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Krollmann N, Hunger R, Paasch C, Mantke R. Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients. Ann Med Surg (Lond) 2024; 86:50-55. [PMID: 38222712 PMCID: PMC10783355 DOI: 10.1097/ms9.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Background Studies have evaluated long-term occurrence of incisional hernia, cosmesis, and postoperative pain after single-incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. The authors performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period. Methods All patients that underwent SILC at the University Hospital Brandenburg an der Havel Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications, and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale). Results In total 125 patients underwent SILC. The single-incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 0.8% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6%, an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (visual analog scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar. Conclusion The present study demonstrates that SILC is a safe alternative in terms of incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow-up period and multiport laparoscopic cholecystectomy, our result is comparable.
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Affiliation(s)
- Niklas Krollmann
- Department of General Surgery, University Hospital Brandenburg an der Havel, Brandenburg, Germany
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Sanders DL, Pawlak MM, Simons MP, Aufenacker T, Balla A, Berger C, Berrevoet F, de Beaux AC, East B, Henriksen NA, Klugar M, Langaufová A, Miserez M, Morales-Conde S, Montgomery A, Pettersson PK, Reinpold W, Renard Y, Slezáková S, Whitehead-Clarke T, Stabilini C. Midline incisional hernia guidelines: the European Hernia Society. Br J Surg 2023; 110:1732-1768. [PMID: 37727928 PMCID: PMC10638550 DOI: 10.1093/bjs/znad284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/08/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023]
Affiliation(s)
- David L Sanders
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maciej M Pawlak
- Academic Department of Abdominal Wall Surgery, Royal Devon University
Foundation Healthcare Trust, North Devon District Hospital,
Barnstaple, UK
- University of Exeter Medical School,
Exeter, UK
| | - Maarten P Simons
- Department of Surgery, OLVG Hospital Amsterdam,
Amsterdam, The
Netherlands
| | - Theo Aufenacker
- Department of Surgery, Rijnstate Hospital Arnhem,
Arnhem, The Netherlands
| | - Andrea Balla
- IRCCS San Raffaele Scientific Institute,
Milan, Italy
| | - Cigdem Berger
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Frederik Berrevoet
- Department for General and HPB Surgery and Liver Transplantation, Ghent
University Hospital, Ghent, Belgium
| | | | - Barbora East
- 3rd Department of Surgery at 1st Medical Faculty of Charles University,
Motol University Hospital, Prague, Czech Republic
| | - Nadia A Henriksen
- Department of Gastrointestinal and Hepatic Diseases, University of
Copenhagen, Herlev Hospital, Copenhagen, Denmark
| | - Miloslav Klugar
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Alena Langaufová
- Department of Health Sciences, Faculty of Medicine, Masaryk
University, Brno, Czech
Republic
| | - Marc Miserez
- Department of Abdominal Surgery, University Hospital Gasthuisberg, KU
Leuven, Leuven, Belgium
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Department of General and
Digestive Surgery, University Hospital Virgen del Rocio, University of
Sevilla, Sevilla, Spain
| | - Agneta Montgomery
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Patrik K Pettersson
- Department of Surgery, Skåne University Hospital,
Malmö, Sweden
- Department of Clinical Sciences, Malmö Faculty of Medicine, Lund
University, Lund, Sweden
| | - Wolfgang Reinpold
- Hamburg Hernia Centre, Department of Hernia and Abdominal Wall Surgery,
Helios Mariahilf Hospital Hamburg, Teaching Hospital of the University of Hamburg,
Hamburg, Germany
| | - Yohann Renard
- Reims Champagne-Ardennes, Department of General, Digestive and Endocrine
Surgery, Robert Debré University Hospital, Reims,
France
| | - Simona Slezáková
- The Czech National Centre for Evidence-Based Healthcare and Knowledge
Translation (Cochrane Czech Republic, Czech CEBHC: JBI Centre of Excellence, Masaryk
University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of
Medicine, Masaryk University, Brno, Czech Republic
| | - Thomas Whitehead-Clarke
- Centre for 3D Models of Health and Disease, Division of Surgery and
Interventional Science, University College London,
London, UK
| | - Cesare Stabilini
- Department of Surgery, University of Genoa,
Genoa, Italy
- Policlinico San Martino, IRCCS, Genoa,
Italy
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Seo JW, Park KB, Chin HM, Jun KH. Is single incision laparoscopic surgery (SILS) for gastric gastrointestinal stromal tumor (GIST) dependent on the location of the tumor? BMC Surg 2023; 23:247. [PMID: 37605202 PMCID: PMC10441706 DOI: 10.1186/s12893-023-02141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND We compared the surgical outcomes of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for gastric gastrointestinal stromal tumor (GIST). METHODS We performed single-incision gastric wedge resection on prospectively-enrolled 15 consecutive patients with gastric GIST between November 2020 and April 2022 in a single tertiary center. The early perioperative outcomes of these patients were compared to those of patients who underwent CLS. The indications did not differ from those for conventional laparoscopic procedures for gastric GIST. RESULTS In total, 30 patients were assigned to the SILS (n = 15) and CLS (n = 15) groups. There were no significant differences in the estimated blood loss and intraoperative blood transfusion between the SILS and CLS groups. There were no intraoperative complications or conversions to multiple-port or open surgery in the SILS group. Proximally located tumors were more commonly treated with CLS than with SILS (P = 0.045). GISTs located in the greater curvature were more commonly treated with SILS than with CLS, although the difference was not statistically significant (P = 0.08). The mean incision length in the SILS group was 4.1 cm shorter than that in the CLS group (3.2 ± 0.7 and 7.3 ± 5.2 cm, respectively, P = 0.01). The postoperative analgesic dose was significantly lower in the SILS than in the CLS group (0.4 ± 1.4 and 2.1 ± 2.3, respectively P = 0.01). Also, the duration of postoperative use of analgesic was shorter in SILS than in CLS (0.4 ± 0.7 and 2.0 ± 1.8, respectively, P = 0.01). There were no significant differences in the early postoperative complications between the groups. CONCLUSIONS SILS is as safe, feasible, and effective for the treatment of gastric GIST as CLS with comparable postoperative complications, pain, and cosmesis. Moreover, SILS can be considered without being affected by the type or location of the tumor.
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Affiliation(s)
- Ji Won Seo
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Min Chin
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Jung JH, Kim HC, Cho JY, Jang JY, Lee JH, Lee H, Han IW, Lee HK, Heo JS. Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea. MINIM INVASIV THER 2023:1-8. [PMID: 36930866 DOI: 10.1080/13645706.2022.2153341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
INTRODUCTION The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). MATERIAL AND METHODS This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. RESULTS MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. CONCLUSIONS From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.
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Affiliation(s)
- Ji Hye Jung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyung Chul Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Portelli M, Attard S, Bezzina T. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy: a meta-analysis of the literature. Eur Surg 2023. [DOI: 10.1007/s10353-022-00791-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Gao P, Cai H, Peng B, Cai Y. Single-port laparoscopic pancreaticoduodenectomy. Surg Endosc 2023; 37:1166-1172. [PMID: 36151394 DOI: 10.1007/s00464-022-09618-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/07/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Performing a single-port laparoscopic pancreatectomy is technically challenging. Single-port laparoscopic pancreaticoduodenectomy (SPLPD) is rarely reported in English literature. METHODS Eighty-seven cases of laparoscopic pancreaticoduodenectomy (LPD) were performed by a single surgical team in the Department of Pancreatic Surgery, West China Hospital, Sichuan University between February 2020 and December 2020. Among these, 13 cases of LPD (group 1) were performed using a single-port device. Basing on the same inclusion and exclusion criteria, 68 cases of LPD performed using traditional 5-trocar were included as a control group (group 2). The patient's demographic characteristics, intraoperative, and postoperative variables were prospectively collected and retrospectively analyzed. RESULTS Five men and eight women were included in the SPLPD group. The median age of these patients was 57 years. The patients who underwent SPLPD required a longer operative time (332.7 ± 38.1 min vs. 305.8 ± 64.7 min; p = 0.03) than those in the LPD group. The estimated blood loss, conversion rate, blood transfusion rate, time to oral intake, postoperative hospital stays, and perioperative complications were comparable between the two groups. The short-term oncological outcomes, such as R0 rate and lymph node harvested, were comparable between the two groups. The 90-day mortality of all patients was zero. CONCLUSIONS SPLPD is a safe and feasible procedure for well-selected patients in an experienced minimally invasive pancreatic surgery team. SPLPD may provide several potential advantages, such as the requirement of fewer trocars, fewer abdominal complications, and reduced participation of assistants than conventional LPD.
