Feasibility of single-incision laparoscopic cholecystectomy for acute cholecystitis

Single-incision versus conventional multiport laparoscopic cholecystectomy in acute cholecystitis according to disease severity: single center retrospective study in Korea

Purpose

The safety of single-incision laparoscopic cholecystectomy (SILC) for acute cholecystitis (AC) has not yet been confirmed.

Methods

This single-center retrospective study included patients who underwent laparoscopic cholecystectomy (LC) for AC between April 2010 and December 2020. Propensity scores were used to match patients who underwent SILC with those who underwent conventional multiport LC (CMLC) in the entire cohort and in the two subgroups.

Results

A total of 1,876 patients underwent LC for AC, and 427 (22.8%) underwent SILC. In the propensity score-matched analysis of the entire cohort (404 patients in each group), the length of hospital stay (2.9 days vs. 3.5 days, p = 0.029) was shorter in the SILC group than in the CMLC group. No significant differences were observed in other surgical outcomes. In grade I AC (336 patients in each group), the SILC group showed poorer surgical outcomes than the CMLC group, regarding operation time (57.6 minutes vs. 52.4 minutes, p = 0.001) and estimated blood loss (22.9 mL vs. 13.1 mL, p = 0.006). In grade II/III AC (58 patients in each group), there were no significant differences in surgical outcomes between the two groups. Postoperative pain outcomes were also not significantly different in the two groups, regardless of severity.

Conclusion

This study demonstrated that SILC had similar surgical and pain outcomes to CMLC in patients with AC; however, subgroup analysis showed that SILC was associated with poor surgical outcomes than CMLC in grade I AC. Therefore, SILC should be carefully performed in patients with AC by experienced hepatobiliary surgeons.

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.

Single-Port Cholecystectomy for Cholecystitis Versus Non-Cholecystitis

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.

Emergency single-incision laparoscopic cholecystectomy for acute cholecystitis: A multi-center study

Single-incision laparoscopy is accepted as a safe alternative to multiple port laparoscopy for elective cholecystectomy; however, there are limited data on its use in patients with acute cholecystitis. The present multi-center study evaluated the outcomes of emergency single-incision surgeries for acute cholecystitis in hospitals in Belgium, Jamaica, and Trinidad and Tobago over a 5-year period. Standardized definitions of uncomplicated and complicated acute cholecystitis were used and the data were compared using SPSS software. The results revealed that over the 5-year period, 108 patients with a mean age of 48±15 years and a mean body mass index of 27±4.2 kg/m² underwent emergency single-incision cholecystectomies. The surgeries were successful in 92.1% of cases without supplemental trocars being used. The overall morbidity rates (9.3%) were also comparable to the historic controls with multiple port cholecystectomy. As was expected, the complicated cholecystitis group required a significantly longer operating time (86.11±30.16 vs. 66.79±16.8; P<0.00194), as well as supplemental trocars (7.9%) vs. 0; P=0.0413). On the whole, the present study demonstrates that emergency single-incision cholecystectomy is a technically feasible and safe procedure for patients with acute cholecystitis. These findings advocate a low threshold to place additional ports to assist with dissection and exposure.

Single Incision Cholecystectomies for Acute Cholecystitis: A Single Surgeon Series from the Caribbean

Introduction. Single incision laparoscopic surgery (SILS) is accepted as a safe alternative to conventional multiport laparoscopic (MPL) cholecystectomy for benign gallbladder disease. Since many surgeons carefully select patients without inflammation, there are limited data on SILS for acute cholecystitis. We report a single surgeon experience with SILS cholecystectomy for patients with acute cholecystitis. Materials and Methods. After securing ethical approval, we performed an audit of all SILS cholecystectomies for acute cholecystitis by a single surgeon from January 1, 2009, to December 31, 2019. The following data were extracted: patient demographics, intraoperative details, surgical techniques, specialized equipment utilized, conversions (additional port placement), morbidity, and mortality. Data were analyzed using SPSS 12.0. Results. SILS cholecystectomy was performed in 25 females at a mean age of 35 ± 4.1 (SD) years and a mean BMI of 31.9 ± 3.8 (SD) using a direct fascial puncture technique without access platforms. The operations were completed in 83 ± 29.4 minutes (mean ± SD) with an estimated blood loss of 76.9 ± 105 (mean + SD). Three (12%) patients required additional 5 mm port placement (conversions), but no open operations were performed. The patients were hospitalized for 1.96 ± 0.9 days (mean ± SD). There were 2 complications: postoperative superficial SSI (grade I) and a diaphragmatic laceration (grade III). No bile duct injuries were reported. There were 9 patients with complicated acute cholecystitis, and this sub-group had longer mean operating times (109.2 ± 27.3 minutes) and mean postoperative hospital stay (1.3 ± 0.87 days). Conclusion. The SILS technique is a feasible and safe approach to perform cholecystectomy for acute cholecystitis. We advocate a low threshold to place additional ports to assist with difficult dissections for patient safety.

