Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy

Background

This study aimed to compare the outcomes of single-incision laparoscopic cholecystectomy (SILC) versus conventional 4-port laparoscopic cholecystectomy (LC).

Methods

From November 2009 to August 2010, 51 patients with symptomatic gallstone or gallbladder polyps were randomized to SILC (n = 24) or 4-port LC (n = 27).

Results

Mean surgical time (43.5 vs 46.5 min), median blood loss (1 vs 1 mL) and mean hospital stay (1.5 vs 1.8 d) were similar for both the SILC and 4-port LC group. There were no open conversions and no major complications. The mean total wound length of the SILC group was significantly shorter (1.76 vs 2.25 cm). The median visual analogue pain score at 6 hours after surgery was similar (4.5 vs 4.0) but the SILC group had a significantly worse pain score on day 7 (1 vs 0). There was no difference in time to resume usual activity (mean, 5.6 vs 5.0 d). The median cosmetic score of SILC was significantly higher than at 3 months after surgery (7 vs 6).

Conclusions

SILC was feasible and safe for properly selected patients in experienced hands.     

Three-port vs standard four-port laparoscopic cholecystectomy

Background: Since the first laparoscopic cholecystectomy (LC) was reported in 1990, it has met with widespread acceptance as a standard procedure using four trocars. The fourth (lateral) trocar is used to grasp the fundus of the gallbladder so as to expose Calots triangle. It has been argued that the fourth trocar is not necessary in most cases. Therefore, the aim of this study was to compare the three-port vs the four-port technique. Methods: Between 1998 and 2000, 200 consecutive patients undergoing elective LC for gallstone disease were randomized to be treated via either the three- or four-port technique. Results: There was no difference between the two groups in age, sex, or weight. In terms of outcome, there was no difference between the two groups in success rate, operating time, number of oral analgesic tablets (paracetamol), visual analogue score, or postoperative hospital stay; however, the three-port group required fewer analgesic injections (nalbuphine) (0.4 vs 0.77, p = 0.024). Conclusion: The three-port technique is as safe as the standard four-port one for LC. The main advantages of the three-port technique are that it causes less pain, is less expensive, and leaves fewer scars.     

Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal.

OBJECTIVES: With increasing surgeon experience, laparoscopic cholecystectomy has undergone many refinements including reduction in port number and size. Three-port laparoscopic cholecystectomy has been reported to be safe and feasible in various clinical trials. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of 3-port laparoscopic cholecystectomy versus conventional 4-port laparoscopic cholecystectomy. METHODS: Seventy-five consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to undergo either the 3-port or the 4-port technique. Four surgical tapes were applied to standard 4-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the 4 sites was assessed on the first day after surgery by using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length of the operation, postoperative stay, and patient satisfaction score on surgery and scars. RESULTS: Demographic data were comparable for both groups. Patients in the 3-port group had shorter mean operative time (47.3+/-29.8 min vs 60.8+/-32.3 min) for the 4-port group (P=0.04) and less pain at port sites (mean score using 10-cm unscaled VAS: 2.19+/-1.06 vs 2.91+/-1.20 (P=0.02). Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score (mean score using 10-cm unscaled VAS: 8.2+/-1.7 vs 7.8+/-1.7, P=0.24) on surgery and scars were similar between the 2 groups. CONCLUSION: Three-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes with fewer surgical scars and without any increased risk of bile duct injury compared with 4-port laparoscopic cholecystectomy. Thus, it can be recommended as a safe alternative procedure in elective laparoscopic cholecystectomy.     

Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy

Background:The aim of this study was to compare micropuncture laparoscopic cholecystectomy (MPLC), with three 3.3-mm cannulas and one 10-mm cannula with conventional laparoscopic cholecystectomy (CLC). Methods: Patients were randomized to undergo either CLC or MPLC. The duration of each operative stage and the procedure were recorded. Interleukin-6 (IL-6), adrenocorticotropic hormone (ACTH), and vasopressin were sampled for 24 h. Visual analogue pain scores (VAPS) and analgesic consumption were recorded for 1 week. Pulmonary function and quality of life (EQ-5D) were monitored for 4 weeks. Statistical analysis was performed using the Mann–Whitney test or Fishers exact test. Results are expressed as median (interquartile range). Results: Forty-four patients entered the study, but four were excluded due to unsuspected choledocholithiasis (n = 3) or the need to reschedule surgery (n = 1). The groups were comparable in terms of age, duration of symptoms, and indications for surgery. Total operative time was similar (CLC, 63 [52–81] min vs MPLC 74 [58–95] min; p = 0.126). However, time to place the cannulas after skin incision (CLC, 5:42 [3:45–6:37] min vs MPLC, 7:38 [5:57–10:15] min; p = 0.015) and to clip the cystic duct after cholangiography (CLC, 1:05 [0:40–1:35] min vs MPLC, 3:45 [2:26–7:49] min; p < 0.001) were significantly longer for MPLC. Six CLC patients and one MPLC patient required postoperative parenteral opiates (p = 0.04). Oral analgesic consumption was similar in both groups (p = 0.217). Median VAPS were lower at all time points for MPLC, but this finding was not significant (p = 0.431). There were no significant differences in postoperative stay, IL-6, ACTH or vasopressin responses, pulmonary function, or EQ-5D scores. Conclusions: The thinner instruments did not significantly increase the total duration of the procedure. MPLC reduced the use of parenteral analgesia postoperatively, which may prove beneficial for day case patients, but it did not have a significant impact on laboratory variables, lung function or quality of life.     

Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial

Background

In recent years, new devices providing multiple channels have made the performance of laparoscopic cholecystectomy through a single access site not only feasible but much easier. The potential benefits of laparoendoscopic single-site (LESS) cholecystectomy may include scarless surgery, reduced postoperative pain, reduced postoperative length of stay, and improved postoperative quality of life. There are no comparative data between LESS cholecystectomy and standard laparoscopic cholecystectomy (LC) available at present with which to quantify these benefits.

Methods

This study was a prospective, randomized, dual-institutional pilot trial comparing LESS cholecystectomy with standard LC. The primary end point was postoperative quality of life, measured as length of hospital stay, postoperative pain, cosmetic results, and SF-36 questionnaire scores. Secondary end points included operative time, conversion to standard LC, difficulty of exposure, difficulty of dissection, and complication rate.

Results

No significant differences in postoperative lengths of stay were found in the two groups. Postoperative pain evaluation using a visual analogue scale showed significantly better outcomes in the standard LC arm on the same day of surgery (P = .041). No differences in postoperative pain were found at the next visual analogue scale evaluation or in the postoperative administration of pain-relieving medications. Cosmetic satisfaction was significantly higher in the LESS group at 1-month follow-up (mean, 94.5 ± 9.4% vs 86 ± 22.3%; median, 100% vs 90%; P = .025). Among the 8 scales of the SF-36 assessing patients' physical and mental health, scores on the Role Emotional scale were significantly better in the LESS group (mean, 80.05 ± 29.42 vs 68.33 ± 25.31; median, 100 vs 66.67; P < .0001).

Conclusions

In this pilot trial, LESS cholecystectomy resulted in similar lengths of stay and improved cosmetic results and SF-36 Role Emotional scores but performed less well on pain immediately after surgery. A larger multicenter trial is needed to confirm and further investigate these results.     

Robot-assisted laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a comparative study

Background: The efficacy of conventional laparoscopic cholecystectomy (CLC) was compared with robot-assisted laparoscopic cholecystectomy (RLC). Surgical trainees performed the LC to avoid the surgeons experience bias. Methods: Two surgical trainees performed 10 CLCs and 10 RLCs at random with a Zeus-Aesop Surgical Robotic System. The primary efficacy parameters were the total time and the number of actions involved in the procedure. The secondary parameters were setup and dissection times, and the number of grasping and dissection actions. Surgical complications were evaluated. Results: For CLC and RLC, respectively, the total times were 95.4 ± 28 min and 123.5 ± 33.3 min and the total actions were 420 ± 176.3 and 363.5 ± 158.2. For CLC, the times required for setup (21 ± 10.4 min) and dissection (50.2 ± 17.7 min) were less than for RLC (33.8 ± 11.3 min and 72 ± 24.3 min, respectively). The numbers of grasping and dissection actions were not significantly different: 41.4 ± 26.5 and 378 ± 173.7, respectively, for CLC versus 48.9 ± 27 and 314.6 ± 141.9, respectively, for RLC. Conclusion: Although feasible, RLC requires significantly more time than CLC because of slower performed actions.     

