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Ayyaz FM, Joyner J, Cheetham M, Briggs TWR, Gray WK. Association of day-case rates with post COVID-19 recovery of elective laparoscopic cholecystectomy activity across England. Ann R Coll Surg Engl 2025; 107:54-60. [PMID: 38563060 PMCID: PMC11658879 DOI: 10.1308/rcsann.2023.0111] [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] [Accepted: 11/28/2023] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION The aim of this study was to investigate the safety of day-case laparoscopic cholecystectomy, and the association between day-case rates and, post the COVID-19 pandemic, recovery of activity to prepandemic levels for integrated care boards (ICBs) in England. METHODS This was a retrospective observational study of the Hospital Episodes Statistics (HES) data set. Elective laparoscopic cholecystectomies for the period 1 January 2019 to 31 December 2022 were identified. Activity levels for 2022 were compared with those for the whole of 2019 (baseline). Day-case activity was identified where the length of stay recorded in the HES was zero days. RESULTS Data were available for 184,252 patients across the 42 ICBs in England, of which 120,408 (65.3%) were day-case procedures. By December 2022, activity levels for the whole of England had returned to 88.2% of prepandemic levels. The South West region stood out as having recovered activity levels to the greatest extent, with activity at 97.3% of prepandemic levels during 2022. The South West also had the highest postpandemic day-case rate at 74.9% of all patients seen as a day-case during 2022; this compares with an England average of 65.3%. At an ICB level, there was a significant correlation between day-case rates and postpandemic activity levels (r = 0.362, p = 0.019). There was no strong or consistent evidence that day-case surgery had poorer patient outcomes than inpatient surgery. CONCLUSIONS Recovery of elective laparoscopic cholecystectomy activity has been better in South West England than in other regions. Increasing day-case rates may be important if ICBs in other regions are to increase activity levels up to and beyond prepandemic levels.
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Affiliation(s)
| | | | | | | | - WK Gray
- Getting It Right First Time Programme, NHS England and NHS Improvement, UK
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Yu X, Wang X, Li A, Su J, Du W, Liu Y, Zeng W, Yan L, Zhao Y. Investigating precise control pathway for haemostatic clip usage in laparoscopic cholecystectomy based on patient clinical variations: an exploratory retrospective observational study. BMJ Open 2024; 14:e082072. [PMID: 39645263 PMCID: PMC11367286 DOI: 10.1136/bmjopen-2023-082072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 07/19/2024] [Indexed: 12/09/2024] Open
Abstract
OBJECTIVES To explore a precise control pathway based on patient clinical variations for haemostatic clip usage in laparoscopic cholecystectomy (LC) through on-site research data from a teaching hospital. Specifically, the study aimed to: (1) to calculate the optimal haemostatic clip consumption in LC based on diagnostic grouping and surgical combinations, and (2) to provide evidence for cost containment of high-value medical consumables used in LC. DESIGN Retrospective observational study. SETTING Hospital in southwest China. PARTICIPANTS The inclusion criteria were set as inpatients whose medical records included International Classification of Diseases codes 1-3 with code 51.2300 (corresponding to LC surgery) and who were discharged on medical advice. A dataset containing 1001 patients without any haematological diagnoses was collected. PRIMARY AND SECONDARY OUTCOME MEASURES Two ordered multinomial logit models were established to identify factors affecting haemostatic clip use in LC. Two-step clustering was used to form subgroups. The premodel included preoperative variables (acute cholecystitis and scarring/fibrotic atrophy), while the full model added intraoperative variables (anatomical variation and severe adhesions). Both models met application prerequisites. RESULTS Key factors influencing haemostatic clip usage were identified, including acute cholecystitis, scarring/fibrotic atrophy, anatomical variation and severe adhesions. Consumption references for haemostatic clips were established for LC patients with good prognoses on discharge. The ordered multinomial logit model revealed that acute cholecystitis decreased the odds of using four or more clips (p<0.001), while anatomical variation, scarring/fibrotic atrophy and severe adhesions increased the odds (p<0.001 for all). The model suggested using no more than three clips in 17.30% of cases, precisely four clips in 81.72% of cases and five or more clips in 0.98% of cases, depending on the co-occurring factors. Model-predicted clip usage was consistent with actual usage (consistency=0.56). CONCLUSIONS This study provides a framework for evidence-based consumable management in LC, demonstrating the potential for extrapolation to other consumables and surgical combinations. Continuous monitoring and timely adjustment will be imperative as medical products and practices evolve.
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Affiliation(s)
- Xiru Yu
- Institute for Hospital Management, Tsinghua University, Shenzhen, Guangdong Province, China
| | - Xiaodong Wang
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ang Li
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Hepatopancreatobiliary Surgery, Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Jiao Su
- Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Wei Du
- Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Yu Liu
- Guang'an People's Hospital, Guang'an, Sichuan, China
| | - Wenqi Zeng
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ling Yan
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ying Zhao
- Department of Equipment and Materials, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Morcos RKA, Oliveira Souza Lima SR, Bokhari SFH, Almadhoun MKIK, Patel M, Hlyan NP. A Comprehensive Analysis of Single-Incision Laparoscopic Cholecystectomy: Trends, Challenges, and Future Directions. Cureus 2024; 16:e54493. [PMID: 38516458 PMCID: PMC10955148 DOI: 10.7759/cureus.54493] [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] [Accepted: 02/19/2024] [Indexed: 03/23/2024] Open
Abstract
Single-incision laparoscopic cholecystectomy (SILC) is a minimally invasive surgical technique introduced as an advancement to laparoscopic cholecystectomy (LC). This narrative review delves into the emergence of SILC, emphasizing its distinct advantages such as improved cosmesis, reduced postoperative pain, and potentially faster recovery compared to traditional LC. The study meticulously examines current trends and challenges in SILC, including variations in techniques and their impact on patient outcomes. Furthermore, the article sheds light on the technical intricacies and longer operative times associated with SILC. It aims to contribute valuable insights to the medical community by synthesizing existing literature and recent research findings, fostering a deeper understanding of SILC, and guiding future advancements in minimally invasive surgical approaches. The discussion extends to the learning curve, complications, and a comparative analysis between SILC and traditional LC, offering a nuanced understanding of their respective strengths and limitations. The article concludes with a forward-looking perspective, exploring future directions and innovations in SILC, including advancements in surgical techniques and the integration of innovative technologies, such as robotic assistance and in vivo robots, to enhance precision and efficacy. The call for continued research into the long-term outcomes, safety, and refined patient selection criteria emphasizes the evolving landscape of SILC and its potential to shape the future of minimally invasive abdominal surgeries.