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Affiliation(s)
- Pan Gao
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - He Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Bing Peng
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yunqiang Cai
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, No 37, Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Rasa HK, Erdemir A. Our initial single port robotic cholecystectomy experience: A feasible and safe option for benign gallbladder diseases. World J Gastrointest Endosc 2022; 14:769-776. [PMID: 36567824 PMCID: PMC9782565 DOI: 10.4253/wjge.v14.i12.769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although single-port laparoscopic cholecystectomy has been performed for over 25 years, it is still not popular. The narrow working space used in this surgery limits the movement of instruments and causes ergonomic challenges. Robotic surgery not only resolves the ergonomic challenges of single-port laparoscopic surgery but is also considered a good option with its additional technical advantages, like a three-dimensional display and not being affected by tremors. However, the extent to which these technical and ergonomic advantages positively affect the surgical outcomes and how safe the single-port robotic surgeries need to be assessed for each particular surgery.
AIM To evaluate the feasibility and safety of single-port robotic cholecystectomy for patients with cholelithiasis.
METHODS The electronic records of the first 40 consecutive patients with gallbladder lithiasis who underwent single-port robotic cholecystectomy from 2013 to 2021 were analyzed retrospectively. In addition to the demographic characteristics of the patients, we analyzed American Society of Anesthesiologists (ASA) scores and body mass index. The presence of an accompanying umbilical hernia was also noted. The amount of blood loss during the operation, the necessity to place a drain in the subhepatic area, and the need to use grafts during the closure of the fascia of the port site were determined. Hospital stay, readmission rates, perioperative and postoperative complications, the Clavien-Dindo complication scores and postoperative analgesia requirements were also evaluated.
RESULTS The mean age of the 40 patients included in the study was 49.5 ± 11.6 years, and 26 were female (65.0%). The umbilical hernia was present in 24 (60.0%) patients, with a body mass index median of 29.3 kg/m2 and a mean of 29.7 ± 5.2 kg/m2. Fifteen (37.5%) of the patients were evaluated as ASA I, 18 (45.0%) as ASA II, and 7 (17.5%) as ASA III. The mean bleeding amount during the operation was 58.4 ± 55.8 mL, and drain placement was required in 12 patients (30.0%). After port removal, graft reinforcement during fascia closure was preferred in 14 patients (35.0%). The median operation time was 93.5 min and the mean was 101.2 ± 27.0 min. The mean hospital stay was 1.4 ± 0.6 d, and 1 patient was readmitted to the hospital due to pain (2.5%). Clavien-Dindo I complications were seen in 14 patients (35.0%), and five (12.5%) complications were wound site problems.
CONCLUSION In addition to the technological and ergonomic advantages robotic surgery provides surgeons, our study strongly supports that single-port robotic cholecystectomy is a feasible and safe option for treating patients with gallstones.
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Affiliation(s)
- Huseyin Kemal Rasa
- Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
| | - Ayhan Erdemir
- Department of General Surgery, Anadolu Medical Center Hospital, Kocaeli 41400, Turkey
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Noitumyae J, Mahatharadol V, Niramis R. Single-Incision Pediatric Laparoscopic Surgery: Surgical Outcomes, Feasibility Indication, and the Systematic Review. J Laparoendosc Adv Surg Tech A 2022; 32:1190-1202. [PMID: 35900259 DOI: 10.1089/lap.2021.0869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Single-incision laparoscopic surgery (SILs) has reported the evidence in basic and advanced pediatric laparoscopy. The objective was to review the feasibility and outcomes between basic and advanced procedures of the conventional laparoscopic surgery (CLs) and the SILs at our institute, and to compare the results with the published studies in a systematic review and meta-analysis. Patients and Methods: A retrospective study was conducted from January 2017 to March 2020. Demographic data, operations, conversion rate, and complications were collected and analyzed. The MEDLINE and PubMed were searched in relation to the pediatric SILs and the pediatric CLs in the published series from 1985 to 2021. We combined our retrospective study with a systematic review for meta-analysis. Results: Two hundred twenty-seven patients underwent pediatric laparoscopic surgery during the study period. The procedures included 199 (87.7%) for basic laparoscopy (appendectomy, cholecystectomy, testicular vessel ligation, closure of indirect inguinal hernia, and hydrocele) and 28 (13.3%) for advanced laparoscopy (Meckel diverticulectomy, pull-through operation for Hirschsprung's disease, choledochal cyst excision, and Nissen fundoplication). There was no statistical significance in operative time, length of stay (LOS), conversion rate, recurrence, and complication. The systematic review demonstrated 19 studies and, combined with our present study, produced 2865 patients for analysis. The meta-analysis reported increased LOS in the SILs group in cholecystectomy (mean difference [MD] 0.23 day, 95% confidence intervals [CI] 0.02-0.43 day, P = .03 and I2 = 0%) and choledochal cyst excision (MD 0.18 day, 95% CI 0.02-0.33 day, P = .03 and I2 = 0%). There was no statistical difference in operative time, LOS, conversion, and complication in other procedures. Conclusion: The SILs is a feasible indication and safe for surgical pediatric laparoscopy including basic to advanced procedure laparoscopy. It is demonstrated that there were no statistical differences in the operative time, LOS, and the complication. However, LOS in some procedures seems to be different due to the complexity and guideline.
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Affiliation(s)
- Jarruphong Noitumyae
- Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Varaporn Mahatharadol
- Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Rangsan Niramis
- Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
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Casaccia M, Ponzano M, Testa T, Martigli SP, Contratto C, De Cian F. Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis. JSLS 2022; 26:JSLS.2022.00020. [PMID: 35967963 PMCID: PMC9355797 DOI: 10.4293/jsls.2022.00020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background and Objectives: To assess the safety and efficacy of single-port laparoscopic cholecystectomy (SPLC) for the treatment of symptomatic cholelithiasis in different gallbladder pathologic conditions. Methods: All patients who underwent SPLC in our department between October 1, 2017 and March 31, 2020 were registered consecutively in a prospective database. Patients’ charts were retrospectively divided according to histological diagnosis: normal gallbladder (NG) (n = 13), chronic cholecystitis (CC) (n =47), and acute cholecystitis (AC) (n = 10). The parameters for assessing the procedure outcome included operative time, blood loss, use of additional trocars, conversion to laparotomy, intraoperative and postoperative complications, and length of hospital stay. Patient groups were statistically compared. Results: Seventy patients underwent SPLC. Duration of surgery increased from NG (55 ± 22.7 min) to CC (70 ± 33.5 min), and to AC patients (110.5 ± 50.5 min), which is statistically significant (P = .001). Postoperative complication rates were 7.6% in NG patients, 17% in CC, and 30% in AC (P = .442). Length of hospitalization was shorter for NG patients (1.0 ± 0.6 days) versus CC (2.0 ± 1.1 days) and AC patients (2.0 ± 4.7 days), with statistical significance (P = .020). Multivariate analysis found that pathology type and the occurrence of postoperative complications were independent predictors for prolonged operative times and prolonged hospital stay, respectively. Conclusion: SPLC is feasible for acute and chronic cholecystitis with good procedural outcomes. Since SPLC technique itself can be sometimes challenging with the existing technology, its application, especially in cases of acute cholecystitis, should be done with caution. Only prospective randomized studies on this approach for acute and chronic gallbladder diseases will assess the complete reliability of this technique.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Marta Ponzano
- Unit of Clinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgery, San Martino Hospital, Genoa, Italy
| | - Sofia Paola Martigli
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Cecilia Contratto
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
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Berlet M, Jell A, Bulian D, Friess H, Wilhelm D. [Clinical value of alternative technologies to standard laparoscopic cholecystectomy - single port, reduced port, robotics, NOTES]. Chirurg 2022; 93:566-576. [PMID: 35226123 DOI: 10.1007/s00104-022-01608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.
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Affiliation(s)
- M Berlet
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - A Jell
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - D Bulian
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Zentrum für interdisziplinäre Viszeralmedizin (ZIV), Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - H Friess
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - D Wilhelm
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland.
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Melly C, McGeehan G, O’Connor N, Johnston A, Bass G, Mohseni S, Donohoe C, Bucholc M, Sugrue M. OUP accepted manuscript. BJS Open 2022; 6:6603491. [PMID: 35668711 PMCID: PMC9171002 DOI: 10.1093/bjsopen/zrac062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/24/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient-reported outcome measures (PROMs) in patients undergoing laparoscopic cholecystectomy. Methods A PROSPERO-registered (registration number CRD42021261707) systematic review was undertaken for all relevant English language articles using PubMed version of MEDLINE, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards and included the keywords: laparoscopic cholecystectomy AND patient outcome OR patient-reported outcome OR patient-reported outcome measure OR PRO OR PROM. Medical Subjects Heading terms were used to search PubMed and Scopus. Articles published from 1 January 2011 to 2 June 2021 were included. Results A total of 4960 individual articles were reviewed in this study, of which 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy and underwent methodological index for non-randomized studies (MINORS) grading. Twenty-one articles spanning 19 countries and four continents met all inclusion criteria and were included in the qualitative data synthesis. There was significant heterogeneity in PROMs identified with eight different comprehensive PROM tools used in the 21 studies. There was wide variation in the time points at which PROMs were recorded. Fourteen of 21 studies recorded PROMs before and after surgery, and 7 of 21 recorded PROMs only after surgery. Follow-up intervals ranged from 3 days to 2 years after surgery. Conclusions This study identified that while post-laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. The EQ-5D™ (EuroQoL Group, Rotterdam, the Netherlands) provides a simple platform for the modern digital era.
