. METHODS A retrospective chart review of patients who underwent LC and SPIDER cholecystectomy by a single surgeon during a concurrent 44-month period at Baptist Health South Florida hospitals was performed focusing on demographics, indication for surgery, complications and incisional hernia rates. Exclusion criteria were concomitant surgery and hernia repair at the time of surgery. RESULTS A total of 612 patients underwent minimally invasive cholecystectomy: 279 cases for SPIDER cholecystectomy and 333 for multiport LC. Baseline differences in patient characteristics between the SPIDER and LC groups were statistically significant. The SPIDER group had younger and healthier patients (lower ASA classification scores) with predominant diagnosis of cholelithiasis (69 %) compared to the LC group which had more complex cases. Total complications rate for both SPIDER and LC were 0.4 % (n = 1) and 3 % (n = 10), respectively. Conversion to open cholecystectomy occurred in one patient from the LC group (0.3 %). Conversion rate from SPIDER to additional ports or LC was performed in 5 cases (1.8 %) with no conversions to open surgery. Hemoperitoneum was reported in 2 cases, one for each approach, requiring reoperation. CONCLUSION Single-incision laparoscopic cholecystectomy with SPIDER is a safe and feasible technique with similar outcomes to multiport LC. However, statistical significant difference was reported in baseline characteristics of both groups. No incisional hernias were reported in this case series for either technique.
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Affiliation(s)
| | - Pedro Garcia-Quintero
- Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA
| | | | - Juan-Carlos Verdeja
- Baptist Health Medical Group - General Surgery, Baptist Health South Florida, Miami, FL, USA. .,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA.
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He GL, Jiang ZS, Cheng Y, Lai QB, Zhou CJ, Liu HY, Gao Y, Pan MX, Jian ZX. Tripartite comparison of single-incision and conventional laparoscopy in cholecystectomy: A multicenter trial. World J Gastrointest Endosc 2015; 7:540-546. [PMID: 25992193 PMCID: PMC4436922 DOI: 10.4253/wjge.v7.i5.540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 02/09/2015] [Accepted: 04/07/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare the characteristics of two single-incision methods, and conventional laparoscopy in cholecystectomy, and demonstrate the safety and feasibility.
METHODS: Three hundred patients with gallstones or gallbladder polyps were admitted to two clinical centers from January 2013 to January 2014 and were randomized into three groups of 100: single-incision three-device group, X-Cone group, and conventional group. The operative time, intraoperative blood loss, complications, postoperative pain, cosmetic score, length of hospitalization, and hospital costs were compared, with a follow-up duration of 1 mo.
RESULTS: A total of 142 males (47%) and 158 females (53%) were enrolled in this study. The population characteristics of these three groups is no significant differences exist in terms of age, sex, body mass index and American Society of Anesthesiology (P > 0.05). In results, there were no significant differences in blood loss, length of hospitalization, postoperative complications.The operative time in X-Cone group was significantly longer than other groups.There were significant differences in postoperative pain scores and cosmetic scores at diffent times after surgery (P < 0.05).
CONCLUSION: This study shows that this two single-incision methods are safe and feasible. Both methods are superior to the conventional procedure in cosmetic and pain scores.
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Escobar-Dominguez JE, Hernandez-Murcia C, Gonzalez AM. Description of robotic single site cholecystectomy and a review of outcomes. J Surg Oncol 2015; 112:284-8. [PMID: 25973731 DOI: 10.1002/jso.23931] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/19/2015] [Indexed: 12/30/2022]
Abstract
New technologies have been developed to make laparoscopic cholecystectomy less invasive through single incision laparoscopic surgery (SILS), however this approach has its own limitations. Single incision robotic surgery (SIRC) is designed to overcome them. The concerns that limit adoption of this technology are attributed increases in costs, prolonged learning curves and surgical times. Here, we provide a literature review as well as our own experience with SIRC, with the intent to clarify these important concerns.
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Affiliation(s)
| | | | - Anthony M Gonzalez
- Baptist Health Medical Group -General Surgery, Baptist Health South Florida, Miami, Florida
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Cawich SO, Thomas D, Hassranah D, Naraynsingh V. Evolution of SILS Cholecystectomy in the Caribbean: The Direct Transfascial Puncture Technique Using Conventional Instruments without Working Ports. Case Rep Surg 2014; 2014:164342. [PMID: 25349766 PMCID: PMC4202274 DOI: 10.1155/2014/164342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/15/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Single incision laparoscopic cholecystectomy (SILC) has become accepted as an alternative to conventional multiport cholecystectomy. However, SILC is still limited in applicability in low resource centres due to the expense associated with specialized access platforms, curved instruments, and flexible scopes. Presentation of Case. We present three cases where a modified SILC technique was used with conventional instruments and no working ports. The evolution of this technique is described. Discussion. In order to contain cost, we used conventional instruments and three transfascial ports placed in an umbilical incision, but we noted significant instrument clashes that originated at the port platforms. Therefore, we modified our technique by omitting ports for the working instruments. The technique allowed us to exchange instruments as necessary, maximized ergonomics, and prevented collisions from the bulky port platforms. Finally, the puncture left by the instrument alone did not require fascial closure at the termination of the procedure. Conclusion. The direct transfascial puncture using conventional laparoscopic instruments without working ports is a feasible option that minimizes cost and increases ergonomics.