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Affiliation(s)
- Rami Kamal Atiya Morcos
- General Surgery, Ministry of Health Holdings, Riyadh, SAU
- General Surgery, Ain Shams University Hospitals, Cairo, EGY
| | | | | | | | - Mitwa Patel
- Medicine, David Tvildiani Medical University, Tbilisi, GEO
| | - Nay Phone Hlyan
- Emergency Medicine, Sheffield Teaching Hospital National Health Service (NHS) Foundation Trust, Sheffield, GBR
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Robotic Surgery: Rediscovering Human Anatomy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312744. [PMID: 34886470 PMCID: PMC8657036 DOI: 10.3390/ijerph182312744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/24/2021] [Accepted: 12/01/2021] [Indexed: 11/17/2022]
Abstract
Since its advent, robotic surgery has redefined the operating room experience. It directly addressed and resolved many of the shortcomings of laparoscopic methods while maintaining a minimally invasive approach that brought benefits in cosmesis and healing for patients but also benefits in ergonomics and precision for surgeons. This new platform has brought with it changes in surgical training and education, principally through the utilization of virtual reality. Accurate depictions of human anatomy seen through augmented reality allow the surgeon-in-training to learn, practice and perfect their skills before they operate on their first patient. However, the anatomical knowledge required for minimally invasive surgery (MIS) is distinct from current methods of dissection and prosection that inherently cater towards open surgery with large cuts and unobstructed field. It is integral that robotic surgeons are also equipped with accurate anatomical information, heralding a new era in which anatomists can work alongside those developing virtual reality technology to create anatomical training curricula for MIS. As the field of surgery and medicine in general moves to include more and more technology, it is only fitting that the building blocks of medical education follow suit and rediscover human anatomy in a modern context.
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Holländer S, von Heesen M, von Heesen A, Spiliotis AE, Gäbelein G, Scherber PR, Glanemann M. Minimally Invasive Cholecystectomy: Transvaginal or Transabdominal Approach-Which Technique Is Preferred by Female Hospital Employees? J Laparoendosc Adv Surg Tech A 2021; 32:515-521. [PMID: 34283667 DOI: 10.1089/lap.2021.0389] [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: 11/13/2022] Open
Abstract
Background: Evidence is lacking concerning a clear benefit of single-port laparoscopic cholecystectomy (SILC) and transvaginal cholecystectomy (TVC) over the classical laparoscopic cholecystectomy (CLC). In this study, we investigated the preferences of the operation techniques among female employees in a tertiary university clinic. Materials and Methods: Study participants in the department of general surgery and gynecology were interviewed regarding their personal felt preferences for the mentioned procedures using a standardized illustrated questionnaire. Results: A total of 111 participants were included in the study. In 70.3% of cases, the transvaginal approach was unknown. The classical techniques were preferred in 95.2% of respondents. Participants with a wish for children showed a higher preference for nontransvaginal techniques (P = .011). The acceptance rate of transvaginal techniques among employees of the department of gynecology was higher than those of the department of general surgery (P = .028). Conclusions: The overall acceptance rate for TVC is low. Especially in case of a wish for children, SILC and CLC represent the preferred techniques. The lack of popularity of TVC could be an explanation for the refusal of this technique. Among employees of the gynecologic department, a transvaginal approach was significantly more often accepted. The cosmetic outcome and the knowledge about an operation technique certainly influence the decision making for the preferred surgical method.
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Affiliation(s)
- Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Maximilian von Heesen
- Department of General- and Visceral Surgery, University Hospital Göttingen, Göttingen, Germany
| | - Anika von Heesen
- Department of Gynecology, University Hospital Göttingen, Göttingen, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Philipp Robert Scherber
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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Weyl A, Chantalat E, Daniel G, Bordier B, Chaynes P, Doumerc N, Malavaud B, Vaysse C, Roumiguié M. Transvaginal minimally invasive approach: An update on safety from an anatomical, anatomopathological and clinical point of view. J Gynecol Obstet Hum Reprod 2020; 50:101941. [PMID: 33045446 DOI: 10.1016/j.jogoh.2020.101941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The aim of this work was to analyze the transvaginal approach in minimally invasive surgery in terms of anatomical, histopathological and functional characteristics, to show the safety of this surgical approach. METHODS Anatomical study was first conducted by dissection on fresh cadavers of adult women in order to measure the distance between the vaginal incision and the ureters, rectum and hypogastric nerves. In parallel, an anatomopathological study detailed and compared the macroscopic and histological characteristics of the anterior and posterior surfaces of vaginal samples obtained from cadavers and patients in the context of a hysterectomy for benign pathology. Finally, patients who underwent a transvaginal approach nephrectomy or transplantation were retrospectively enrolled for a clinical examination and an evaluation of their sexuality. RESULTS The anatomical study conducted on seventeen cadavers showed that the posterior vaginal fornix was remote from the major structures of the pelvis such as rectum, ureters, hypogastric plexus, which allowed a safe incision. Mechanical tests further demonstrated that the posterior vaginal fornix was more extensible than the anterior and histological features showed no major vascular or nervous structures. Ten patients were included in the retrospective clinical study. Long-term follow up showed no negative impact on the texture of the vagina or satisfaction from sexual intercourse. CONCLUSIONS Anatomical, histological and functional data supported that transvaginal approach by posterior vagina fornix incision is a minimally invasive surgery that can be performed safely and effectively by a skilled surgeon in cases with a specific surgical indication for this approach.