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Affiliation(s)
| | - Gearoid McGeehan
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- University of Limerick School of Medicine, University of Limerick, Limerick, Ireland
| | - Niall O’Connor
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Alison Johnston
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
| | - Gary Bass
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery Orebro University Hospital, & School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Claire Donohoe
- Department of Surgery, Trinity College Dublin, St James’ Hospital, Dublin, Ireland
| | - Magda Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
| | - Michael Sugrue
- Department of Surgery, Letterkenny University Hospital and Donegal Clinical Research Academy, Donegal, Ireland
- EU INTERREG Centre for Personalized Medicine, Intelligent Systems Research Centre, School of Computing, Engineering and Intelligent Systems, Ulster University, Magee Campus, Derry-Londonderry, UK
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Um MH, Lee SJ, Choi IS, Moon JI, Lee SE, Sung NS, Kwon SU, Bae IE, Rho SJ, Kim SG, Yoon DS, Choi WJ. Completion of single-incision laparoscopic cholecystectomy using the modified Konyang standard method. Surg Endosc 2021; 36:4992-5001. [PMID: 34734302 DOI: 10.1007/s00464-021-08856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND To date, a surgical method for single-incision laparoscopic cholecystectomy (SILC) has not been standardized. Therefore, this study aimed to introduce a standardized surgical method for SILC, in addition to reporting our experience over 10 years. METHODS Patients who underwent SILC at a single institution between April 2010 and December 2019 were included in this study. We analyzed the patient demographics and surgical outcomes according to the surgical method used: phase 1 (Konyang standard method, KSM) comprising initial 3-channel SILC, phase 2 (modified KSM, mKSM) comprising 4-channel SILC with a snake retractor, and phase 3 (commercial mKSM, C-mKSM) using a commercial 4-channel port. RESULTS Of 1372 patients (mean age, 51.3 years; 781 [56.9%] women), 418 (30.5%) surgeries were performed for acute cholecystitis (AC), 33 (2.4%) were converted to multiport or open cholecystectomy, and 49 (3.6%) developed postoperative complications. The mean operation time (OT) and length of postoperative hospital stay (LOS) were 51.9 min and 2.6 days, respectively. Overall, 325 patients underwent SILC with the KSM, 660 with the mKSM, and 387 with the C-mKSM. In the C-mKSM group, the number of patients with AC was the lowest (26.8% vs. 38.2% vs. 20.4%, p < 0.001) and the OT (51.7 min vs. 55.4 min vs. 46.1 min, p < 0.001), estimated blood loss (24.5 mL vs. 15.5 mL vs. 6.1 mL, p < 0.001), and LOS (2.8 days vs. 2.5 days vs. 2.3 days, p = 0.001) were significantly improved. The surgical outcomes were better in the non-AC group than in the AC group. CONCLUSION Based on our 10 year experience, C-mKSM is a safe and feasible method of SILC in selected patients, although there were lower percentage of patients with AC compared to other groups.
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Affiliation(s)
- Min Ho Um
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea.
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Nak Song Sung
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seung Jae Rho
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
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13
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Valcarenghi J, Hernigou J, Apicella G, Clegg E, Rousie M, Chasse E. Long-term follow-up of the incisional hernia rate after single-incision laparoscopic cholecystectomy: a prospective observational study. Acta Chir Belg 2021; 121:320-326. [PMID: 32375576 DOI: 10.1080/00015458.2020.1765673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the long-term occurrence rate of incisional hernias following single-incision laparoscopic cholecystectomy (SILC). BACKGROUND Since the 90 s, SILC has emerged as a less invasive alternative to standard laparoscopic cholecystectomy in selected patients. But concerns over port-incisional hernias have not been addressed. METHODS Between February 2009 and February 2011, 142 patients referred for gallstones who agreed to undergo SILC were included in a monocenter prospective observational study. All of the procedures were carried out using a single-port access technique. The occurrence rates of incisional hernias were analyzed with the Kaplan-Meier actuarial method. Statistical significance was set at p < .05. RESULTS A total of 142 patients with gallbladder pathology were included in the study; 138 of them underwent SILC and 4 were converted to standard multiport cholecystectomy. Twelve patients (8%) were found to have developed a port-site incisional hernia (PSH) by physical examination or by imaging. The Kaplan-Meier curve showed that the rate of PSH development was 83% in the first 2 years after surgery. After 2 years, this risk becomes quite low. CONCLUSIONS Our results indicate that the SILC procedure is a safe option for treatment of benign gallbladder diseases for selected patients, albeit with a high incisional hernia rate.
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Affiliation(s)
| | - Jacques Hernigou
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Giulia Apicella
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emilie Clegg
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Maxime Rousie
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
| | - Emmanuel Chasse
- Department of Surgery, Centre Hospitalier EpiCURA, Hainaut, Belgium
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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Zhao JJ, Syn NL, Chong C, Tan HL, Ng JYX, Yap A, Kabir T, Goh BKP. Comparative outcomes of needlescopic, single-incision laparoscopic, standard laparoscopic, mini-laparotomy, and open cholecystectomy: A systematic review and network meta-analysis of 96 randomized controlled trials with 11,083 patients. Surgery 2021; 170:994-1003. [PMID: 34023139 DOI: 10.1016/j.surg.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most randomized trials on minimally invasive cholecystectomy have been conducted with standard (3/4-port) laparoscopic or open cholecystectomy serving as the control group. However, there exists a dearth of head-to-head trials that directly compare different minimally invasive techniques for cholecystectomy (eg, single-incision laparoscopic cholecystectomy versus needlescopic cholecystectomy). Hence, it remains largely unknown how the different minimally invasive cholecystectomy techniques fare up against one another. METHODS To minimize selection and confounding biases, only randomized controlled trials were considered for inclusion. Perioperative outcomes were compared using frequentist network meta-analyses. The interpretation of the results was driven by treatment effects and surface under the cumulative ranking curve values. A sensitivity analysis was also undertaken focusing on a subgroup of randomized controlled trials, which recruited patients with only uncomplicated cholecystitis. RESULTS Ninety-six eligible randomized controlled trials comprising 11,083 patients were identified. Risk of intra-abdominal infection or abscess, bile duct injury, bile leak, and open conversion did not differ significantly between minimally invasive techniques. Needlescopic cholecystectomy was associated with the lowest rates of wound infection (surface under the cumulative ranking curve value = 0.977) with an odds ratio of 0.095 (95% confidence interval: 0.023-0.39), 0.32 (95% confidence interval: 0.11-0.98), 0.33 (95% confidence interval: 0.11-0.99), 0.36 (95% confidence interval: 0.14-0.98) compared to open cholecystectomy, single-incision laparoscopic cholecystectomy, mini-laparotomy, and standard laparoscopic cholecystectomy, respectively. Mini-laparotomy was associated with the shortest operative time (surface under the cumulative ranking curve value = 0.981) by a mean difference of 22.20 (95% confidence interval: 13.79-30.62), 12.17 (95% confidence interval: 1.80-22.54), 9.07 (95% confidence interval: 1.59-16.54), and 8.36 (95% confidence interval: -1.79 to 18.52) minutes when compared to single-incision laparoscopic cholecystectomy, needlescopic cholecystectomy, standard laparoscopic cholecystectomy, and open cholecystectomy, respectively. Needlescopic cholecystectomy appeared to be associated with the shortest hospitalization (surface under the cumulative ranking curve value = 0.717) and lowest postoperative pain (surface under the cumulative ranking curve value = 0.928). CONCLUSION Perioperative outcomes differed across minimally invasive techniques and, in some instances, afforded superior outcomes compared to standard laparoscopic cholecystectomy. These findings suggest that there may be equipoise for exploring further the utility of novel minimally invasive techniques and potentially incorporating them into the general surgery training curriculum.
