A comparative study of single incision laparoscopic cholecystectomy with conventional laparoscopic instruments versus multiple port laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20184623Keywords:
Multi-port laparoscopic cholecystectomy, Single port laparoscopic cholecystectomyAbstract
Background: Treatment of gall stones have evolved markedly since open cholecystectomy was first described by Lange Buch in 1881. Management has progressed through eras of nonsurgical management, laparotomy, minilaparotomy and now laparoscopic cholecystectomy which is the gold standard for the treatment of gall stone disease today. Laparoscopic surgery is the procedure of choice for most benign gall bladder diseases unless obvious contraindication exists. There has been a trend toward minimizing the required number and size of ports to reduce postoperative pain with better cosmetic results.
Methods: Comparative randomized study was conducted in Department of Surgery, SDM College of Medical Sciences and Hospital between February 2017 to July 2018. 60 patients who fit into the inclusion criteria were included in the study. 30 patients were included in the multiport cholecystectomy and 30 in the SILC. Random allocation of patients presenting with symptoms suggestive of gall bladder disease with confirmatory USG study. Group1: single incision laparoscopic cholecystectomy, Group2: multiple port laparoscopic cholecystectomy.
Results: Majority of presenting patients were in age group 41-50 years. No significant difference in the mean age of patients, surgical complication, conversion rates and SSI operated by the two techniques. Median time required to complete cholecystectomy by SILC technique was not significantly higher than that required for multiport cholecystectomy. Statistically significant lower postoperative pain score was seen in patients with SILC compared to Multiport laparoscopic cholecystectomy. Patients operated by SILC technique had a postoperative hospital stay of mean 4.04 days, almost same as for patients operated by multiport technique.
Conclusions: Difference of Conversion rates and time required for SILC is not significantly higher than that required for multiport cholecystectomy. No rise in intra and post-operative complications occurred in the single port surgery. Postoperative pain is significantly lower in patients undergoing SILC Length of postoperative hospital stay and incidence of SSI for single port cholecystectomy is almost as same as for multiport cholecystectomy.
Metrics
References
Morgenstern L. Carl Langenbuch and the first cholecystectomy. Surgical endoscopy. 1992;6(3):113-4.
Beal JM. Historical perspective of gall stone disease. Surg Gynecol Obstet. 1984;158(2):181-9.
Reynolds W Jr. The first laparoscopic cholecystectomy. JSLS. 2001; 5(1):89-94.
Gall Stones and Laparoscopic cholecystectomy, NIH consensus statement online 1992;10(3):1-20.
Soper NJ, Stockmann PT, Dunnegan DL et al. Laparoscopic cholecystectomy: the New ‘Gold standard’? Arch Surg. 1992;127S:917-921.
Boni L, Dionigi G, Rovera F. Natural orifices transluminal endoscopic surgery (NOTES) and other allied “ultra” minimally invasive procedures: are we losing the plot? Surg Endosc. 2009(23):927-9.
Dunkin BJ. Natural Orifice Transluminal Endoscopic Surgery (NOTES): educational Challenge. World J Gastrointestinal Surg. 2010;2:224-30.
Kala Z, Hanke I, Neumann C. A modified technique in laparoscopy assisted Appendectomy- a transumblical approach through a single port. Rozhl Chir. 1996;75:15-8.
Podolsky ER, Curcillo II PG, Rottman SJ. Single port access (SPA) surgery- of initial experience of a novel minimal access approach applied across surgical specialities. Surg Endosc. 2008;22:S172.
Rao PP, Bhagwat SM, Rane A, Rao PP. The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB. 2008;10(5):336-40.
Kuon LS, You YK, Park JH, Kim HJ, Lee KK, Kim DG. Single-port trans umbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2009;19(4):495-9.
Kravetz AJ, Iddings D, Basson MD, Kia MA. The learning curve with single-port cholecystectomy. J Society Laparoendoscopic Surg. 2009;13(3):332.
Ersin S, Firat O, Sozbilen M. Single-incision laparoscopic cholecystectomy: is it more than a challenge? Surgical endoscopy. 2010;24(1):68.
Chow A, Purkayastha S, Aziz O, Paraskeva P. Single-incision laparoscopic surgery for cholecystectomy: an evolving technique. Surgical endoscopy. 2010;24(3):709-14.
Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS. Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointestinal Surg. 2009;13(2):188-92.
Abd Ellatif ME, Askar WA, Abbas AE. Quality-of-life measures after single-access versus conventional laparoscopic cholecystectomy: a prospective randomized study. Surg Endosc. 2013;27(6):1896-906.
Culp BL, Cedillo VE, Arnold DT. Single-incision laparoscopic cholecystectomy versus traditional four-port cholecystectomy. In Baylor University Medical Center Proceedings. 2012;25 (4):319-23.
Bucher P, Pugin F, Buchs NC, Ostermann S, Morel P. Randomized clinical trial of laparoendoscopic single‐site versus conventional laparoscopic cholecystectomy. British Journal of Surgery. 2011;98(12):1695-702.
Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg. 2011;202(3):254-8.
Asakuma M, Hayashi M, Komeda K, Shimizu T, Hirokawa F, Miyamoto Y. Impact of single‐port cholecystectomy on postoperative pain. Br J Surg. 2011;98(7):991-5.
Prasad A, Mukherjee KA, Kaul S, Kaur M. Postoperative pain after cholecystectomy: conventional laparoscopy versus single-incision laparoscopic surgery. J Minimal Access Surg. 2011;7(1):24.