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Affiliation(s)
- Ariane Weyl
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France.
| | - Elodie Chantalat
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Gwendoline Daniel
- Department of Anatomopathology, Institut Universitaire du cancer de Toulouse Oncopole, 1 av Irene Joliot-Curie, 31100, Toulouse, France
| | - Benoît Bordier
- Department of Urology, Clinique Pasteur, 45 avenue de Lombez, 31300, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
| | - Charlotte Vaysse
- Department of Gynecologic Surgery, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France; Department of Anatomy, Université Paul Sabatier Toulouse III, 133 route de Narbonne, 31400, Toulouse, France
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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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Xu Y, Wang H, Yang M. Preoperative nursing visit reduces preoperative anxiety and postoperative complications in patients with laparoscopic cholecystectomy: A randomized clinical trial protocol. Medicine (Baltimore) 2020; 99:e22314. [PMID: 32957397 PMCID: PMC7505285 DOI: 10.1097/md.0000000000022314] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Anxiety is a kind of emotional disorder caused by acute conditions or trigger. It is manifested in the components of the autonomic nervous system, for instance, stress, anxiety, nervosity, and discomfort. Most patients with anxiety are more active, nervous, and alert to various stimuli. Inappropriate management of early postoperative anxiety will not only prolong recovery but also increase the risk of other complications. We conduct a randomized clinical trial to investigate the influences of nursing visits against the preoperative anxiety and postoperative complications in patients undergoing laparoscopic cholecystectomy (LC). METHODS This is a single center, placebo-controlled randomized trial, which will be performed from August 2020 to December 2020. The trial is performed in accordance with the SPIRIT Checklist for randomized studies. It is authorized by the Ethics Committee of Taizhou Hospital of Zhejiang Province (D20211-34). Two hundred patients undergoing LC will be included in this study. Patients are randomly divided into 2 groups: experiential group (n = 100) or control group (n = 100). The experimental group is given preoperative nursing visit to each patient 1 day before the operation, whereas the control group did not receive the preoperative nursing intervention. The patients in experience group also received education on the surgery team and the environment of operating room, the process of anesthesia, advantages of laparoscopic surgery, and the postoperative care from recovery room to discharge. The primary outcomes include State-Trait anxiety level and postoperative visual analogue scale. Secondary outcomes include total consumption of analgesics and postoperative complications. RESULTS Figure (a) will show the comparison of outcomes between 2 groups. CONCLUSION The preoperative nursing visit may decrease the anxiety and the complications after operation in patients receiving LC. TRIAL REGISTRATION This study protocol is registered in Research Registry (researchregistry5924).
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Krishna A, Bansal VK, Gupta S, Misra MC. Prospective Randomized Controlled Study to Compare the Outcome of Standard 4-Port Laparoscopic Cholecystectomy with Single-Incision Laparoscopic Cholecystectomy in Patients with Gallstone Disease. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Suh SW, Choi Y, Han HS, Yoon YS, Cho JY, Choi YS, Lee SE, Jeong J. Solo single-incision laparoscopic cholecystectomy: a safe substitute for conventional laparoscopic cholecystectomy. ANZ J Surg 2019; 89:900-904. [PMID: 31293047 DOI: 10.1111/ans.15347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/09/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite the incremental application of single-incision laparoscopic cholecystectomy (SILC), this procedure has technical difficulties, including physical disturbance and an unstable surgical view through the small incision; therefore, we introduce the solo SILC (S-SILC) technique using a laparoscopic scope holder, as a simple, fixed and easy-to-perform procedure for an unassisted surgeon. METHODS We performed a comparative analysis of S-SILC (n = 566) and conventional three-incision laparoscopic cholecystectomy (n = 874) performed from January 2013 to December 2016 at multiple centres. RESULTS There was no significant difference of operative time between the two groups (P = 0.176); however, S-SILC showed a higher incidence of intraoperative gallbladder perforation, especially in the initial period (17.0% versus 2.3%, P < 0.001); and shorter post-operative hospital stay (3.3 ± 1.7 versus 1.9 ± 2.7 days, P < 0.001) than conventional three-incision laparoscopic cholecystectomy. There were no significant differences in major post-operative complications between the two groups (P = 0.909) and operation type (P = 0.971) was not a significant risk factor for major post-operative complications in multivariate analysis. CONCLUSION S-SILC is a feasible and safe procedure; however, careful selection of surgical candidates is necessary in the early period of the experience with this method.
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Affiliation(s)
- Suk-Won Suh
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Yoo-Shin Choi
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Seung-Eun Lee
- Department of Surgery, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Jaehong Jeong
- Department of Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
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Carvalho GL, Lima DL, Shadduck PP, de Góes GHB, Alves de Carvalho GB, Cordeiro RN, Calheiros EMQ, Cavalcanti Dos Santos D. Which Cholecystectomy do Medical Students Prefer? JSLS 2019; 23:JSLS.2018.00086. [PMID: 30675093 PMCID: PMC6333563 DOI: 10.4293/jsls.2018.00086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction: This study was undertaken to identify which minimally invasive technique medical students prefer for cholecystectomy and what factors determine their decision. Methods: Brazilian medical students watched a video reviewing the advantages and disadvantages of six different surgical approaches to cholecystectomy: open surgery, conventional laparoscopy, mini-laparoscopy (MINI), single-incision laparoscopic surgery, natural-orifice transluminal endoscopic surgery, and robotic surgery. Respondents then answered questions about hypothetical situations in which the participants would be submitted to elective cholecystectomy. Results: One hundred eleven medical students completed the survey, 60 females (54%) and 51 males (46%). Most students were 19–26 years old. When asked whether they would consider an open cholecystectomy if minimally invasive surgery (MIS) techniques were available, only 9% answered yes. Senior medical students were the least willing to consider open surgery (P = .036). When asked if they would prefer conventional laparoscopy, MINI, or robotic surgery for their cholecystectomy, 85% of the women and 63% of the men chose MINI (P = .025). When asked if they would consider a single-incision laparoscopic surgery or natural-orifice transluminal endoscopic surgery approach, 94 respondents (84%) answered no. When asked to rank which factors they consider the most important when choosing a surgical technique, they ranked safety of the procedure first (58%) and surgeon experience second (30%). Conclusion: When Brazilian medical students were asked to select a surgical approach for cholecystectomy, most chose MINI. The preference for MINI was strongest amongst female medical students. Both female and male medical students ranked safety as the most important factor.