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Affiliation(s)
- Joseph J Zhao
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Cheryl Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Julia Yu Xin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ashton Yap
- Townsville Hospital, Queensland, Australia
| | - Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Hepatopancreatobiliary Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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16
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Wang W, Sun X, Wei F. Laparoscopic surgery and robotic surgery for single-incision cholecystectomy: an updated systematic review. Updates Surg 2021. [PMID: 33886106 DOI: 10.1007/s13304-021-01056-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
The role of single-incision laparoscopic cholecystectomy (SILC) and single-incision robotic cholecystectomy (SIRC) is still unclear. We update the summarization of the feasibility and safety of SILC and SIRC. A comprehensive search of SILC and SIRC of English literature published on PubMed database between January 2015 and November 2020 was performed. A total of 70 articles were included: 41 covering SILC alone, 21 showing SIRC alone, 7 reporting both, and 1 study not specified. In total, 7828 cases were recorded (SILC/SIRC/not specified, 6234/1544/50); and the gender of 7423 cases was definitively reported: the female rate was 64.0% (SILC/SIRC/not specified, 62.1%/71.5%/74.0%). The weighted mean for body mass index (BMI), operative time, blood loss and post-operative hospital stay was 25.5 kg/m2 (SILC/SIRC, 25.0/27.0 kg/m2), 73.8 min (SILC/SIRC, 68.2/88.8 min), 12.6 mL (SILC/SIRC, 12.1/14.8 mL) and 2.5 days (SILC/SIRC, 2.8/1.9 days), respectively. The pooled prevalence of an additional port, conversion to open surgery, post-operative complications, intraoperative biliary injury, and incisional hernia was 4.1% (SILC/SIRC, 4.7%/1.9%), 0.9% (SILC/SIRC, 0.7%/1.5%), 5.9% (SILC/SIRC, 6.2%/4.1%), 0.1% (SILC/SIRC, 0.2%/0.09%), and 2.1% (SILC/SIRC, 1.4%/4.8%), respectively. Compared with conventional laparoscopic cholecystectomy, SIRC has experienced more postoperative incisional hernias (risk difference = 0.05, 95% confidence interval 0.02-0.07; P < 0.0001). By far, SILC and SIRC have not been considered a standard procedure. With the innovation of medical devices and gradual accumulation of surgical experience, feasibility and safety of performing SILC and SIRC will improve.
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Casaccia M, Fornaro R, Papadia FS, Testa T, Mascherini M, Ibatici A, Ghiggi C, Bregante S, De Cian F. Single-Port vs. Conventional Multi-Port Laparoscopic Lymph Node Biopsy. JSLS 2021; 24:JSLS.2020.00045. [PMID: 33100817 PMCID: PMC7546779 DOI: 10.4293/jsls.2020.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background and Objectives The purpose of the investigation was to compare clinical results and diagnostic accuracy for conventional multiport laparoscopic lymph node biopsy (MPLB) and single-port laparoscopic lymph node biopsy (SPLB) operations at a single institution. Methods A set of 20 SPLB patients operated on from October 2016 to May 2019 were compared to an historical series of 35 MPLB patients. Primary endpoints were the time of surgery, estimated blood loss, surgical conversion, length of stay and morbidity. The secondary endpoint was the diagnostic accuracy of the technique. Results SPLB was completed laparoscopically in all cases. Two MPLB patients (5.7%) experienced a surgical conversion due to intraoperative difficulties. Duration of surgery was similar in SPLB and MPLB groups respectively (84 ± 31.7 min vs. 81.1 ± 22.2; P = .455). A shorter duration of hospital stay was shown for patients operated on by SPLB compared to the MPLB group (1.7 ± 0.9 days vs. 2.1 ± 1.2 days; P = .133). The postoperative course was uneventful in both groups. In 95% of the SPLB and 97.1% of the MPLB cases respectively, LLB achieved the necessary information for the diagnosis. Conclusion SPLB has shown good procedural and postoperative outcomes as well as a high diagnostic yield, comparable to traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Francesco Saverio Papadia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Tommaso Testa
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Genoa, Italy
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Ali Alshahri TM, Abounozha S, Ibrahim R. Is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Ann Med Surg (Lond) 2021; 63:102123. [PMID: 33643645 PMCID: PMC7895687 DOI: 10.1016/j.amsu.2021.01.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
A best evidence topic has been constructed using a described protocol. The three-part question addressed was: is single port laparoscopic cholecystectomy superior to standard cholecystectomy in post-operative pain? Using the reported search, 8083 papers were found. 8 studies were deemed to be suitable to answer the question. The outcomes assessed were post-operative pain differ in single or standard laparoscopic cholecystectomy, all study used VAS (visual analogue scale). The evidence showed no difference in post-operative pain for patients went for single laparoscopic in compared with standard laparoscopic cholecystectomy. No difference in post-operative pain for patients who had single laparoscopic compared with standard laparoscopic cholecystectomy. May differ in hospital stay and cosmesis but not for post-operative pain. If your main concern is post-operative pain evidence not supporting any technique over other.
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19
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Alarcón I, Yang T, Balla A, Morales-Conde S. Single/reduced port surgery vs. conventional laparoscopic gastrectomy: systematic review and meta-analysis. MINIM INVASIV THER 2021; 31:515-524. [PMID: 33600291 DOI: 10.1080/13645706.2021.1884571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The aim is to compare single port surgery (SPS)/reduced port surgery (RPS) versus conventional laparoscopy (CL) for gastrectomy for gastric cancer in terms of intra- and postoperative outcomes. MATERIAL AND METHODS After a search in Pubmed and Embase, six articles were included. Pooled analysis was used to evaluate the statistically significance for each variable. RESULTS Two hundred and thirty-three and 230 patients underwent SPS/RPS and CL, respectively. One hundred and eighty-eight patients and 45 patients underwent subtotal and total gastrectomy, respectively, using the SPS/RPS approach. One hundred and eighty-five patients and 45 patients underwent subtotal and total gastrectomy, respectively, by CL. In 85 patients, an extra trocar was systematically placed at the end of surgery. Statistically significant differences were not observed about preoperative staging. The pooled analysis regarding operative time, blood loss, postoperative complications, number of harvested lymph nodes and postoperative hospital stay showed that the only statistically significant difference between the two approaches is the shorter hospital stay in case of SPS/RPS. CONCLUSIONS SPS/RPS total or subtotal gastrectomy shows a lower postoperative hospital stay, with comparable operative time, blood loss, early postoperative complication rate and number of harvested lymph nodes in comparison to CL, provided extensive experience in minimally invasive gastrectomy is present. Abbreviations: AGC: advanced gastric cancer; BMI: body mass index; CI: confidence interval; CL: conventional laparoscopy; LESS: laparoendoscopic single site; MD: mean difference; NOS: Newcastle-Ottawa Scale; OR: odds ratio; PRISMA: Preferred Reporting Items for Systematic Review and Meta-Analysis; ROBIN-I: Risk Of Bias In Non-randomised Studies - of Interventions; RPS: reduced port surgery; RR: risk ratio; SILS: single incision laparoscopic surgery; SPS: single port surgery; WMD: weighted mean differences.
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Affiliation(s)
- Isaias Alarcón
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - Tao Yang
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain
| | - Andrea Balla
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain.,Department of General Surgery and Surgical Specialties "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Salvador Morales-Conde
- Department of General and Digestive Surgery, Unit of Innovation in Minimally Invasive Surgery, University Hospital "Virgen del Rocio", University of Seville, Seville, Spain.,Unit of General and Digestive Surgery, Hospital QuironSalud Sagrado Corazón, Seville, Spain
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20
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Subirana H, Rey FJ, Barri J, Robres J, Parra L, Martín M, Memba R, Mullerat JM, Jorba R. Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial. J Minim Access Surg 2021; 17:311-317. [PMID: 32964868 PMCID: PMC8270025 DOI: 10.4103/jmas.jmas_97_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time. Methods: This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate. Results: In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures. Conclusions: SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.
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Affiliation(s)
- Helena Subirana
- Department of General Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Francisco Javier Rey
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Joan Barri
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Joaquim Robres
- Department of General Surgery, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Lourdes Parra
- Department of Anesthesiology, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Montserrat Martín
- Department of Clinical Epidemiology, Hospital General de l'Hospitalet, Consorci Sanitari Integral, Barcelona, Spain
| | - Robert Memba
- Department of General Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
| | - Josep Maria Mullerat
- Department of General Surgery, Hospital Moisès Broggi, Consorci Sanitari Integral, Barcelona, Spain
| | - Rosa Jorba
- Department of General Surgery, Hospital Universitari Joan XXIII de Tarragona, Tarragona, Spain
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Casaccia M, Lemoli RM, Angelucci E, Bregante S, Ballerini F, Ibatici A, Ghiggi C, De Cian F. Feasibility of Single-Port Laparoscopic Lymph Node Biopsy for Intra-Abdominal Lymphoma: A Case Series. J Laparoendosc Adv Surg Tech A 2020; 31:458-461. [PMID: 33216698 DOI: 10.1089/lap.2020.0695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Laparoscopic lymph node biopsy through a multi-port access (MPLB) is a well-established technique for intra-abdominal lymphoma diagnosis. The aim of the current study is to assess the feasibility and the diagnostic accuracy of the single-port laparoscopic lymph node biopsy (SPLB) in intra-abdominal lymphoma. Materials and Methods: Between October 2016 and February 2019, 15 patients underwent SPLB to rule out or to follow the progression of a lymphoma. The clinical outcome and the pathology reports were analyzed retrospectively. Results: SPLB was completed laparoscopically in all cases. The total number of biopsies performed for each procedure was sometimes multiple (median: 2; range: 1-3). Duration of surgery was 85 ± 32 minutes (range: 75-105 minutes). Length of hospitalization was 1.8 ± 0.7 days (range: 1-3 days). No major postoperative complications occurred. A cutaneous infection managed conservatively was observed in a patient. In 10 patients, SPLB was used to establish a diagnosis whereas in 5 patients it was performed to follow a progression of a lymphoproliferative disease. In 93.3% of the cases, SPLB achieved the correct diagnosis and subsequent therapeutic decisions. Conclusion: SPLB has shown good procedure and postoperative outcomes as well as a high diagnostic yield, comparable to literature data on traditional MPLB. Therefore, our results show that this approach is safe and effective and can be an equally valid option to MPLB to obtain a diagnosis or to follow the progression of a lymphoproliferative disease. Further studies are necessary to support these results before its widespread adoption.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Roberto Massimo Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Emanuele Angelucci
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Stefania Bregante
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Filippo Ballerini
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, Genoa, Italy
| | - Adalberto Ibatici
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Chiara Ghiggi
- Hematology and Transplant Center Division, IRCCS San Martino Hospital, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
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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: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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Datta RR, Schönhage S, Dratsch T, Toader J, Müller DT, Wahba R, Kleinert R, Thomas M, Dieplinger G, Stippel DL, Bruns CJ, Fuchs HF. Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision. Surg Endosc 2021; 35:5338-51. [PMID: 32968918 DOI: 10.1007/s00464-020-07998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
Abstract
Background Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.