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Affiliation(s)
- Shamir O. Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Dexter Thomas
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Dale Hassranah
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine, Trinidad and Tobago
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Tamini N, Rota M, Bolzonaro E, Nespoli L, Nespoli A, Valsecchi MG, Gianotti L. Single-incision versus standard multiple-incision laparoscopic cholecystectomy: a meta-analysis of experimental and observational studies. Surg Innov 2014; 21:528-545. [PMID: 24608182 DOI: 10.1177/1553350614521017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The advantages of single-incision surgery for the treatment of gallstone disease is debated. Previous meta-analyses comparing single-incision laparoscopic cholecystectomy (SILC) and standard laparoscopic multiport cholecystectomy (SLMC) included few and underpowered trials. To overcome this limitation, we performed a meta-analysis of randomized and nonrandomized studies. METHODS A MEDLINE, EMBASE, and Cochrane Library literature search of studies published in and comparing SILC with SLMC was performed. The primary outcome was safety of SILC as measured by the overall rate of postoperative complications and biliary spillage. Feasibility was another primary outcome as measured by the conversion and operative time. Postoperative pain, length of hospital stay, perioperative blood loss, time to return to normal activity, and cosmetic satisfaction were secondary outcomes. RESULTS We identified 43 studies of which 30 were observational reports and 13 experimental trials, for a total of 7489 patients (2090 SILC and 5389 SLMC). The overall rate of complications was comparable between groups (relative risk [RR] = 1.08; 95% CI = 0.87-1.35; P = .46), as were the rates of biliary spillage (RR = 1.16; 95% CI = 0.73-1.84; P = .53) and conversion rate (RR = 0.88; 95% CI = 0.53-1.46; P = .62). Operative time was in favor of SLMC (weighted mean difference = 0.73; 95% CI = 0.67-0.79; P < .0001). Secondary outcomes favored SILC, but with marginal advantages. CONCLUSIONS SILC is a feasible technique but without any significant advantage over SLMC for relevant end points. Although secondary outcomes favored SILC, the small magnitude of the advantage and the low quality of assessment methods question the clinical significance of these benefits.
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Affiliation(s)
- Nicolò Tamini
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Matteo Rota
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Elisa Bolzonaro
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Luca Nespoli
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | - Angelo Nespoli
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
| | | | - Luca Gianotti
- Milano-Bicocca University, San Gerardo Hospital, Monza, Italy
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Yang YS, Oh KY, Hur MH, Kim SY, Yim HS. Laparoendoscopic single-site surgery using conventional laparoscopic instruments and glove port technique in gynecology: a single surgeon's experience. J Minim Invasive Gynecol 2014; 22:87-93. [PMID: 25051536 DOI: 10.1016/j.jmig.2014.07.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 11/30/2022]
Abstract
STUDY OBJECTIVE To report a single surgeon's experience with 120 laparoendoscopic single-site surgery (LESS) procedures using conventional laparoscopic instruments and a homemade glove port system to treat benign gynecologic diseases. DESIGN Retrospective chart analysis (Canadian Task Force classification III). SETTING Eulji University Hospital. PATIENTS One hundred twenty patients who underwent LESS performed by a single surgeon to treat benign gynecologic diseases between November 2010 and November 2012. INTERVENTION LESS using conventional instrumentation was performed using our specialized glove port technique, which consists of the combination of the homemade glove port system designed to minimalize collision of the trocar on the tip of the finger of the surgical glove, a sufficient rectus fasciotomy, the surgeon's position at the patient's head, and adequate positioning of the instruments. MEASUREMENTS AND MAIN RESULTS The LESS procedures performed were laparoscopically assisted vaginal hysterectomy (n = 50), ovarian cystectomy (n = 25), myomectomy (n = 14), oophorectomy (n = 11), salpingectomy (n = 9), fimbrioplasty or neosalpingstomy (n = 7), and adhesiolysis only (n = 4). Median patient age was 40 years, and median body mass index was 23. Median operative time was 100 minutes (range, 50-145 minutes) for laparoscopically assisted vaginal hysterectomy, 70 minutes (range, 30-150 minutes) for ovarian cystectomy, 107 minutes (range, 65-180 minutes) for myomectomy, 55 minutes (range, 25-130 minutes) for oophorectomy, 85 minutes (range, 35-110 minutes) for salpingectomy, 70 minutes (range, 25-140 minutes) for neosalpingostomy or fimbrioplasty, and 35 minutes (range, 30-60-minutes) for adhesiolysis only. All procedures were completed successfully without the need for additional ports or conversion to the standard laparoscopic approach. One perioperative complication occurred. The complication rate was 83% (1 of 120). Other postoperative complications were not observed at follow-up. CONCLUSION Our experience shows that LESS using conventional laparoscopic instruments and our glove port technique is a feasible and safe technique for the surgical management of various gynecologic conditions. Therefore, our homemade glove port laparoscopic system used in our specialized technique provides a simple, cost-effective approach to LESS and would probably make laparoscopic procedures using conventional instruments easier.