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Affiliation(s)
| | | | - Phillip P Shadduck
- Department of Surgery, Duke Regional Hospital, Duke University, Durham, North Carolina, USA
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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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Kilkenny J, Larson DJ, MacCormick M, Brown SHM, Singh A. Muscular workload of veterinary students during simulated open and laparoscopic surgery: A pilot study. Vet Surg 2017; 46:868-878. [PMID: 28557023 DOI: 10.1111/vsu.12672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/08/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare upper extremity muscle activity and workload between simulated open surgery, multiple port laparoscopic surgery (MLS), and single incision laparoscopic surgery (SLS) techniques in veterinary students. STUDY DESIGN Pilot study. POPULATION Veterinary students (n = 10) from years 1 to 4. METHODS Bipolar skin surface electrodes were fixed bilaterally to the forearm flexor, forearm extensor, biceps brachii, triceps brachii, and upper trapezius muscles. Electromyography data were recorded during one repetition of 2 simulated surgical exercises via open surgery, MLS, and SLS. Participants completed a validated workload survey after each simulated surgical technique. Muscle activity and perceived workload were compared between surgical techniques with 1-way ANOVAs and Fisher's LSD post hoc tests. RESULTS Muscle activity during peg transfer was higher with MLS and SLS compared to simulated open surgery in the right and left forearm extensors (both P < .0001), right (P < .0001) and left biceps (P = .0005), right triceps (P = .0004), and right upper trapezius muscles (P = .0211). Similar results were found for the right and left forearm extensors (both P < .0001), right (P = .0381) and left (P = .0147) forearm flexors, right biceps (P < .0001), and right triceps (P = .0004) during a simulated suture task. Participants found laparoscopic techniques more mentally demanding, physically demanding, complex, and stressful compared to a simulated open surgical technique. CONCLUSION In veterinary students, average muscle activity and perceived workload were highest using MLS and SLS compared to an open surgical technique when performing simulated surgical exercises in a laparoscopic box trainer.
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Affiliation(s)
- Jessica Kilkenny
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Dennis J Larson
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Mathew MacCormick
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Stephen H M Brown
- Department of Human Health and Nutritional Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Ece I, Ozturk B, Yilmaz H, Yormaz S, Şahin M. The effect of single incision laparoscopic cholecystectomy on systemic oxidative stress: a prospective clinical trial. Ann Surg Treat Res 2017; 92:179-183. [PMID: 28382289 PMCID: PMC5378557 DOI: 10.4174/astr.2017.92.4.179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose Single incision laparoscopic cholecystectomy (SILC) has become a more frequently performed method for benign gallbladder diseases all over the world. The effects of SILC technique on oxidative stress have not been well documented. The aim of this study was to evaluate the effect of laparoscopic cholecystectomy techniques on systemic oxidative stress by using ischemia modified albumin (IMA). Methods In total, 70 patients who had been diagnosed with benign gallbladder pathology were enrolled for this prospective study. Twenty-one patients underwent SILC and 49 patients underwent laparoscopic cholecystectomy (LC). All operations were performed under a standard anesthesia protocol. Serum IMA levels were analysed before operation, 45 minutes and 24 hours after operation. Results Demographics and preoperative characteristics of the patients were similiar in each group. The mean duration of operation was 37.5 ± 12.5 and 44.6 ± 14.3 minutes in LC and SILC group, respectively. In both groups, there was no statistically significant difference in hospital stay, operative time, or conversion to open surgery. Operative technique did not effect the 45th minute and 24th hour IMA levels. However, prolonged operative time (>30 minutes) caused an early increase in the level of IMA. Twenty-fourth hour IMA levels were not different. Conclusion SILC is an effective and safe surgical prosedure for benign gallbladder diseases. Independent of the surgical technique for cholecystectomy, the prolonged operative time could increase the tissue ischemia.
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Affiliation(s)
- Ilhan Ece
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Bahadir Ozturk
- Department of Biochemistry, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Huseyin Yilmaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Serdar Yormaz
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
| | - Mustafa Şahin
- Department of Surgery, Faculty of Medicine, Selcuk University, Konya, Turkey
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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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16
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Kudsi OY, Castellanos A, Kaza S, McCarty J, Dickens E, Martin D, Tiesenga FM, Konstantinidis K, Hirides P, Mehendale S, Gonzalez A. Cosmesis, patient satisfaction, and quality of life after da Vinci Single-Site cholecystectomy and multiport laparoscopic cholecystectomy: short-term results from a prospective, multicenter, randomized, controlled trial. Surg Endosc 2016; 31:3242-3250. [PMID: 27864724 DOI: 10.1007/s00464-016-5353-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy evolved from the traditional multiport laparoscopic technique. Prior trials have demonstrated improved cosmesis with the single-incision technique. Robotic single-site surgery minimizes the technical difficulties associated with laparoscopic single-incision approach. This is the first prospective, randomized, controlled study comparing robotic single-site cholecystectomy (RSSC) and multiport laparoscopic cholecystectomy (MPLC) in terms of cosmesis and patient satisfaction. METHODS Patients with symptomatic benign gallbladder disease were randomized to RSSC or MPLC. Data included perioperative variables such as operative time, conversion and complications and cosmesis satisfaction, body image perception, quality of life using validated questionnaires, at postoperative visits of 2, 6 weeks and 3 months. RESULTS One hundred thirty-six patients were randomized to RSSC (N = 83) and MPLC (N = 53) at 8 institutions. Both cohorts were dominated by higher enrollment of females (RSSC = 78%, MPLC = 92%). The RSSC and MPLC cohorts were otherwise statistically matched. Operative time was longer for RSSC (61 min vs. 44 min, P < 0.0001). There were no differences in complication rates. RSSC demonstrated a significant superiority in cosmesis satisfaction and body image perception (P value < 0.05 at every follow-up). There was no statistically significant difference in patient-reported quality of life. Multivariate analysis of female patients demonstrated significantly higher preference for RSSC over MPLC in cosmesis satisfaction and body image perception with no difference seen in overall quality of life. CONCLUSIONS Results from this trial show that RSSC is associated with improved cosmesis satisfaction and body image perception without a difference in observed complication rate. The uncompromised safety and the improved cosmesis satisfaction and body image perception provided by RSSC for female patients support consideration of the robotic single-site approach. ClinicalTrials.gov identifier NCT01932216.