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Barajas-Gamboa JS, Huidobro F, Jensen J, Luengas R, Rodriguez J, Abril C, Corcelles R, Kroh M. First in-human experience with a novel robotic platform and Magnetic Surgery System. Int J Med Robot 2020; 17:1-7. [PMID: 32926528 DOI: 10.1002/rcs.2163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Magnetic technologies have been introduced to reduce invasiveness of surgical procedures. This study was aimed to analyse the performance of a novel combined magnetic-robotic controller as an enhanced accessory to the Magnetic Surgical System in laparoscopic cholecystectomy (LC). METHODS This was a prospective study of 10 consecutive patients undergoing LC with this novel surgical system. RESULTS Ten patients were included, nine were female. The mean age was 30.3 ± 9 years. All patients had chronic cholecystitis. Procedures were completed successfully. The median operative time was 50 ± 11 min. The system performed effectively in all cases with no need of additional interventions. There were no device-related complications or side effects. All patients were discharged the same day. Recovery was uneventful during follow-up. CONCLUSIONS This study demonstrates the first in-human successful performance of surgeries utilizing a novel combination of magnetic and robotic technologies in one integrated system.
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Affiliation(s)
- Juan S Barajas-Gamboa
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Felipe Huidobro
- Department of General Surgery, Hospital Padre Hurtado, Santiago de Chile, Chile
| | - Joaquin Jensen
- Department of General Surgery, Hospital Padre Hurtado, Santiago de Chile, Chile
| | - Rafael Luengas
- Department of General Surgery, Clinica RedSalud, Santiago de Chile, Chile
| | - John Rodriguez
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Carlos Abril
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ricard Corcelles
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew Kroh
- Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.,Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Chen QL, Chen K, Huang DY, Pan Y, Yan JF, Wang XF, Cai XY. Trans-umbilical single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty of inguinal hernia by self-made glove port. Medicine (Baltimore) 2020; 99:e21787. [PMID: 32846810 PMCID: PMC7447498 DOI: 10.1097/md.0000000000021787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.
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Klein D, Barutcu AG, Kröll D, Kilian M, Pratschke J, Raakow R, Raakow J. Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up. Langenbecks Arch Surg 2020; 405:551-61. [PMID: 32602079 DOI: 10.1007/s00423-020-01911-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
Background Within the last years, single-incision laparoscopic cholecystectomy (SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain. Methods A randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long-term follow-up after surgery was added. Results Ninety-eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups. Conclusions Taking into account a follow-up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates. Trial registration German Registry of Clinical Trials DRKS00012447
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Lee W, Roh YH, Kang SH, Kim CY, Choi Y, Han HS, Han HJ, Song TJ, Kang CM, Lee WJ, Choi SH, Jeong SY, Hong TH, You YK, Lee JH, Moon JI, Choi IS. The chronological change of indications and outcomes for single-incision laparoscopic cholecystectomy: a Korean multicenter study. Surg Endosc 2021; 35:3025-32. [PMID: 32583067 DOI: 10.1007/s00464-020-07748-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although single-incision laparoscopic cholecystectomy (SILC) is a common procedure, the change in its surgical indications and perioperative outcomes has not been analyzed. METHODS We collected the clinical data of patients who underwent pure SILC in 9 centers between 2009 and 2018 and compared the perioperative outcomes. RESULTS In this period, 6497 patients underwent SILC. Of these, 2583 were for gallbladder (GB) stone (39.7%), 774 were for GB polyp (11.9%), 994 were for chronic cholecystitis (15.3%), and 1492 were for acute cholecystitis (AC) (23%). 162 patients (2.5%) experienced complication, including 20 patients (0.2%) suffering from biliary leakage. The number of patients who underwent SILC for AC increased over time (p = 0.028), leading to an accumulation of experience (27.4 vs 23.7%, p = 0.002). The patients in late period were more likely to have undergone a previous laparotomy (29.5 vs 20.2%, p = 0.006), and to have a shorter operation time (47.0 vs 58.8 min, p < 0.001). Male (odds ratio [OR]; 1.673, 95% confidence interval [CI] 1.090-2.569, p = 0.019) and moderate or severe acute cholecystitis (OR; 2.602, 95% CI 1.677-4.037, p < 0.001) were independent predictive factors for gallbladder perforation during surgery, and open conversion (OR; 5.793, 95% CI 3.130-10.721, p < 0.001) and pathologically proven acute cholecystitis or empyema (OR; 4.107, 95% CI 2.461-6.854, p < 0.001) were related with intraoperative gallbladder perforation CONCLUSION: SILC has expanded indication in late period. In this period, the patients had shorter operation times and a similar rate of severe complications, despite there being more numerous patients with AC.
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Hu H, Zhao G, Zhang K, Cai H, Jiang Z, Huang A, Cai J, Xu A, Li H, He C. The Clinical Application of a Self-developed Gasless Laparoendoscopic Operation Field Formation Device on Patients Undergoing Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2020; 30:441-6. [PMID: 32555068 DOI: 10.1097/SLE.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND We have designed a new gasless laparoscopic operation field formation (LOFF) device for cholecystectomy which was successfully tested on animal model. The goal of this study is to investigate the feasibility, safety and effectiveness of this LOFF device on patients undergoing cholecystectomy. METHODS Patients with cholecystolithiasis or gallbladder polyps who underwent single port cholecystectomy from June 2015 to May 2016 were retrospectively reviewed. Either the LOFF-assisted laparoendoscopic single-port surgery (LESS) (LOFF-LESS) or the traditional LESS was performed. Operation time, intraoperative bleeding, postoperative hospital stay, surgical complications, incision pain score, shoulder and back pain and cosmetic satisfaction were compared. RESULTS A total of 186 patients were included in this study, with 79 in the LOFF-LESS group and 107 in the LESS group. There was no significant difference between LOFF-LESS group and LESS group in operation field establishment time, cholecystectomy time, intraoperative bleeding, postoperative hospital stay, incision pain and cosmetic satisfaction. A lower intraoperative arterial carbon dioxide pressure was documented in the LOFF-LESS group (P<0.01). The incidence of postoperative shoulder and back pain was significantly lower in LOFF-LESS group (P<0.01). CONCLUSION LOFF-LESS has comparable benefits of traditional LESS; it deceases incidence of pneumoperitoneum related complications as well.
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Hoyuela C. Must the Surgeons Move Toward Single-Incision Laparoscopic Surgery Given its Cosmetic Benefits? World J Surg 2020; 44:2199-200. [PMID: 32232514 DOI: 10.1007/s00268-020-05494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sahm M, Reinsch AK, Otto R, Mönch C, Gerdes M, Winde G, Lancee S, Meyer L, Mantke A, Lippert H, Croner R, Mantke R. [Morbidity and Mortality of Single Incision Cholecystectomy: Results of a 3-Year Register Analysis]. Zentralbl Chir 2020; 145:390-398. [PMID: 32016926 DOI: 10.1055/a-1071-8082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study). PATIENTS AND METHODS The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05. RESULTS Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications. CONCLUSION The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m2 which has a significant influence on the intraoperative rate of complications in mild adverse events.