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Affiliation(s)
- Yun Seok Yang
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea.
| | - Kwoan Young Oh
- Division of Gynecologic Endoscopy, Department of Obstetrics and Gynecology, Eulji University, Daejeon, Korea
| | - Myung Haeng Hur
- Department of Nursing, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea
| | - Soo Young Kim
- Department of Preventive Medicine, Eulji University, Daejeon, Korea; Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea
| | - Hyun Soon Yim
- Research Institute of IT Convergence Medicine, Eulji University, Daejeon, Korea; Yim Hyun Soon Obstetrics and Gynecology Clinic, Daejeon, Korea
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Single-incision versus conventional laparoscopic cholecystectomy in patients with uncomplicated gallbladder disease: a meta-analysis. Surg Laparosc Endosc Percutan Tech 2013; 22:487-97. [PMID: 23238374 DOI: 10.1097/sle.0b013e3182685d0a] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard treatment for cholecystectomy. Recently, single-incision laparoscopic cholecystectomy (SILC) has been suggested as an alternative technique. METHODS Six databases were searched and reference lists of retrieved articles were checked to identify eligible studies. Data from randomized clinical trials related to the safety and effectiveness of SILC versus conventional laparoscopic cholecystectomy (CLC) were extracted by 2 independent reviewers. Odds ratio and mean differences were calculated with 95% confidence intervals based on intention-to-treat analyses whenever possible. RESULTS Fifteen studies with 1113 patients met the eligibility criteria. Methodologic quality was unclear in most trails. Operating time was significantly longer in the single-incision laparoscopic surgery group compared with the CLC group (P<0.00001). Cosmesis was improved in single-incision laparoscopic patients at 1 month (P<0.00001). The pooled mean difference in pain scores at 24 hours was -0.75 in favor of the SILC technique (P=0.04). There was no significant difference in the conversion rates, adverse events, analgesia requirements, or the length of hospital stay between the 2 groups. CONCLUSIONS The current evidence shows that patients with uncomplicated cholelithiasis or polypoid lesions of the gallbladder who prefer a better cosmetic outcome, SILC offers a safe alternative to CLC. Further high-powered randomized trials are need to determine whether SILC truly offer any advantages, especially be focused on failure of technique, adverse events, cosmesis, and quality of life.
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Buzad FA, Corne LM, Brown TC, Fagin RS, Hebert AE, Kaczmarek CA, Pack AN, Payne TN. Single-site robotic cholecystectomy: efficiency and cost analysis. Int J Med Robot 2013; 9:365-70. [PMID: 23640914 DOI: 10.1002/rcs.1507] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Single-incision surgery has gained in popularity, and the recent development of specialized robotic and laparoscopic instruments may remove some of the ergonomic and technical difficulties associated with this approach. However, questions of cost and efficiency remain. METHODS We prospectively collected perioperative outcome and efficiency (operative time, case volume) data for our single-site robotic cholecystectomy cases and retrospectively reviewed data for our single-incision laparoscopic cholecystectomy cases. RESULTS There were no differences in patient characteristics or perioperative outcomes between the robotic (n = 20) and laparoscopic (n = 10) groups; operative times were equivalent (84.6 vs 85.5 min; p = 0.8737) and blood loss and complications were minimal. There was a higher robotic case volume, with an average of two robotic cases (range 1-4)/day vs one/day for laparoscopic cases (range 1-1; p = 0.0306). Streamlined instrument costs were essentially equivalent. CONCLUSIONS Robotic single-site cholecystectomy is a safe, cost-effective alternative to single-incision laparoscopic cholecystectomy in a robot-existing model.
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Affiliation(s)
- Francis A Buzad
- Texas Institute for Robotic Surgery and Austin Diagnostic Clinic, Austin, TX, USA
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