Completion of single-incision laparoscopic cholecystectomy using the modified Konyang standard method

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.

Comparison of outcomes of single-incision and conventional laparoscopic cholecystectomy for cholecystitis requiring percutaneous transhepatic gallbladder drainage

INTRODUCTION

Single-incision laparoscopic cholecystectomy (SILC) has been accepted as a less invasive alternative to conventional laparoscopic cholecystectomy (CLC). However, the feasibility and safety of SILC for acute cholecystitis, especially in cases with percutaneous transhepatic gallbladder drainage (PTGBD), are still limited because of the technical difficulty of SILC. The aim of this study was to retrospectively evaluate the safety and feasibility of SILC compared to CLC for cholecystitis requiring PTGBD.

METHODS

From 1 July 2017 to 8 June 2019, eight patients underwent SILC with PTGBD, and nine underwent CLC with PTGBD. The patients' data, including the operative time, total blood loss, conversion rate to laparotomy, and perioperative complications, were compared.

RESULTS

In seven of eight patients, SILC was successfully performed. Only one patient required conversion to open surgery because necrosis prevented the cystic duct from being clipped. However, bile leakage occurred in this patient and was successfully treated with percutaneous drainage and antibiotics. In the CLC group, one patient required laparotomy but had no postoperative complications due to strong adhesion. One patient underwent reoperation for bile duct injury after the first operation. One other complication (ie, wound infection) was seen in the CLC group. There was no significant difference in the mean operative time and estimated blood loss between the SILC and CLC groups.

CONCLUSION

With our gallbladder retraction method, SILC may be a relatively safe and feasible alternative to CLC for cholecystitis, even in cases requiring PTGBD.

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

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.

The First Additional Port During Single-Incision Laparoscopic Cholecystectomy

Background and Objectives:

Single-incision laparoscopic cholecystectomy (SILC) has become increasingly popular. Regarding the difficulties of SILC in acute cholecystitis, additional port insertion is sometimes required. However, appropriate locations for additional port insertion have not been well studied. In the present study, the safety and effectiveness of the first additional port insertion in the epigastric region during SILC was assessed.

Methods:

Additional port insertions were needed in 52 of 113 patients who underwent SILC for acute cholecystitis. The first port was inserted in the epigastric region and the second (if required) was inserted in the right lateral subcostal area. A drainage catheter was positioned through the epigastric port.

Results:

One additional port was inserted in 43 patients and two additional ports were inserted in 9 patients. Mean operation time was 45.0 minutes in the Pure SILC group and 83.3 minutes in Additional Port group. Mean hospital stay was 3.7 days in the Pure SILC group and 5.9 days in Additional Port group. There was no open conversion. Intra-operative (n = 5) and postoperative bile leakages (n = 2) were identified in six patients. Timing of operation after onset of symptoms was significantly greater in the group with bile duct injury than in those without bile duct injury in patients who required additional ports.

Conclusions:

The first additional port in the epigastric area during SILC for acute cholecystitis helps to complete the operation without open conversion. However, the procedure can be performed safely in selective patients with relatively short duration of symptoms.

Laparoscopic cholecystectomy combined with Xiaoyanlidan tablets for treatment of acute cholecystitis patients: Curative effect and impact on prognosis and serological indicators

AIM

To observe the curative effect of laparoscopic cholecystectomy combined with Xiaoyanlidan tablets in the treatment of acute cholecystitis as well as its impact on prognosis and serological indicators.

METHODS

One hundred cases of acute cholecystitis treated at Jiaxing Hospital of Traditional Chinese Medicine from January 2017 to December 2017 were randomly divided into an observation group and a control group, with 50 cases in each group. Both groups underwent laparoscopic cholecystectomy, and the observation group was additionally treated with Xiaoyanlidan tablets. The clinical efficacy, incidence of complications, serological indicators [C reactive protein (CRP), procalcitonin (PCT), cancer antigen (CA) 19-9, thyroid-stimulating hormone (TSH), and insulin (Ins)], recurrence rate of choledocholithiasis, and indexes of liver function were observed and compared in the two groups.

RESULTS

The total effective rate of the observation group was 90%,which was significantly higher than that of the control group (76%, P < 0.05).The incidence of postoperative complications in the observation group was 2%, which was significantly lower than that in the control group (16%, P < 0.05). CRP, PCT, CA19-9, TSH, and Ins in the observation group were significantly lower than those in the control group 1 wk after operation (P < 0.05). The incidence of postoperative choledocholithiasis in the observation group was 10%, which was significantly lower than that in the control group (26%, P < 0.05). Glutamic-pyruvic transaminase and aspartate aminotransferase levels in the observation group were significantly lower than those in the control group (P < 0.05).

CONCLUSION

Laparoscopic cholecystectomy combined with Xiaoyan-lidan tablets can effectively improve the inflammatory response, reduce the incidence of postoperative complications, and improve the total effective rate in the treatment of acute cholecystitis.