New ideas and improved instrumentation for laparoscopic cholecystectomy

Summary A new cholangiograsper cannula was developed through which a Fr 4 or 5 ureteric cannula can be advanced into the incised cystic duct and held in a watertight position. This instrument facilitates intraoperative cholangiography. A plastic trocar stylet eliminates the metal shadow of the trocar during cholangiography. A new laparocamera is described where camera and telescope are built together in one unit decreasing the need for additional manipulation during the procedure. A camera holder driven by air helps the operator to keep his/her hands free. The need for a third assistant is avoided by inserting the camera into a (presterilized) holder, the position of which is controlled by press buttons.     

腹腔镜与开腹胆囊切除术对比分析

我院于1994年8月～1996年6月完成腹腔镜胆囊切除术(LC)70例,为了客观地评价LC的优越性及不足之处,本文随机将1993年7月～     

The cost of laparoscopic versus open cholecystectomy in a community hospital

This retrospective study reviewed the hospital and professional costs, charges, and reimbursements for laparoscopic cholecystectomy (lap chole) and open cholecystectomy (open chole) and compared the two procedures. There was no significant difference in hospital costs between lap and open chole procedures; however, there were marked differences in the categories of costs for each procedure. The mean total (hospital and professional) charge was 8% greater for lap chole. The mean total (hospital and professional) reimbursement for patients with private insurance was 23% greater for lap chole, but no significant difference was seen for patients on Medicare or Medicaid. Lap chole patients returned to work 11 days sooner than open chole patients; this can result in a 69% decrease in short-term disability costs to employers. The clinical variables that significantly affect total charges and reimbursement are discussed.     

T-tube placement during laparoscopic cholecystectomy

Summary The management of common bile duct stones during laparoscopic cholecystectomy can pose a challenge to the surgeon as no definitive management plan is universally accepted at this time. We present a case where a common bile duct exploration was performed through a choledochotomy, describing how the t-tube was placed.The contents of this article do not necessarily reflect the views of the Department of the Army or the Department of Defense     

腹腔镜胆囊切除术与开腹胆囊切除术的临床特征及住院费用的对比

目的 对腹腔镜胆囊切除术的安全性，临床及经济价值作出评估。方法 对行ＬＣ的２７８例患者与开腹胆囊切除术的２３４例患者进行对比调查。结果 ＬＣ与ＯＣ具有相同的安全性；ＬＣ患者术后总的疼痛时间与严重疼痛时间，住院及出院后恢复工作的时间均明显短于ＯＣ患者；     

Comparison of serum C-reactive protein concentrations for laparoscopic versus open cholecystectomy

In an attempt to quantify the difference in tissue damage between open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), we have compared in a prospective manner the pre- and postoperative concentrations of serum C-reactive protein (CRP) in 17 patients undergoing LC and 13 patients undergoing OC. In addition, we measured the pre- and postoperative white blood cell counts (WBC), the postoperative body temperature, and the postoperative duration of hospitalization. There were no differences in the preoperative serum CRP concentrations—5.9±2.62 mg/l (mean±SD) for the LC group and 6.12±2.38 mg/l for the OC group.Serum CRP rose markedly following OC compared to that of patients who underwent LC (128.6±45.1 mg/l vs 26.8±10.5 mg/l) (P<0.001). There were also significant differences in the postoperative WBC count (14,000±2,900 cells for the OC group vs 10,600±3,000 cells for the LC group), the postoperative body temperature (37.5±0.3°C vs 37.0±0.3°C), and the postoperative hospital stay (5.5±1.5 days vs 1.9±0.9 days). There was no correlation between serum CRP concentrations and the other postoperative parameters.These results provide us with biochemical evidence supporting the clinical observation that LC is far less traumatic to the patient than OC.     