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Affiliation(s)
- Maik Sahm
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland.,Klinik für Chirurgie, DRK Kliniken Berlin-Köpenick, Deutschland
| | - Anne-Katrin Reinsch
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
| | - Ronny Otto
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Christian Mönch
- Klinik für Chirurgie, Westpfalz Klinikum GmbH, Kaiserslautern, Deutschland
| | - Martin Gerdes
- Klinik für Chirurgie, Krankenhaus St. Raphael, Ostercappeln, Deutschland
| | - Günther Winde
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Herford, Deutschland
| | - Steffen Lancee
- Klinik für Chirurgie, Kreiskrankenhaus des Vogelsbergkreises in Alsfeld GmbH, Deutschland
| | - Lutz Meyer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Helios Vogtland-Klinikum Plauen, Deutschland
| | - Anne Mantke
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
| | - Hans Lippert
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Roland Croner
- Klinik für Allgemein-, Viszeral-, Gefäß und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Rene Mantke
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
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Raakow J, Klein D, Barutcu AG, Biebl M, Pratschke J, Raakow R. Single-port versus multiport laparoscopic surgery comparing long-term patient satisfaction and cosmetic outcome. Surg Endosc 2020; 34:5533-9. [PMID: 31993818 DOI: 10.1007/s00464-019-07351-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022]
Abstract
Introduction Several studies and meta-analysis showed Single-port or Single-incision laparoscopic surgery (SPL) to be superior over Multiport laparoscopic surgery (MPL) mainly in terms of postoperative pain and cosmetic result. But very little is known whether these results are only a short-term effect or are persistent on the long run after SPL. We therefore evaluated and compared long-term outcomes regarding cosmesis and chronic pain after SPL and MPL. Methods We conducted a comparative study with propensity score matching of all patients undergoing SPL or MPL between October 2008 and December 2013 in terms of postoperative cosmetic results and chronic pain. Follow-up data were obtained from mailed patient questionnaires and telephone interviews. Postoperative cosmesis was assessed using the patients overall scar opinion on a 10-point scale and the Patients scale of the standardized Patient and Observer Scar assessment scale (POSAS). Chronic pain was assessed by 10-point scales for abdominal and umbilical scar pain. Results A total of 280 patients were included in the study with 188 patients (67.1%) after SPL and 92 patients (32.9%) following MPL. 141 patients (50.4%) underwent a cholecystectomy and 139 patients (49.6%) underwent an appendectomy. The mean follow-up time was 61.1 ± 19.1 months. The mean wound satisfaction assed by the overall scar and the PSOAS Patients scale score of the patients showed no significant difference between MPL and SPL. Patients after SPL reported more overall complains than after MPL (8.7% vs. 2.5%, respectively), but without statistical significance (p = 0.321). Umbilical pain scores were comparable between the two groups (1.4 ± 1.0 vs. 1.4 ± 1.0, p = 0.831). Conclusion We found no difference in long-term cosmetic outcomes after SPL and MPL. Chronic pain at the umbilical incision site was comparable on the long run.
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Abstract
Background and Objectives Safety, efficacy, and costs are still debated issues in single-port laparoscopy. The aim of the study was to compare clinical outcomes and hospital costs for conventional 4-port laparoscopic cholecystectomy (4PLC) and single-port laparoscopic cholecystectomy (SPLC) performed at a single institution. Methods A series of 40 SPLC patients operated on from October 2016 to May 2017 were compared to a hystorical series of 40 4PLC patients. Primary endpoints were the operative time, blood loss, postoperative pain, analgesia requirement, length of stay, and morbidity. Secondary endpoints were the operative costs and total hospital costs. Results No patient required surgical conversion in both groups. Duration of surgery was significantly longer in the SPLC group. Length of hospitalization was shorter for patients operated on by SPLC (1.9 ± 0.9 vs 2.3 ± 1.2 days; P = .104). According to visual analogue scale evaluation, the pain profile was similar. Minor postoperative complications were present in 12.5% of the SPLC group and 2.5% in 4PLC group (P = .200). The total hospitalization costs associated with SPLC procedure were lower compared to standard 4PLC procedure. As regards the disposable operating room equipment costs, a statistically significant difference in favor of SPLC technique was found. Conclusion SPLC has shown relevant procedure and postoperative outcomes when compared to traditional 4PLC. The technique has proved to be promising even in cases of acute cholecystitis considered to date a relative contraindication. Further studies are needed to confirm its safety and feasibility in this setting. In contrast with the current evidence of increased costs for the single-port technique, a reduction of material and hospitalization costs was experienced in our study.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Denise Palombo
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Andrea Razzore
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Emma Firpo
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
| | - Fabio Gallo
- Section of Biostatistics, Department of Health Sciences (DISSAL), Genoa University, Italy
| | - Rosario Fornaro
- Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy
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Alhambra-Rodríguez de Guzmán C, Morandeira-Rivas AJ, Herrero-Bogajo ML, Moreno-Sanz C. Incidence and Risk Factors of Incisional Hernia After Single-Incision Endoscopic Surgery. J Laparoendosc Adv Surg Tech A 2019; 30:251-255. [PMID: 31829780 DOI: 10.1089/lap.2019.0728] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction: Abdominal wall complications are one of the most controversial issues regarding single-incision endoscopic surgery. The aim of this study was to analyze the incidence and risk factors of incisional hernia after single-incision endoscopic cholecystectomy. Materials and Methods: An observational retrospective study was performed, on a cohort of patients cholecystectomized laparoscopically through a transumbilical single incision due to gallbladder lithiasis or polyps. Postoperative complications were analyzed, with special interest in the incisional hernia rate, whose results were assessed in the long-term follow-up. Univariate and multivariate analyses were also performed to evaluate possible variables associated with the appearance of incisional hernia. Cumulative sum charts (CUSUM) were used to identify trends in the incisional hernia risk. Results: Some 109 patients were included in the study. With a mean follow-up of nearly 38 months, an incisional hernia incidence of 5.5% was found, with 67% being diagnosed during the first year of follow-up. In the Cox regression analysis, two variables showed an independent association with the emergence of incisional hernia, body mass index (hazard ratio [HR] 1.30; 95% confidence interval [CI 1.053-1.606]; P .015), and wound infection (HR 26.32; [3.186-217.40]; P .002]. CUSUM charts showed a decrease in the risk of incisional hernia after the first 10 cases. Conclusions: Single-incision endoscopic cholecystectomy is associated with a substantially high risk of postoperative incisional hernia (5.5%).
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Affiliation(s)
| | | | | | - Carlos Moreno-Sanz
- General and Digestive Surgery, General Hospital La Mancha Centro, Alcázar de San Juan, Spain
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Casaccia M, Papadia FS, Palombo D, Di Domenico S, Sormani MP, Batistotti P, Mascherini M, De Cian F. Single-Port Versus Conventional Laparoscopic Cholecystectomy: Better Cosmesis at the Price of an Increased Incisional Hernia Rate? J Laparoendosc Adv Surg Tech A 2019; 29:1163-1167. [PMID: 31264921 DOI: 10.1089/lap.2019.0374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: The incidence of trocar site hernia (TSH) in single-port laparoscopic cholecystectomy (SPC) is still a debated issue. Aim of this retrospective study was to compare the incidence of postoperative hernia and cosmetic results among patients undergoing SPC and multiport laparoscopic cholecystectomy (MPC) performed at a single institution. Methods: A series of 60 SPC and 60 MPC patients operated on between July 2016 and May 2018 were compared. Primary endpoint was to assess the incidence of TSH at long term. All the patients were admitted as outpatients for physical examination and scar measurement. Secondary endpoints were the cosmetic results assessed by a cosmesis score (CS) and the body image questionnaire (BIQ). Results: After a median 18-month follow-up (range: 6-29 months), a hernia in umbilical trocar site was detected in 4 (7.1%) SPC patients and 1 (2%) MPC patient, the difference not being statistically significant (P = .216). BIQ was almost equivalent in SPC and MPC groups (5.15 versus 5.27; P = .518), respectively. Statistically significant differences in favor of SPC were found in CS (22.3 versus 19.72; P = .001) and in total length of scars (1.2 cm versus 4 cm; P < .001). Conclusions: SPC technique has proved to be safe and effective in experienced hands. Superior cosmesis of SPC over MPC is confirmed, but close attention to fascial closure is a vital component of SPC, and surgeons performing single-site surgery need to be aware of this increased potential for hernia formation.