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Affiliation(s)
- Omar Yusef Kudsi
- Tufts University School of Medicine, Boston, MA, USA. .,, One Pearle Street, Suite 2000, Brockton, MA, 02301, USA.
| | | | | | - Justin McCarty
- St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
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Hajong R, Hajong D, Natung T, Anand M, Sharma G. A Comparative Study of Single Incision versus Conventional Four Ports Laparoscopic Cholecystectomy. J Clin Diagn Res 2016; 10:PC06-PC09. [PMID: 27891389 DOI: 10.7860/jcdr/2016/19982.8601] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/23/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Cholelithiasis is one of the most common disorders of the digestive tract encountered by general surgeons worldwide. Conventional or open cholecystectomy was the mainstay of treatment for a long time for this disease. In the 1980s laparoscopic surgery revolutionized the management of biliary tract diseases. It brought about a revolutionary change in the basic concepts of surgical principles and minimal access surgery gradually started to be acknowledged as a safe means of carrying out surgeries. AIM To investigate the technical feasibility, safety and benefit of Single Incision Laparoscopic Cholecystectomy (SILC) versus Conventional Four Port Laparoscopic Cholecystectomy (C4PLC). MATERIALS AND METHODS This prospective randomized control trial was conducted to compare the advantages if any between the SILC and C4PLC. Thirty two patients underwent SILC procedure and C4PLC, each. The age of the patients ranged from 16-60years. Other demographic data and indications for cholecystectomy were comparable in both the groups. Simple comparative statistical analysis was carried out in the present study. Results on continuous variables are shown in Mean ± SD; whereas results on categorical variables are shown in percentage (%) by keeping the level of significance at 5%. Intergroup analysis of the various study parameters was done by using Fisher exact test. SPSS version 22 was used for statistical analysis. RESULTS The mean operating time was higher in the SILC group (69 ± 4.00 mins vs. 38.53 ± 4.00 mins) which was of statistical significance (p=<0.05). Furthermore, the patients of the SILC group had less post-operative pain, with lesser analgesic requirements (p=<0.05), shorter hospital stay and earlier return to normal activity. CONCLUSION SILC is feasible and safe in trained hands. It did not compromise the procedural safety, or lead to any complication. The operating time was longer otherwise it has almost similar clinical outcomes to those of C4PLC.
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Affiliation(s)
- Ranendra Hajong
- Associate Professor, Department of Surgery, NEIGRIHMS , Shillong, Meghalaya, India
| | - Debobratta Hajong
- Resident Doctor, Department of Surgery, NEGRIHMS , Shillong, Meghalaya, India
| | - Tanie Natung
- Associate Professor, Department of Ophthalmology, NEIGRIHMS , Shillong, Meghalaya, India
| | - Madhur Anand
- Resident Doctor, Department of Surgery, NEGRIHMS , Shillong, Meghalaya, India
| | - Girish Sharma
- Resident Doctor, Department of Surgery, NEGRIHMS , Shillong, Meghalaya, India
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Jang EJ, Roh YH, Choi CJ, Kim MC, Kim KW, Choi HJ. Comparison of outcomes after single-port laparoscopic cholecystectomy in relation to patient body mass index. JSLS 2016; 18:JSLS-D-14-00048. [PMID: 25516701 PMCID: PMC4266224 DOI: 10.4293/jsls.2014.00048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background and Objectives: Single-port laparoscopic cholecystectomy may contribute to a paradigm shift in the field of laparoscopic cholecystectomy surgery by providing patients with benefits beyond those observed after other surgical procedures. This study was designed to evaluate clinically meaningful differences in operative outcomes between obese and nonobese patients after single-port laparoscopic cholecystectomy. Methods: Data were collected retrospectively from 172 patients who had undergone single-port laparoscopic cholecystectomy performed by the same surgeon at a single medical center between January and December 2011. For the outcome analysis, patients were divided into nonobese and obese patient groups according to their body mass index (<25 kg/m2 vs ≥25 kg/m2). Results: Demographic and clinical data did not differ significantly between obese patients (n = 65) and nonobese patients (n = 107). In addition, statistically significant differences pertaining to most measured surgical outcomes including postoperative hospital stay, bile spillage, additional port use, and open conversion were not detected between the groups. However, the two groups differed significantly regarding operative time such that nonobese patients had shorter operative times than obese patients (P < .05). Conclusion: The results of this study showed that operative time for single-port laparoscopic cholecystectomy was the only difference between obese and nonobese patients. Given this result, body mass index may not be as relevant a factor in patient selection for single-port laparoscopic cholecystectomy as previously thought.
