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Abstract
Purpose
Single-port laparoscopic cholecystectomy (SPLC) is a technique under development in the field of minimally-invasive surgery. We have considered the feasibility of SPLC based on the advantages or restrictions compared with multi-port procedures.
Methods
Two hundred seventeen patients with benign gallbladder disease who underwent SPLC or multi-port laparoscopic cholecystectomy (MPLC) during the most recent 10 months were retrospectively reviewed.
Results
Patients were divided into two or three groups based on the operative period and disease. The mean age and ASA scale were different between the three groups. The intra-operative bile leakage and post-operative hospital stay were significantly less in the SPLC group; however, the blood loss and operative time was greater in the SPLC group. When patients with empyema of the gallbladder were excluded and all patients were reassigned into two groups based on the operative method, the incidence of bile leakage and post-operative hospital stay were similar between the two groups. The mean blood loss and operative time were higher in the patients who underwent SPLC. The mean numeric rating scale (NRS) and requirement for opioid analgesics were similar in the two groups.
Conclusion
With the exception of increased intra-operative hemorrhage and a longer operative time, the risks associated with SPLC were not greater than MPLC. With adequate analgesics, advances in laparoscopic instruments, and surgical experience, SPLC is expected to gain acceptance amongst physicians.
References
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Fig. 1.
(A) Hand-made single-port laparoscopic system. (B) Laparoscopic instruments and wound retractor equipped in the umbilical port.
Table 1.
Six patients who underwent other operations combined with MPLC*
Table 2.
Pre-operative clinical characteristics of patients
| Group 1 (n=121) | Group 2 (n=41) | Group 3 (n=55) | P-value | |
|---|---|---|---|---|
| Mean age, years (range) | 53.7 (14∼85) | 58.3 (19∼86) | 43.7 (17∼73) | ＜0.001 |
| Gender, M： F, N (%) | 56 (46.3)：65 (53.7) | 24 (58.5)：17 (41.5) | 25 (45.5)：30 (54.5) | 0.354 |
| BMI* (kg/m2) (mean±SD†) | 24.7±3.3 (15.0∼37.5) | 24.6±4.8 (16.1∼41.3) | 24.0±3.9 (17.1∼39.8) | 0.512 |
| ASA‡ scale (mean±SD†) | 1.5±0.6 | 1.9±0.7 | 1.3±0.5 | ＜0.001 |
| Diagnosis, N (%) | 0.017 | |||
| Gallbladder stone | 91 (75.2) | 25 (61.0) | 39 (70.9) | |
| Gallbladder polyp | 17 (14.0) | 2 (4.9) | 10 (18.2) | |
| Glabladder empyema | 9 (7.4) | 8 (19.5) | 1 (1.8) | |
| Chronic cholecystitis | 2 (1.7) | 5 (12.2) | 4 (7.3) | |
| Others§ | 2 (1.7) | 1 (2.4) | 1 (1.8) |
Table 3.
Post-operative clinical variables
| Group 1 (n=121) | Group 2 (n=41) | Group 3 (n=55) | P-value | |
|---|---|---|---|---|
| Bile leakage, N (%) | 9 (7.4) | 10 (24.4) | 2 (3.6) | 0.001 |
| Mean blood loss (cc) (range) | 11.0 (0∼200) | 35.2 (0∼500) | 32.4 (0∼400) | 0.034 |
| Mean operative time (min) (range) | 52.3 (25∼137) | 62.2 (29∼116) | 65.4 (35∼113) | ＜0.001 |
| Mean post-operative hospital stay (day) (range) | 1.6 (1∼6) | 2.1 (1∼7) | 1.4 (1∼3) | 0.002 |
| Mean NRS* score (range) | 3.2 (0∼9) | 3.6 (0∼8) | 4.0 (0∼10) | 0.096 |
| Mean requirement of pethidine (mg) (range) | 30.0 (0∼125) | 35.0 (0∼125) | 32.5 (0∼100) | 0.759 |
| Complications, N (%) | 4† (3.3) | 0 (0) | 0 (0) | 0.201 |
| Open conversion, N (%) | 0 (0) | 0 (0) | 1 (1.8) | 0.271 |
Table 4.
Perioperative clinical results between the new two groups
| Group A† (n=145) | Group B‡ (n=54) | P-value | |
|---|---|---|---|
| Mean age, years (range) | 53.5 (14∼85) | 43.9 (17∼73) | ＜0.001 |
| Gender, M： F, N (%) | 70 (48.3)：75 (51.7) | 25 (46.3)：29 (53.7) | 0.804 |
| BMI* (kg/m2) (mean±SD§) | 247±3.8 | 24.0±3.9 | 0.290 |
| ASA scale (mean±SD§) | 1.5±0.6 | 1.3±0.5 | 0.050 |
| Bile spillage, N (%) | 9 (6.2) | 2 (3.7) | 0.492 |
| Mean blood loss (cc) (range) | 10.5 (0∼100) | 33.0 (0∼400) | 0.003 |
| Mean operative time (min) (range) | 52.6 (25∼111) | 65.2 (35∼113) | ＜0.001 |
| Mean post-operative hospital stay (day) (range) | 1.6 (1∼6) | 1.4 (1∼3) | 0.094 |
| Mean NRS score (range) | 3.4 (0∼9) | 3.9 (0∼10) | 0.074 |
| Mean requirement of pethidine (mg) (range) | 32.5 (0∼125) | 32.5 (0∼100) | 0.928 |
| Complications, N (%) | 4 (2.8) | 0 (0) | 0.218 |
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