The chronological change of indications and outcomes for single-incision laparoscopic cholecystectomy: a Korean multicenter study

Lower abdominal approach in laparoscopic cholecystectomy: A propensity score-matching analysis and prospective cohort study

BACKGROUND

Classic laparoscopic cholecystectomy) using multiple ports is a widely used method with excellent surgical outcomes. However, the resulting wounds do not meet the cosmetic needs of patients. Therefore, this study aimed to find a new minimally invasive surgical method for invisible wounds while maintaining surgical safety through a new port site.

METHODS

In this prospective cohort study, we used propensity score matching analysis to evaluate the perioperative outcomes of multiport laparoscopic cholecystectomy using articulating devices with the lower abdominal approach. We performed a propensity score matching analysis of prospectively maintained data from 228 patients who underwent classic laparoscopic cholecystectomy using straight instruments and laparoscopic cholecystectomy with a lower abdominal approach using articulating devices between January and October 2022. A single surgeon performed all operations included in the study. We evaluated several perioperative outcomes.

RESULTS

No differences were found in potential confounding factors, such as sex, age, admission type, previous abdominal surgery, and medical comorbidities, between the 2 groups after propensity score matching. In the classic laparoscopic cholecystectomy group, the mean operation time was shorter (43.73 ± 23.71 vs 50.60 ± 9.75 min; P < .04). No significant difference was noted in the 2 groups' numerical rating scale scores for pain, body mass index, and incidence of postoperative complications. The mean length of hospital stay was longer for patients who underwent classic laparoscopic cholecystectomy (4.27 vs 2.07 days; P = .064). The lower abdominal laparoscopic cholecystectomy group had delayed defecation after surgery.

CONCLUSION

Regarding surgical outcomes and minimal invasiveness, lower abdominal laparoscopic cholecystectomy is a feasible cholecystectomy method.

Optimal indication for single-incision laparoscopic cholecystectomy in benign gallbladder diseases

Laparoscopic cholecystectomy has become a basic procedure for cholecystectomy due to rapid recovery and cosmetic satisfaction after surgery, and it is currently the primary treatment for most benign gallbladder diseases. Thanks to advances in laparoscopic equipment and techniques, single-incision laparoscopic cholecystectomy (SILC) was introduced. Initially, SILC was performed only on highly selected patients due to the high proficiency required and the potential collision of surgical instruments due to the narrow operating space. However, as surgeons gradually accumulated experience with it and various surgical equipment was introduced, the indications were gradually expanded. Nevertheless, clear indications for SILC have not yet been established. If continuous technological development and large-scale SILC clinical results are accumulated, the indications for SILC will be clearer and can be expanded in the future.

Optimal indication of single-incision laparoscopic cholecystectomy using Konyang Standard Method in benign gallbladder diseases

Purpose

The optimal indications for single-incision laparoscopic cholecystectomy (SILC) have not yet been established.

Methods

This single-center retrospective study included consecutive patients who underwent SILC between April 2010 and June 2020. Difficult surgery (DS) (conversion to multiport or open cholecystectomy, adjacent organ injury, operation time of ≥90 minutes, or estimated blood loss of ≥100 mL) and poor postoperative outcome (PPO) (postoperative hospital stay ≥ 7 days or Clavien-Dindo grade ≥ II postoperative complications) were defined to comprehensively evaluate surgical difficulty and postoperative outcomes, respectively.

Results

Of 1,405 patients (mean age, 51.2 years; 802 female [57.1%]), 427 (grade I, n = 358; grade II/III, n = 69) underwent SILC for acute cholecystitis (AC), 34 (2.4%) needed conversion to multiport (n = 33) or open cholecystectomy (n = 1), 7 (0.5%) had adjacent organ injury during surgery, and 49 (3.5%) developed postoperative complications. Of the patients, 89 and 52 had DS and PPO, respectively. In the multivariate analysis, grade I AC, grade II/III AC, and body mass index of ≥30 kg/m² were significant predictors of DS. Age of ≥70 years and DS were significant predictors of PPO. In a subgroup analysis of patients with AC, DS (9.5% vs. 27.5%, p < 0.001) and PPO (5.0% vs. 15.9%, p = 0.001) were more frequent in patients with grade II/III AC than in those with grade I AC.

Conclusion

SILC is not recommended in patients with grade II/III AC and should be carefully performed by experienced and well-trained surgeons.

Chronological trends in patients undergoing cholecystectomy in Korea: a nationwide health insurance claims study

Purpose

The incidence of gallstone disease and cholecystectomy is increasing worldwide. The aim of this study was to determine trends in the incidence of cholecystectomy in Korea.

Methods

The National Health Insurance Services database was used to determine patterns in proportion of cholecystectomy and cholecystostomy in the total population of Korea from 2003 to 2017. The age-standardized rate (ASR) was calculated to compare the cholecystectomy and cholecystostomy according to changes in the population structure over time. The ASR was investigated according to patient age, sex, socioeconomic status, use of computed tomography, and type of hospital to identify trends.

Results

The ASR per 100,000 based on the 2010 population of cholecystectomy cases increased markedly from 67.7 to 211.4 between 2003 and 2017. The ASR was consistently higher in female than male (71.9 vs. 63.6 in 2003, 221.8 vs. 201.8 in 2017). Furthermore, the ASR for cholecystectomy increased with age, and surgery for gallstone disease was performed more often at a specialized center than at other medical facilities. The length of hospital stay of cholecystectomy decreased steadily from 10.6 days in 2003 to 6.9 days in 2017.

Conclusion

This study shows that the incidence of cholecystectomy and cholecystostomy has steadily increased over the years in Korea, with a trend toward older age and higher socioeconomic status in patients undergoing cholecystectomy. Increasing use of computed tomography investigations could be a primary cause for this trend. An integrated strategy is needed to manage the increase in older patients undergoing cholecystectomy and shorten their hospital stay with medical safety.

Analogies between medusa and single port surgery in gastroenterology and hepatology: A review

Single port surgery (SPS) was introduced as an attractive, minimally invasive surgical technique that ensures esthetic results for many types of visceral surgery. Initially, surgeons immediately set about performing SPS without preliminary knowledge or training, which resulted in higher complication rates. Today, current studies conclusively show that SPS is scientifically rehabilitated and indicated for simple and complex laparoscopic procedures. We here describe the astonishing analogies between Greek mythology and modern surgery.