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Affiliation(s)
- Eun Jeong Jang
- Dong-A University College of Medicine, Busan, South Korea
| | - Young Hoon Roh
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Chan Joong Choi
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Min Chan Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
| | - Hong Jo Choi
- Department of Surgery, Dong-A University College of Medicine, Busan, South Korea
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Tyagi S, Sinha R, Tyagi A. Single incision laparoscopic cholecystectomy: Less scar, less pain. J Minim Access Surg 2016; 13:118-123. [PMID: 28281475 PMCID: PMC5363117 DOI: 10.4103/0972-9941.186686] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
CONTEXT AND AIMS: Our study aims to evaluate the post-operative pain and cosmesis of single-incision laparoscopic cholecystectomy (SILC) in comparison with the standard, 3-port laparoscopic cholecystectomy (SLC) with respect to the length of incision, cosmetic scores, post-operative pain scores and duration of hospital stay. SETTINGS AND DESIGN: This comparative randomised study was conducted in a tertiary care centre teaching hospital between September 2012 and 2014. One hundred and fifty consecutive patients, who qualified as per inclusion criteria, were included in the study. SUBJECTS AND METHODS: Seventy-five patients were included in the SLC arm and 75 in the SILC arm. SILC procedure was carried out as transumbilical multiport technique and SLC as 3-port technique utilizing - 5, 5, 10 mm ports. STATISTICAL ANALYSIS USED: The data for the primary observations (post-operative pain scores, cosmetic score and incision length) and secondary observation (post-operative hospital stay) were noted. Weighted mean difference was used for calculation of quantitative variables, and odds ratios were used for pooling qualitative variables. RESULTS: Pain scores at 4 and 24 h were significantly better for SILC arm than SLC arm (at 4 h - 4.84 ± 0.95 vs. 6.17 ± 0.98, P < 0.05 and at 24 h - 3.84 ± 0.96 vs. 5.17 ± 0.09, P < 0.05). Length of incision was significantly smaller (SILC - 2.631 ± 0.44 cm vs. SLC - 5.11 ± 0.44 cm), P < 0.05 and cosmetic score was significantly better in SILC arm (6.25 ± 1.24) than SLC arm (4.71 ± 1.04), P < 0.05. Difference between the hospital stay is insignificant for two arms SILC (2.12 ± 0.34) and SLC (2.13 ± 0.35), P > 0.05. DISCUSSION: Significant difference was found in duration and intensity of pain between two procedures at 4 and 24 h. Cosmesis was significantly better in SILC than SLC group, the sample size in our study was small to arrive at a definite conclusion. The procedure can be selectively and judiciously performed by surgeons trained in regular laparoscopic surgery. Furthermore, the threshold for conversion should be low in learning phase. Widespread application must await Level 1 evidence from prospective trials.
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Affiliation(s)
- Shantanu Tyagi
- Department of Surgery, MLB Medical College, Jhansi, Uttar Pradesh, India
| | - Rajeev Sinha
- Department of Surgery, MLB Medical College, Jhansi, Uttar Pradesh, India
| | - Aarti Tyagi
- Department of Surgery, MLB Medical College, Jhansi, Uttar Pradesh, India
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Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol 2015; 5:238-254. [PMID: 26713285 PMCID: PMC4686422 DOI: 10.5662/wjm.v5.i4.238] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 11/25/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.
METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.
RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.
CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.
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Ikumoto T, Yamagishi H, Iwatate M, Sano Y, Kotaka M, Imai Y. Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis. World J Gastrointest Endosc 2015; 7:1327-1333. [PMID: 26722614 PMCID: PMC4689795 DOI: 10.4253/wjge.v7.i19.1327] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/03/2015] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To assess the safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis.
METHODS: All patients who underwent SILC at Sano Hospital (Kobe, Japan) between January 2010 and December 2014 were included in this retrospective study. Clinical data related to patient characteristics and surgical outcomes were collected from medical records. The parameters for assessing the safety of the procedure included operative time, volume of blood loss, achievement of the critical view of safety, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and duration of postoperative hospital stay. Patient backgrounds were statistically compared between those with and without conversion to laparotomy.
RESULTS: A total of 100 patients underwent SILC for acute cholecystitis during the period. Preoperative endoscopic treatment was performed for suspected choledocholithiasis in 41 patients (41%). The mean time from onset of acute cholecystitis was 7.7 d. According to the Updated Tokyo Guidelines (TG13) for the severity of cholecystitis, 86 and 14 patients had grade I and grade II acute cholecystitis, respectively. The mean operative time was 87.4 min. The mean estimated blood loss was 80.6 mL. The critical view of safety was obtained in 89 patients (89%). Conversion laparotomy was performed in 12 patients (12%). Postoperative complications of Clavien-Dindo grade III or greater were observed in 4 patients (4%). The mean duration of postoperative hospital stay was 5.7 d. Patients converted from SILC to laparotomy tended to have higher days after onset.
CONCLUSION: SILC is feasible for acute cholecystitis; in addition, early surgical intervention may reduce the risk of laparotomy conversion.
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Meillat H, Birnbaum DJ, Fara R, Mancini J, Berdah S, Bège T. Do height and weight affect the feasibility of single-incision laparoscopic cholecystectomy? Surg Endosc 2015; 29:3594-3599. [PMID: 25759236 DOI: 10.1007/s00464-015-4115-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/13/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Laparoscopic cholecystectomy is the gold standard for gallbladder removal and the most common laparoscopic procedure worldwide. Single-incision laparoscopic surgery has recently emerged as a less invasive potential alternative to conventional three- or four-port laparoscopy. However, the feasibility of single-incision laparoscopic cholecystectomy (SILC) remains unclear, and there are no rigorous criteria in the literature. Identifying patients at risk of failure of this new technique is essential. The aim of our study was to determine risk factors that may predict failure of the procedure. METHODS From May 2010 to March 2012, 110 consecutive patients underwent SILC and were reviewed retrospectively. The main feasibility criterion was the procedure failure rate, defined as addition of supplementary port(s) and prolonged (>60 min) operative time. The factors evaluated were age, gender, height, weight, body mass index, previous abdominal surgery, indication for surgery and gallbladder suspension. RESULTS There was conversion in 16 patients (14.5%), and the operative time exceeded 60 min for 20 patients (30.9%). Univariate analysis showed a significant independent association between additional port requirement and each of weight as a continuous value, weight ≥80 kg, BMI >26.5 kg/m(2) and height >172 cm. Univariate analysis also showed a significant independent association between prolonged operative duration (>60 min) and each of height and weight as continuous values, height >172 cm and previous abdominal surgery. In the multivariate analysis, only weight remained independently associated with additional port requirement, and height remained independently associated with prolonged operative duration. CONCLUSION Preoperative identification of the factors increasing the risk of conversion may assist surgeons in making decisions concerning the management of patients, including appropriate use of SILC.
