Journal List > J Korean Surg Soc > v.80(1) > 1011265

Song, Ho, Kim, Kim, You, Choi, Choi, and Heo: Clinical Analysis of Single-Port Laparoscopic Cholecystectomies: Early Experience

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.
jkss-80-43f1.tif
Table 1.
Six patients who underwent other operations combined with MPLC*
Gender/Age Gallbladder disease Combined problem Combined operation
F/52 Stone Renal cell cancer Right kidney partial nephrectomy
M/56 Stone Renal cell cancer Left radical nephrectomy
F/62 Stone Renal cell cancer Left radical nephrectomy
M/51 Stone Non-function kidney Left nephrectomy
M/60 Stone Papillary thyroid cancer Total thyroidectomy
F/47 Polyp Adrenal cortical adenoma Left adrenalectomy

* MPLC = multi-port laparoscopic cholecystectomy.

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)  

* BMI = body mass index;

SD = standard deviation;

ASA = American Society of Anesthesiologists;

§ Others = biliary dyskinesia, acalculus cholecystitis, gallstone pancreatitis.

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

* NRS = numeric rating scale;

Two voiding difficulty, one biliary stricture, one myocardial ischemia.

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

* BMI = body mass index,

Group A = patients who underwent MPLC with all diagnosis criteria excluding gallbladder empyema;

Group B = patients who underwent SPLC with all diagnosis criteria excluding gallbladder empyema;

§ SD = standard deviation.

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