Single incision laparoscopic cholecystectomy for patients with Mirizzi syndrome

Since multiport laparoscopic cholecystectomy has become a standard treatment for gallbladder (GB) disease, a single incision laparoscopic surgical technique has been tried to decrease the surgical site pain and achieve a better cosmetic out come in selected patients. The development of devices dedicated for single incision laparoscopic cholecystectomy (SILC) is expanding the indication of this single incision laparoscopic technique to more complicated GB diseases. Mirizzi syndrome (MS) is one of the complex uncommon gallstone diseases in patients undergoing cholecystectomy. Because the laparoscopic procedure has become a routine treatment for cholecystectomy, several studies have reported their experience with the laparoscopic technique for the treatment of MS with a comparable outcome in Csendes type I or II. Because the indication for SILC cholecystectomy is expanded to more complicated GB conditions, and the desire of patients for a less painful, better cosmetic surgical outcome has increased, our medical center used this single incision laparoscopic surgical technique for MS Csendes types I and II patients. Here, we report 2 successful cases of SILC for patients with MS types I and II without significant morbidity.

Safety of single-incision laparoscopic cholecystectomy for acute cholecystitis

BACKGROUND

Single-incision laparoscopic cholecystectomy (SILC) is a common procedure performed worldwide. In this study, we evaluated the safety and efficacy of SILC for acute cholecystitis.

METHODS

Patients who underwent SILC between September 2012 and December 2016 were retrospectively enrolled and divided into acute and chronic groups. Demographic, operative and outcome data were obtained by reviewing medical records, physical examination and telephone follow-up.

RESULTS

In total, 1435 patients were included in this study: 220 (15.3%) in the acute group and 1215 (84.7%) in the chronic group. The mean operative time was longer in the acute group than in the chronic group (44.7 ± 21.6 versus 32.8 ± 9.8 min; P < 0.001). Insertion of additional ports was performed in 17 patients: six in the acute group and 11 in the chronic group. Conversion to abdominal laparotomy was performed in eight patients: one in the acute group and seven in the chronic group. The mean post-operative hospital stay was 31.7 ± 20.4 h in the acute group and 27.7 ± 13.7 h in the chronic group. The complication rate was similar between the acute (n = 8, 3.6%) and chronic (n = 33, 2.7%) groups.

CONCLUSION

SILC does not increase the complication rate and is a safe and feasible technique for both chronic and acute cholecystitis.

Feasibility and safety of single-incision laparoscopic cholecystectomy in elderly patients: A single institution, retrospective case series

INTRODUCTION

To evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) for uncomplicated gallbladder in elderly patients.

MATERIALS AND METHODS

A retrospective analysis of 810 patients undergoing SILC from May 2009 to October 2016 at Osaka Police Hospital was performed, and the outcomes of the patients aged < 80 years and the patients ≥ 80 years were compared.

RESULTS

The median operative times of patients <80 years and patients ≥80 years were 100 min and 110 min, respectively (p = 0.4). The conversion rates to a different operative procedure (multi-port laparoscopic cholecystectomy or open cholecystectomy) were 3% (22/763) of patients < 80 years and 0% of patients ≥ 80 years (p = 0.6). Perioperative complications were seen in 6% (46/763) of patients < 80 years and 17% (8/47) of patients ≥ 80 years (p < 0.05). Pneumonia was seen in 0% (0/763) of patients < 80 years and 4% (3/47) of patients ≥ 80 years (p < 0.05). There was no mortality in either group. The median postoperative hospital stay was 4 days for patients <80 years and 5 days for patients ≥80 years (p < 0.05).

CONCLUSION

SILC for uncomplicated gallbladder could be performed for patients ≥ 80 years with acceptable morbidity and mortality as compared with the previous reports, though the complication rate of patients ≥ 80 years was higher than that of patients < 80 years.

Is Single-incision Laparoscopic Cholecystectomy Feasible for Acute Cholecystitis? A Consecutive Study of 60 Cases

The feasibility of single-incision laparoscopic cholecystectomy (SIL-C) for patients with acute cholecystitis were evaluated based on the timing of operation after onset of symptoms. Sixty patients with acute cholecystitis who underwent SIL-C were divided into 2 groups according to the timing of operation: group E included 23 patients who underwent SIL-C within 72 hours, and group O included 37 patients who underwent SIL-C later. There were no statistical differences between group E and group O in clinicopathologic characteristics. Group E demonstrated significantly shorter operating time and less blood loss than group O. Although the incidences of additional port(s) requirements were not significantly different, 8 patients in group O required open conversion, indicating significantly higher rate. As group E demonstrated favorable surgical outcomes compared with group O, SIL-C for acute cholecystitis seems to be a feasible therapeutic procedure when performed within 72 hours as updated Tokyo Guidelines recommended.