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Affiliation(s)
- Hélène Meillat
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
| | - David Jérémie Birnbaum
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Régis Fara
- Department of Digestive Surgery and Liver Transplantation, Hôpital La Conception, Aix-Marseille Université, Marseille, France
| | - Julien Mancini
- Inserm, IRD, UM 62 SESSTIM, Aix Marseille Université, 13385, Marseille, France
- Public Health Department, APHM, BiosTIC, Hôpital de la Timone, 13385, Marseille, France
| | - Stéphane Berdah
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France
| | - Thierry Bège
- Departments of Digestive Surgery, Hôpital Nord, Aix-Marseille Université, Chemin des Bourrely, 13915, Marseille Cedex 20, France.
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A multicenter study of initial experience with single-incision robotic cholecystectomies (SIRC) demonstrating a high success rate in 465 cases. Surg Endosc 2015; 30:2951-60. [PMID: 26541728 DOI: 10.1007/s00464-015-4583-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND Recently, the robotic single-site platform has been used to ameliorate the difficulties seen in single-incision laparoscopic surgery (SILC) while preserving the benefits of standard laparoscopic cholecystectomy. The purpose of this study is to describe the clinical outcomes of a large series of single-incision robotic cholecystectomy (SIRC). METHODS Medical records of consecutive patients who underwent SIRC were retrospectively reviewed. All procedures were performed by six surgeons at five different North American centers involved in the study. All patients included in the study underwent a cholecystectomy attempted through single site at the umbilicus, using the da Vinci(®) Surgical System (Intuitive Surgical Inc. Sunnyvale, CA). RESULTS A total of 465 patients met study criteria. Median age was 48 years (range 18-89); 351 (75.5 %) were female and 304 (66.4 %) were overweight or obese. Except for gender, case characteristics differed significantly by surgeon/site. Previous abdominal surgery was reported for 226 (48.6 %) cases. SIRC was successfully completed in 455 (97.8 %) cases, and there were no conversions to open surgery. Median surgical time was 52 min with a decreasing trend after 55-85 cases. Male gender, obesity and diagnoses other than biliary dyskinesia were independent predictors of longer surgical times. The complication rate was 2.6 %. CONCLUSIONS Our large, multicenter study demonstrates that robotic single-site cholecystectomy is safe and feasible in a wide range of patients.
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Gaillard M, Tranchart H, Lainas P, Dagher I. New minimally invasive approaches for cholecystectomy: Review of literature. World J Gastrointest Surg 2015; 7:243-248. [PMID: 26523212 PMCID: PMC4621474 DOI: 10.4240/wjgs.v7.i10.243] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/31/2015] [Accepted: 09/16/2015] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic cholecystectomy is the most commonly performed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy (SILC), minilaparoscopic cholecystectomy (MLC) and natural orifice transluminal endoscopic surgery (NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.
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Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 2015; 20:1-10. [PMID: 25846740 DOI: 10.1007/s10029-015-1371-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/28/2015] [Indexed: 12/14/2022]
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Vestweber B, Vestweber KH, Paul C, Rink AD. Single-port laparoscopic resection for diverticular disease: experiences with more than 300 consecutive patients. Surg Endosc 2015; 30:50-8. [DOI: 10.1007/s00464-015-4160-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/12/2015] [Indexed: 02/08/2023]
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Milas M, Deveđija S, Trkulja V. Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 2014; 12:271-289. [PMID: 24529791 DOI: 10.1016/j.surge.2014.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to compare single incision laparoscopic cholecystectomy (SILC) to the standard multiport technique (MLC) for clinically relevant outcomes in adults. METHODS Systematic review and random-effects meta-analysis of randomized trials. RESULTS We identified 30 trials (SILC N = 1209, MLC N = 1202) mostly of moderate to low quality. Operating time (30 trials): longer with SILC (WMD = 12.4 min, 95% CI 9.3, 15.5; p < 0.001), but difference reduced with experience - in 10 large trials (1321 patients) WMD = 5.9 (-1.3, 13.1; p = 0.105). Intra-operative blood loss (12 trials, 1201 patients): greater with SILC, but difference practically irrelevant (WMD = 1.29 mL, 0.24-2.35; p = 0.017). Procedure failure (27 trials, 2277 patients): more common with SILC (OR = 13.9, 4.34-44.7; p < 0.001), but overall infrequent (SILC pooled incidence 4.39%) and almost exclusively addition of a trocar. Post-operative pain (29 trials) and hospital stay (22 trials): no difference. Complications (30 trials): infrequent (SILC pooled incidence 5.35%) with no overall SILC vs. MLC difference. Incisional hernia (19 trials, 1676 patients): very rare (15 vs. 4 cases), but odds significantly higher with SILC (OR = 4.94, 1.26-19.4; p = 0.025). Cosmetic satisfaction (16 trials, 11 with data at 1-3 months): in 5 trials with non-blinded patients (N = 513) in favour of SILC (SMD = 1.83, 0.13, 3.52; p = 0.037), but in 6 trials with blinded patients (N = 719) difference small and insignificant (SMD = 0.42, -1.12, 1.96; p = 0.548). DISCUSSION SILC outcomes largely depend on surgeon's skill, but regardless of it, when compared to MLC, SILC requires somewhat longer operating time, risk of incisional hernia is higher (but overall very low) and early cosmetic benefit is modest. CONCLUSION From the (in)convenience and safety standpoint, SILC is an acceptable alternative to MLC with a modest cosmetic benefit.