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Affiliation(s)
- Marco Casaccia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Francesco Saverio Papadia
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Denise Palombo
- Department of Surgery, San Giacomo Hospital, Novi Ligure, Alessandria, Italy
| | - Stefano Di Domenico
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Maria Pia Sormani
- Unit of Clinical Epidemiology and Trials, National Institute for Cancer Research, Genoa, Italy
| | - Paola Batistotti
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Matteo Mascherini
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
| | - Franco De Cian
- Surgical Clinic Unit I, Department of Surgical Sciences and Integrated Diagnostics (DISC), Genoa University, Genoa, Italy
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Hoyuela C, Juvany M, Guillaumes S, Ardid J, Trias M, Bachero I, Martrat A. Long-term incisional hernia rate after single-incision laparoscopic cholecystectomy is significantly higher than that after standard three-port laparoscopy: a cohort study. Hernia 2019; 23:1205-1213. [DOI: 10.1007/s10029-019-01969-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/28/2019] [Indexed: 02/06/2023]
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Alexander HC, Nguyen CH, Moore MR, Bartlett AS, Hannam JA, Poole GH, Merry AF. Measurement of patient-reported outcomes after laparoscopic cholecystectomy: a systematic review. Surg Endosc 2019; 33:2061-2071. [PMID: 30937619 DOI: 10.1007/s00464-019-06745-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/06/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient-reported outcome (PRO) measures (PROMs) are increasingly used as endpoints in surgical trials. PROs need to be consistently measured and reported to accurately evaluate surgical care. Laparoscopic cholecystectomy (LC) is a commonly performed procedure which may be evaluated by PROs. We aimed to evaluate the frequency and consistency of PRO measurement and reporting after LC. METHODS MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched for prospective studies reporting PROs of LC, between 2013 and 2016. Data on the measurement and reporting of PROs were extracted. RESULTS A total of 281 studies were evaluated. Forty-five unique multi-item questionnaires were identified, most of which were used in single studies (n = 35). One hundred and ten unique rating scales were used to assess 358 PROs. The visual analogue scale was used to assess 24 different PROs, 17 of which were only reported in single studies. Details about the type of rating scale used were not given for 72 scales. Three hundred and twenty-three PROs were reported in 162 studies without details given about the scale or questionnaire used to evaluate them. CONCLUSIONS Considerable variation was identified in the choice of PROs reported after LC, and in how they were measured. PRO measurement for LC is focused on short-term outcomes, such as post-operative pain, rather than longer-term outcomes. Consideration should be given towards the development of a core outcome set for LC which incorporates PROs.
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Affiliation(s)
- Harry C Alexander
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cindy H Nguyen
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Matthew R Moore
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Adam S Bartlett
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Jacqueline A Hannam
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Garth H Poole
- Department of Surgery, Middlemore Hospital, Auckland, New Zealand
| | - Alan F Merry
- Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
- Department of Anaesthesiology, Auckland City Hospital, Auckland, New Zealand.
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Morales-Conde S, Peeters A, Meyer YM, Antoniou SA, Del Agua IA, Arezzo A, Arolfo S, Yehuda AB, Boni L, Cassinotti E, Dapri G, Yang T, Fransen S, Forgione A, Hajibandeh S, Hajibandeh S, Mazzola M, Migliore M, Mittermair C, Mittermair D, Morandeira-Rivas A, Moreno-Sanz C, Morlacchi A, Nizri E, Nuijts M, Raakow J, Sánchez-Margallo FM, Sánchez-Margallo JA, Szold A, Weiss H, Weiss M, Zorron R, Bouvy ND. European association for endoscopic surgery (EAES) consensus statement on single-incision endoscopic surgery. Surg Endosc 2019; 33:996-1019. [PMID: 30771069 PMCID: PMC6430755 DOI: 10.1007/s00464-019-06693-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/06/2019] [Indexed: 12/14/2022]
Abstract
Background Laparoscopic surgery changed the management of numerous surgical conditions. It was associated with many advantages over open surgery, such as decreased postoperative pain, faster recovery, shorter hospital stay and excellent cosmesis. Since two decades single-incision endoscopic surgery (SIES) was introduced to the surgical community. SIES could possibly result in even better postoperative outcomes than multi-port laparoscopic surgery, especially concerning cosmetic outcomes and pain. However, the single-incision surgical procedure is associated with quite some challenges. Methods An expert panel of surgeons has been selected and invited to participate in the preparation of the material for a consensus meeting on the topic SIES, which was held during the EAES congress in Frankfurt, June 16, 2017. The material presented during the consensus meeting was based on evidence identified through a systematic search of literature according to a pre-specified protocol. Three main topics with respect to SIES have been identified by the panel: (1) General, (2) Organ specific, (3) New development. Within each of these topics, subcategories have been defined. Evidence was graded according to the Oxford 2011 Levels of Evidence. Recommendations were made according to the GRADE criteria. Results In general, there is a lack of high level evidence and a lack of long-term follow-up in the field of single-incision endoscopic surgery. In selected patients, the single-incision approach seems to be safe and effective in terms of perioperative morbidity. Satisfaction with cosmesis has been established to be the main advantage of the single-incision approach. Less pain after single-incision approach compared to conventional laparoscopy seems to be considered an advantage, although it has not been consistently demonstrated across studies. Conclusions Considering the increased direct costs (devices, instruments and operating time) of the SIES procedure and the prolonged learning curve, wider acceptance of the procedure should be supported only after demonstration of clear benefits.
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Affiliation(s)
- Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Andrea Peeters
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Yannick M Meyer
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Stavros A Antoniou
- Colorectal Department, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - Isaías Alarcón Del Agua
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | - Amir Ben Yehuda
- Surgery division, Assaf Harofe medical center, Zeriffin, Israel
| | - Luigi Boni
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Elisa Cassinotti
- Department of Surgery, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | | | - Tao Yang
- Unit of Innovation in Minimally Invasive Sugery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", Sevilla, Spain
| | - Sofie Fransen
- Department of Surgery, Laurentius Ziekenhuis Roermond, Roermond, The Netherlands
| | | | | | - Shahin Hajibandeh
- Department of General Surgery, Stepping Hill Hospital, Stockport, UK
| | | | - Marco Migliore
- Department of Surgical Sciences, University of Torino, Torino, Italy
| | | | | | - Antonio Morandeira-Rivas
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | - Carlos Moreno-Sanz
- Department of Surgery, "La Mancha Centro" General Hospital, Alcázar de San Juan, Ciudad Real, Spain
| | | | - Eran Nizri
- Surgery division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Myrthe Nuijts
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonas Raakow
- Center for Innovative Surgery- ZIC, Charité - Universitätsmedizin, Chirurgische Klinik, Campus Charité Mitte/ Campus Virchow-Klinikum, Berlin, Germany
| | | | | | | | - Helmut Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Michael Weiss
- SJOG Hospital - PMU Teaching Hospital, Salzburg, Austria
| | - Ricardo Zorron
- Department of Surgery, University of Insubria, Varese, Italy
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Connell MB, Selvam R, Patel SV. Incidence of incisional hernias following single-incision versus traditional laparoscopic surgery: a meta-analysis. Hernia 2019; 23:91-100. [DOI: 10.1007/s10029-018-1853-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022]
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Barazanchi A, MacFater W, Rahiri JL, Tutone S, Hill A, Joshi G, Kehlet H, Schug S, Van de Velde M, Vercauteren M, Lirk P, Rawal N, Bonnet F, Lavand'homme P, Beloeil H, Raeder J, Pogatzki-Zahn E. Evidence-based management of pain after laparoscopic cholecystectomy: a PROSPECT review update. Br J Anaesth 2018; 121:787-803. [DOI: 10.1016/j.bja.2018.06.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/19/2018] [Accepted: 07/09/2018] [Indexed: 02/07/2023] Open
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Migliore M, Arezzo A, Arolfo S, Passera R, Morino M. Safety of single-incision robotic cholecystectomy for benign gallbladder disease: a systematic review. Surg Endosc 2018; 32:4716-4727. [PMID: 29943057 DOI: 10.1007/s00464-018-6300-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 06/18/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiport laparoscopic cholecystectomy (MLC) is the gold standard technique for cholecystectomy. In order to reduce postoperative pain and improve cosmetic results, the application of the single-incision laparoscopic cholecystectomy (SILC) technique was introduced, leading surgeons to face important challenges. Robotic technology has been proposed to overcome some of these limitations. The purpose of this review is to assess the safety of single-incision robotic cholecystectomy (SIRC) for benign disease. METHODS An Embase and Pubmed literature search was performed in February 2017. Randomized controlled trial and prospective observational studies were selected and assessed using PRISMA recommendations. Primary outcome was overall postoperative complication rate. Secondary outcomes were postoperative bile leak rate, total conversion rate, operative time, wound complication rate, postoperative hospital stay, and port site hernia rate. The outcomes were analyzed in Forest plots based on fixed and random effects model. Heterogeneity was assessed using the I2 statistic. RESULTS A total of 13 studies provided data about 1010 patients who underwent to SIRC for benign disease of gallbladder. Overall postoperative complications rate was 11.6% but only 4/1010 (0.4%) patients required further surgery. A postoperative bile leak was reported in 3/950 patients (0.3%). Conversion occurred in 4.2% of patients. Mean operative time was 86.7 min including an average of 42 min should be added as for robotic console time. Wound complications occurred in 3.7% of patients. Median postoperative hospital stay was 1 day. Port site hernia at the latest follow-up available was reported in 5.2% of patients. CONCLUSIONS The use of the Da Vinci robot in single-port cholecystectomy seems to have similar results in terms of incidence and grade of complications compared to standard laparoscopy. In addition, it seems affected by the same limitations of single-port surgery, consisting of an increased operative time and incidence of port site hernia.