腹腔镜胆囊次全切除术的临床应用

目的：探讨腹腔镜胆囊次全切除术的可行性,总结困难型腹腔镜胆囊切除术的经验,尤其是腹腔镜胆囊次全切除理念在困难型腹腔镜胆囊切除术中的体现及应用。方法回顾分析我院2008年1月至2013年10月所行腹腔镜胆囊次全切除病例,并以2011年5月为时间节点分为 A 组（节点前时段）、B 组（节点后时段）,分别比较前后两组的（胆囊切除实行专病专治）,手术时间、术后住院时间、术中出血量。结果 B 组手术时间（78.1±6.6）min 少于 A 组（97.5±7.3）min,B 组术后住院时间（3.5±0.4）d 少于 A 组（5.6±0.5）d,出血量 B 组（68.9±7.2）ml 多于 A 组（56.7±7.7）ml。差异均有统计学意义。结论腹腔镜胆囊次全切除应成为腹腔镜术者的常规理念;熟练掌握腹腔镜技术、积累一定经验后,腹腔镜胆囊次全切除可作为常规手术操作应用于临床。     

两孔法免钛夹与传统腹腔镜胆囊切除术的对比研究

目的:总结两孔法免钛夹腹腔镜胆囊切除术( laparoscopic cholecystectomy,LC)的优点及局限性.方法:回顾分析2010年2月至2011年6月为100例患者施行LC的临床资料,将其分为两孔法免钛夹组与传统三孔法LC组,每组50例.结果:两组均无并发症发生,无一例中转开腹.两孔免钛夹法手术时间平均...     

Comparison of laparoscopic versus open cholecystectomy in patients with cardiac valve replacement

To evaluate the benefits and safety of laparoscopic cholecystectomy (LC) in patients with cardiac valve replacement (which frequently leads to cholelithiasis), 12 patients with cholelithiasis associated with cardiac valve replacement were studied. The patients were divided into two groups, of 6 patients each, according to the type of operation performed, open cholecystectomy (OC) or LC. The postoperative course was monitored with respect to laboratory data on postoperative days (POD) 1, 3, and 7. The mean duration of operation, blood loss, days to food resumption, length of hospital stay, and morbidity were compared between the two groups. Significant differences (P < 0.05) were found between the OC and LC groups in white blood cell counts on POD 1 (12 980 ± 3040/mm³ vs 8300 ± 1590/mm³), days to food resumption (2.7 ± 0.4 days vs 1.0 ± 0.7 days), and length of postoperative stay (15.8 ± 1.0 days vs 10.8 ± 1.6 days). There were no complications in the LC group, but 1 patient in the OC group had heart failure postoperatively. Our findings indicate the efficacy and safety of LC in patients with cardiac valve replacement. Received: August 14, 2000 / Accepted: December 22, 2000     

两孔法腹腔镜胆囊切除术的临床应用

目的:寻求更具有微创意义的腹腔镜胆囊切除的新术式。方法:回顾分析为452例患者行两孔法腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)的临床资料。结果:428例成功完成两孔法LC,21例改为三孔法,3例改为四孔法,无一例中转开腹及手术并发症发生。结论:采用两孔技术行LC安全可行,具有更微创的优点。     

Low-pressure pneumoperitoneum versus standard pneumoperitoneum in laparoscopic cholecystectomy, a prospective randomized clinical trial

Background  Post-laparoscopic pain syndrome is well recognized and characterized by abdominal and particularly shoulder tip pain; it occurs frequently following laparoscopic cholecystectomy. The etiology of post-laparoscopic pain can be classified into three aspects: visceral, incision, and shoulder. The origin of shoulder pain is only partly understood, but it is commonly assumed that the cause is overstretching of the diaphragmatic muscle fibers owing to a high rate of insufflations. This study aimed to compare the frequency and intensity of shoulder tip pain between low-pressure (7 mmHg) and standard-pressure (14 mmHg) in a prospective randomized clinical trial. Methods  One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were randomized prospectively to either high- or low-pressure pneumoperitoneum and blinded by research nurses who assessed the patients during the postoperative period. The statistical analysis included sex, mean age, weight, American Society of Anesthesiologists (ASA) grade, operative time, complication rate, duration of surgery, conversion rate, postoperative pain by using visual analogue scale, number of analgesic injections, incidence and severity of shoulder tip pain, and postoperative hospital stay. p < 0.05 was considered indicative of significance. Results  The characteristics of the patients were similar in the two groups except for the predominance of males in the standard-pressure group (controls). The procedure was successful in 68 of 70 patients in the low-pressure group compared with in 70 patients in the standard group. Operative time, number of analgesic injections, visual analogue score, and length of postoperative days were similar in both groups. Incidence of shoulder tip pain was higher in the standard-pressure group, but not statistically significantly so (27.9% versus 44.3%) (p = 0.100). Conclusions  Low-pressure pneumoperitoneum tended to be better than standard-pressure pneumoperitoneum in terms of lower incidence of shoulder tip pain, but this difference did not reach statistical significance following elective laparoscopic cholecystectomy.     