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Affiliation(s)
- Mate Milas
- Zagreb University School of Medicine, Zagreb, Croatia
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Perger L, Little DC, Muensterer OJ, Chong AJ, Mortellaro VE, Harmon CM. Minimal access laparoscopic surgery for treatment of ulcerative colitis and familial adenomatous polyposis coli in children and adolescents. J Laparoendosc Adv Surg Tech A 2014; 24:731-4. [PMID: 25247476 DOI: 10.1089/lap.2014.0390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Laparoscopic restorative proctocolectomy is standard surgical treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis coli (FAP). Scar burden can be minimized by reducing the number of laparoscopic ports. The aim of this study is to review the authors' experience with reduced-port laparoscopy in this setting and to compare it with conventional laparoscopy using multiple ports. MATERIALS AND METHODS Charts of pediatric patients undergoing colectomy for UC or FAP between 2009 and 2012 were retrospectively reviewed. Patients who had the operation performed through one or two multichannel ports were assigned to the minimal access (MA) study group. Patients who had four or five single-channel ports with or without an additional small laparotomy were assigned to the LAP group. RESULTS Twenty-two patients were identified. Ages at first operation were 2-18 years (median, 13.5 years). There were no conversions to laparotomy and no mortality. Mean operative times for the MA and LAP groups, respectively, were 250 and 284 minutes for abdominal colectomy with end ileostomy (P=.15), 198 and 301 minutes for completion proctectomy with diverting loop ileostomy (DLI) (P=.26), and 455 and 414 minutes for proctocolectomy with ileal pouch-anal anastomosis and DLI (P=.72). A major complication requiring laparotomy occurred in 1 patient (9%) in the MA group and in 2 patients (18%) in the LAP group. CONCLUSIONS Minimal access laparoscopic surgery for UC and FAP is safe and feasible. A slightly larger incision at the ostomy site facilitates extraction of the specimen and extracorporeal construction of a J-pouch. Operative times and hospital stay are comparable to those with multiport laparoscopy.
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Affiliation(s)
- Lena Perger
- 1 McLane's Children's Hospital at Scott & White, Texas A&M College of Medicine , Temple, Texas
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29
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Postoperative complications following single-incision laparoscopic cholecystectomy: a retrospective analysis in 360 consecutive patients. Surg Endosc 2014; 29:708-13. [PMID: 25052126 DOI: 10.1007/s00464-014-3726-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 06/30/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Single-incision laparoscopic cholecystectomy (SILC) is being increasingly performed based on recent evidence showing its cosmetic advantages. However, there is limited information on outcome data for SILC with respect to postoperative complications. METHODS We retrospectively reviewed a consecutive series of 360 patients undergoing SILC to evaluate the rate, features, and risk factors of postoperative complications. RESULTS During a median follow-up period of 671 days, 17 patients (4.7 %) developed postoperative complications, including bile duct injuries, intraabdominal abscess, wound infection, incisional hernia, paralytic ileus, and pneumonia. Reoperation was required in five patients (1.4 %). Overall inpatient mortality occurred in one patient (0.3 %) who developed aspiration pneumonia. In multivariate stepwise regression analyses, poor physical status (American Society of Anesthesiologists score of ≥3) and preoperative diagnosis of acute cholecystitis were identified as significant risk factors for the development of postoperative complications (P = 0.0009 and P = 0.04, respectively). CONCLUSIONS These findings suggest that SILC is a relatively safe procedure with an acceptable postoperative complication rate but requires careful attention especially in patients with poor physical status and/or acute cholecystitis.
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30
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Ikeda N. Reply to the letter to the editor: Simple technique for gasless transumbilical single-incisional laparoscopic-assisted appendectomy. Langenbecks Arch Surg 2014; 399:675-6. [PMID: 24832475 DOI: 10.1007/s00423-014-1206-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 04/30/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Naoya Ikeda
- Department of Surgery, Nara Prefecture Western Medical Center, 1-14-16 Mimuro, Sango-cho, Ikoma-gun, Nara, 636-0802, Japan,
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Li L, Tian J, Tian H, Sun R, Wang Q, Yang K. The efficacy and safety of different kinds of laparoscopic cholecystectomy: a network meta analysis of 43 randomized controlled trials. PLoS One 2014; 9:e90313. [PMID: 24587319 PMCID: PMC3938681 DOI: 10.1371/journal.pone.0090313] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 01/29/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVE We conducted a network meta analysis (NMA) to compare different kinds of laparoscopic cholecystectomy [LC] (single port [SPLC], two ports [2PLC], three ports [3PLC], and four ports laparoscopic cholecystectomy [4PLC], and four ports mini-laparoscopic cholecystectomy [mini-4PLC]). METHODS PubMed, the Cochrane library, EMBASE, and ISI Web of Knowledge were searched to find randomized controlled trials [RCTs]. Direct pair-wise meta analysis (DMA), indirect treatment comparison meta analysis (ITC) and NMA were conducted to compare different kinds of LC. RESULTS We included 43 RCTs. The risk of bias of included studies was high. DMA showed that SPLC was associated with more postoperative complications, longer operative time, and higher cosmetic score than 4PLC, longer operative time and higher cosmetic score than 3PLC, more postoperative complications than mini-4PLC. Mini-4PLC was associated with longer operative time than 4PLC. ITC showed that 3PLC was associated with shorter operative time than mini-4PLC, and lower postoperative pain level than 2PLC. 2PLC was associated with fewer postoperative complications and longer hospital stay than SPLC. NMA showed that SPLC was associated with more postoperative complications than mini-4PLC, and longer operative time than 4PLC. CONCLUSION The rank probability plot suggested 4PLC might be the worst due to the highest level of postoperative pain, longest hospital stay, and lowest level of cosmetic score. The best one might be mini-4PLC because of highest level of cosmetic score, and fewest postoperative complications, or SPLC because of lowest level of postoperative pain and shortest hospital stay. But more studies are needed to determine which will be better between mini-4PLC and SPLC.
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Affiliation(s)
- Lun Li
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jinhui Tian
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Hongliang Tian
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Rao Sun
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Quan Wang
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Kehu Yang
- The First Clinical College, Lanzhou University, Lanzhou, China
- Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
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Approaches to assessing the benefits and harms of medical devices for application in surgery. Langenbecks Arch Surg 2014; 399:279-85. [DOI: 10.1007/s00423-014-1173-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 02/03/2014] [Indexed: 12/23/2022]
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