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Affiliation(s)
- Marco Migliore
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy.
| | - Simone Arolfo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
| | - Roberto Passera
- Division of Nuclear Medicine, University of Torino, Torino, Italy
| | - Mario Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Torino, Italy
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Shussman N, Appelbaum L, Marom G, Luques L, Elazary R, Abu-Gazala M, Pikarsky AJ, Mintz Y. Changes in abdominal wall thickness during laparoscopy: implications for the use of magnetic assisted surgery. MINIM INVASIV THER 2018; 27:321-326. [DOI: 10.1080/13645706.2018.1457543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Noam Shussman
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Liat Appelbaum
- Diagnostic and Interventional Ultrasound Unit, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Gad Marom
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lisandro Luques
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ram Elazary
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Mahmoud Abu-Gazala
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alon J. Pikarsky
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Yoav Mintz
- Department of General Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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Arezzo A, Passera R, Forcignanò E, Rapetti L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events: results of a meta-analysis of randomized controlled trials. Surg Endosc 2018. [PMID: 29523982 DOI: 10.1007/s00464-018-6143-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Over the last decade, single-incision laparoscopic cholecystectomy (SLC) has gained popularity, although it is not evident if benefits of this procedure overcome the potential increased risk. Aim of the study is to compare the outcome of SLC with conventional multi-incision laparoscopic cholecystectomy (MLC) in a meta-analysis of randomized controlled trials only. METHODS A systematic Medline, Embase, and Cochrane Central Register of Controlled Trials literature search of articles on SLC and MLC for any indication was performed in June 2017. The main outcomes measured were overall adverse events, pain score (VAS), cosmetic results, quality of life, and incisional hernias. Linear regression was used to model the effect of each procedure on the different outcomes. RESULTS Forty-six trials were included and data from 5141 participants were analysed; 2444 underwent SLC and 2697 MLC, respectively. Mortality reported was nil in both treatment groups. Overall adverse events were higher in the SLC group (RR 1.41; p < 0.001) compared to MLC group, as well severe adverse events (RR 2.06; p < 0.001) and even mild adverse events (RR 1.23; p = 0.041). This was confirmed also when only trials including 4-port techniques (RR 1.37, p = 0.004) or 3-port techniques were considered (RR 1.89, p = 0.020). The pain score showed a standardized mean difference (SMD) of - 0.36 (p < 0.001) in favour of SLC. Cosmetic outcome by time point scored a SMD of 1.49 (p < 0.001) in favour of SLC. Incisional hernias occurred more frequently (RR 2.97, p = 0.005) in the SLC group. CONCLUSIONS Despite SLC offers a better cosmetic outcome and reduction of pain, the consistent higher rate of adverse events, both severe and mild, together with the higher rate of incisional hernias, should suggest to reconsider the application of single incision techniques when performing cholecystectomy with the existing technology.
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Affiliation(s)
- A Arezzo
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy.
| | - R Passera
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - E Forcignanò
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - L Rapetti
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
| | - R Cirocchi
- Department of Surgical Sciences, University of Perugia, Terni, Italy
| | - M Morino
- Department of Surgical Sciences, University of Torino, Corso Dogliotti 14, 10126, Turin, Italy
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Mueck KM, Cherla DV, Taylor A, Ko TC, Liang MK, Kao LS. Randomized Controlled Trials Evaluating Patient-Reported Outcomes after Cholecystectomy: A Systematic Review. J Am Coll Surg 2017; 226:183-193.e5. [PMID: 29154921 DOI: 10.1016/j.jamcollsurg.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
| | - Deepa V Cherla
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Amy Taylor
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
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Ko JW, Lee JW, Kwon SW, Choi SH. Advantages of the glove port docking technique in robotic single-site cholecystectomy: comparison with the conventional silicone port. J Robot Surg 2018; 12:437-45. [PMID: 28936582 DOI: 10.1007/s11701-017-0754-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/17/2017] [Indexed: 02/08/2023]
Abstract
Although the da Vinci Single-Site® silicone port allows exact alignment and effective triangulation of instruments, it also has drawbacks. We introduce an alternative docking technique using the Glove port®. From April 2014 to December 2016, respective 50 patients of the conventional silicone port and the glove port group were compared. The mean docking time was 16.6 ± 6.6 min in the silicone port group and 10.6 ± 3.6 min in the glove port group. Re-docking during the operation was needed in three patients in the silicone port group and readjustment of cannulae without re-docking could be simply performed in five patients in the glove port group. Skin injury was observed in 17 patients in the silicone port group and 0 patients in the glove port group without significant complications. Some limitations of the conventional silicone port were improved by the glove port.
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Antoniou SA, García-alamino JM, Hajibandeh S, Hajibandeh S, Weitzendorfer M, Muysoms FE, Granderath FA, Chalkiadakis GE, Emmanuel K, Antoniou GA, Gioumidou M, Iliopoulou-kosmadaki S, Mathioudaki M, Souliotis K. Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION). Surg Endosc 2018; 32:14-23. [DOI: 10.1007/s00464-017-5717-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 07/10/2017] [Indexed: 02/07/2023]
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Xu L, Tan H, Liu L, Si S, Sun Y, Huang J, Atyah M, Yang Z. A randomized controlled trial for evaluation of lower abdominal laparoscopic cholecystectomy. MINIM INVASIV THER 2017; 27:105-112. [PMID: 28537508 DOI: 10.1080/13645706.2017.1327445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To improve minimally invasive outcomes, we designed a new procedure, lower abdominal laparoscopic cholecystectomy (LALC). This study was conducted to evaluate the effects of LALC versus classical (CLC) and single-incision (SILC) laparoscopic cholecystectomy on reducing systemic acute inflammatory response, improving cosmesis, and postoperative pain relief. MATERIAL AND METHODS Beginning from July 2014, 105 patients meeting the inclusion criteria were randomly assigned to three groups: LALC, CLC, and SILC. The primary endpoint was the determination of systemic inflammatory response to the surgery. Other outcome measures included cosmesis, postoperative pain, and perioperative indices. RESULTS Each of the three groups consisted of 35 patients. The duration of the operation was significantly longer in the SILC group (p= .005). The rates of adverse events were similar. Changes in interleukin-6 (p = .001) and tumor-necrosis factor-α (p = .016) measured before and after surgery differed significantly; patients who underwent LALC had the smallest change in inflammatory response. Cosmesis scores at one (p = .002) and 12 (p = .004) weeks after surgery favored LALC and SILC. Significant differences in pain scores at four (p = .011) and 12 h (p = .024) postoperatively were also observed. CONCLUSIONS In selected patients, LALC shows more advantages in terms of lower systemic inflammatory response, improved cosmesis, and a favorable postoperative pain profile when compared with CLC and SILC.
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Affiliation(s)
- Li Xu
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Haidong Tan
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Liguo Liu
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Shuang Si
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Yongliang Sun
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Jia Huang
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
| | - Manar Atyah
- b Peking University Health Science Center , Beijing , PR China
| | - Zhiying Yang
- a Department of Hepatobiliary Surgery , China-Japan Friendship Hospital , Beijing , PR China
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Vaira M, Robella M, Borsano A, De Simone M. Single-port access for Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC): technique, feasibility and safety. Pleura Peritoneum 2016; 1:217-222. [PMID: 30911626 PMCID: PMC6386499 DOI: 10.1515/pp-2016-0021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/28/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC) is a drug delivery system for treatment of peritoneal metastasis (PM). A limitation of this technique is the non-access rate (10-15 %) due to peritoneal adhesions. The aim of the study was to assess feasibility and safety of the single-port access technique for PIPAC. METHODS Single-center, pilot study. Case series, retrospective analysis on 17 patients with PM of various origin treated with intraperitoneal cisplatin, doxorubicin and/or oxaliplatin administered as PIPAC. Single-port access was attempted in all patients by minilaparotomy. RESULTS Twenty-nine PIPAC procedures were performed. Nine patients were subjected to 1 PIPAC, four patients to 2 PIPAC and four patients to 3 PIPAC. Access to peritoneal cavity was possible in all cases. There was no bowel access lesion. Tightness of the abdomen (CO2-flow = 0) was achieved in all cases. No postoperative complications according to CTCAE (Common Terminology Criteria for Adverse Events)>2 were observed, no re-laparotomies required and no postoperative mortality recorded. CONCLUSIONS Single port-access is feasible and safe for PIPAC. Potential advantages over multiple trocars technique are a lower non-access rate, a lower risk of bowel lesions and a better tightness of the abdomen. This has now to be confirmed in a comparative study.
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Affiliation(s)
- Marco Vaira
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Manuela Robella
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Alice Borsano
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
| | - Michele De Simone
- Unit of Surgical Oncology, Candiolo Cancer Institute – FPO, IRCCS, Candiolo, Italy
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