Single-site incision laparoscopic cholecystectomy in children: a single-center initial experience

Laparoscopic cholecystectomy is the standard approach in most pediatric surgical centers. In an attempt to further minimize the surgical trauma and improve cosmetic outcome, new techniques with a single incision through the umbilicus have been proposed. There are still few reports concerning this technique in the pediatric population. We evaluated the feasibility of the single incision for laparoscopic cholecystectomy in children. We performed the operation in 10 patients, with a mean age of 12 years, mean operating time of 122 minutes, and mean hospital stay of 2 days. No complications occurred, and no conversion to open surgery was needed. In 1 patient, an extra 5-mm port was necessary. The cosmetic results were very satisfactory. In our experience, despite its technical difficulty and initial learning curve, single-incision laparoscopic cholecystectomy in the pediatric population is a safe and feasible method.     

Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial

Background: The role of laparoscopic cholecystectomy for acute cholecystitis is not yet clearly established. The aim of this prospective randomized study was to evaluate the safety and feasibility of laparoscopic cholecystectomy for acute cholecystitis and to compare the results with delayed cholecystectomy.Methods: Between January 2001 and November 2002, 40 patients with a diagnosis of acute cholecystitis were assigned randomly to early laparoscopic cholecystectomy within 24 h of admission (early group, n = 20) or to initial conservative treatment followed by delayed laparoscopic cholecystectomy, 6 to 12 weeks later (delayed group, n = 20).Results: There was no significant difference in the conversion rates (early, 25% vs delayed, 25%), operating times (early, 104 min vs delayed, 93 min), postoperative analgesia requirements (early, 5.3 days vs delayed, 4.8 days), or postoperative complications (early, 15% vs delayed, 20%). However, the early group had significantly more blood loss (228 vs 114 ml) and shorter hospital stay (4.1 vs 10.1 days).Conclusions: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible, offering the additional benefit of a shorter hospital stay. It should be offered to patients with acute cholecystitis, provided the surgery is performed within 72 to 96 h of the onset of symptoms.     

Transvaginal cholecystectomy versus single-incision laparoscopic cholecystectomy versus four-port laparoscopic cholecystectomy: a prospective cohort study

Objective

This report describes the first prospective cohort study comparing transvaginal cholecystectomies (TVC) with single incision laparoscopic cholecystectomies (SILC) and four-port laparoscopic cholecystectomies (4PLC).

Methods

Between May 2009 and August 2010, 14 patients underwent a TVC. These patients were compared with patients who underwent SILC (22 patients) or 4PLC (11 patients) in a concurrent, randomized, controlled trial. Demographic data, operative time, numerical pain scales, complications, and return to work were recorded.

Results

Mean age (TVC: 33.5?±?3.0?year; SILC: 38.4?±?3.3?year; 4PLC: 35.5?±?4.1?year; p?=?0.58) and mean BMI (TVC: 28.8?±?1.5?kg/m²; SILC: 31.8?±?1?kg/m²; 4PLC: 31.4?±?2.2?kg/m²; p?=?0.35) were not statistically significant. However, mean operative time (TVC: 67?±?3.9?min; SILC: 48.9?±?2.6?min; 4PLC: 42.3?±?3.9?min; p?p?=?0.02) with equilibration of pain scores by days 14 and 30. Return to work (TVC: 6.4?±?1.5?days; SILC: 13.1?±?1.3?days; 4PLC: 14.1?±?1.4?days; p?Conclusions Transvaginal cholecystectomy is a safe and well-tolerated procedure with statistically significantly less pain at 1 and 3?days after surgery, with a faster return to work but longer operative times compared with single incision and four-port laparoscopic cholecystectomy.