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Yoon JP, Kim HY, Jung J, Lee J, Park S, Byeon GJ. Analgesic effect of ultrasound-guided transversus abdominis plane block with or without rectus sheath block in laparoscopic cholecystectomy: a randomized, controlled trial. BMC Anesthesiol 2024; 24:203. [PMID: 38851689 PMCID: PMC11162032 DOI: 10.1186/s12871-024-02590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/31/2024] [Indexed: 06/10/2024] Open
Abstract
BACKGROUND Ultrasound-guided transversus abdominis plane (TAP) block is commonly used for pain control in laparoscopic cholecystectomy. However, significant pain persists, affecting patient recovery and sleep quality on the day of surgery. We compared the analgesic effect of ultrasound-guided TAP block with or without rectus sheath (RS) block in patients undergoing laparoscopic cholecystectomy using the visual analog scale (VAS) scores. METHODS The study was registered before patient enrollment at the Clinical Research Information Service (registration number: KCT0006468, 19/08/2021). 88 American Society of Anesthesiologist physical status I-III patients undergoing laparoscopic cholecystectomy were divided into two groups. RS-TAP group received right lateral and right subcostal TAP block, and RS block with 0.2% ropivacaine (30 mL); Bi-TAP group received bilateral and right subcostal TAP block with same amount of ropivacaine. The primary outcome was visual analogue scale (VAS) for 48 h postoperatively. Secondary outcomes included the use of rescue analgesics, cumulative intravenous patient-controlled analgesia (IV-PCA) consumption, patient satisfaction, sleep quality, and incidence of adverse events. RESULTS There was no significant difference in VAS score between two groups for 48 h postoperatively. We found no difference between the groups in any of the secondary outcomes: the use of rescue analgesics, consumption of IV-PCA, patient satisfaction with postoperative pain control, sleep quality, and the incidence of postoperative adverse events. CONCLUSION Both RS-TAP and Bi-TAP blocks provided clinically acceptable pain control in patients undergoing laparoscopic cholecystectomy, although there was no significant difference between two combination blocks in postoperative analgesia or sleep quality.
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Affiliation(s)
- Jung-Pil Yoon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hee Young Kim
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Jieun Jung
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
| | - Jimin Lee
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Seyeon Park
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Gyeong-Jo Byeon
- Department of Anesthesia and Pain Medicine, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Geumoro 20, Yangsan, Gyeongnam, 50612, Republic of Korea.
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea.
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Hristov B, Doykov D, Stanchev D, Kraev K, Uchikov P, Kostov G, Valova S, Tilkiyan E, Doykova K, Doykov M. Hepatico-Duodenal Fistula Following Iatrogenic Strasberg Type E4 Bile Duct Injury: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1621. [PMID: 37763740 PMCID: PMC10537085 DOI: 10.3390/medicina59091621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Gallstone disease (GSD) is among the most common disorders worldwide. Gallstones are established in up to 15% of the general population. Laparoscopic cholecystectomy (LC) has become the "gold standard" for treatment of GSD but is associated with a higher rate of certain complications, namely, bile duct injury (BDI). Biliary fistulas (BF) are a common presentation of BDI (44.1% of all patients); however, they are mainly external. Post-cholecystectomy internal BF are exceedingly rare. CASE REPORT a 33-year Caucasian female was admitted with suspected BDI after LC. Strasberg type E4 BDI was established on endoscopic retrograde cholangiopancreatography (ERCP). Urgent laparotomy established biliary peritonitis. Delayed surgical reconstruction was planned and temporary external biliary drains were positioned in the right and left hepatic ducts. During follow-up, displacement of the drains occurred with subsequent evacuation of bile through the external fistula, which resolved spontaneously, without clinical and biochemical evidence of biliary obstruction or cholangitis. ERCP established bilio-duodenal fistula between the left hepatic duct (LHD) and duodenum, with a stricture at the level of the LHD. Endoscopic management was chosen with staged dilation and stenting of the fistulous tract over 18 months until fistula maturation and stricture resolution. One year after stent extraction, the patient remains symptom free. DISCUSSION Management of post-cholecystectomy BDI is challenging. The optimal approach is determined by the level and extent of ductal lesion defined according to different classifications (Strasberg, Bismuth, Hannover). Type E BDI are managed mainly surgically with a delayed surgical approach generally deemed preferable. Only three cases of choledocho-duodenal fistulas following LC BDI currently exist in the literature. Management is controversial, with expectant approach, surgical treatment (biliary reconstruction), or liver transplantation being described. Endoscopic treatment has not been described; however, in the current paper, it proved to be successful. More reports or larger case series are needed to confirm its applicability and effectiveness, especially in the long term.
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Affiliation(s)
- Bozhidar Hristov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Daniel Doykov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Desislav Stanchev
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Gastroenterology Clinic, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Rheumatology Clinic, St. George University Hospital, 6000 Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Second Department of Surgery, St. George University Hospital, 4000 Plovdiv, Bulgaria
| | - Gancho Kostov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Surgery, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Siyana Valova
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Eduard Tilkiyan
- Section "Nephrology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Nephrology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Katya Doykova
- Department of Diagnostic Imaging, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Department of Diagnostic Imaging, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 6000 Plovdiv, Bulgaria
- Clinic of Urology, University Hospital "Kaspela", 4001 Plovdiv, Bulgaria
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Ishikawa M, Asanoma M, Tashiro Y, Takechi H, Matsuyama K, Miyauchi T. Gasless single-port laparoscopic cholecystectomy. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:152-157. [PMID: 35600100 PMCID: PMC8977387 DOI: 10.7602/jmis.2021.24.3.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/13/2021] [Accepted: 08/09/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single port at the umbilicus and using the abdominal wall-lifting method, without establishing pneumoperitoneum. METHODS Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection. RESULTS The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m2. The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups. CONCLUSION The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.
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Affiliation(s)
- Masashi Ishikawa
- Department of Surgery, Shikoku Central Hospital, Shikokuchuo, Japan
| | | | | | - Hirokazu Takechi
- Department of Surgery, Shikoku Central Hospital, Shikokuchuo, Japan
| | - Kazuo Matsuyama
- Department of Surgery, Shikoku Central Hospital, Shikokuchuo, Japan
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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] [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] [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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Jeong Jang E, Kang SH, Kim KW. Early Outcomes of Robotic Single Site Cholecystectomy Using the DaVinci Xi® System. JSLS 2021; 25:JSLS.2020.00082. [PMID: 33628004 PMCID: PMC7881280 DOI: 10.4293/jsls.2020.00082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Robotic surgery has become an established alternative to conventional laparoscopy or single site laparoscopy by solving the problems of angulation, improving the ergonomics of single-incision technology, and overcoming the intrinsic limitations of single-incision laparoscopy. Although the robotic single site technology is non-wristed and, unlike other conventional robotic instruments, only provides rotation, the ergonomics are nevertheless excellent. Therefore, the objective of this study is to present our initial experience in robotic single site cholecystectomy (RSSC) by a surgeon. Through this, we suggest that RSSC could be a feasible and safe procedure for overcoming the shortcomings of single incision laparoscopic cholecystectomy (SILC). METHODS This study is a retrospective data review of 74 patients who underwent RSSC between April 2019 and August 2020 at our institution. The demographic, pre-, and postoperative data were retrospectively collected. RESULTS A total of 74 patients underwent RSSC. The mean age of patients was 44.7 ± 9.5 years, and their mean body mass index was 24 ± 3 kg/m2. Symptomatic gallbladder stone (56.8%) was the most common pre-operative diagnosis. Mean of total operation and docking times was 39.3 ± 12.5 (20 - 85) and 7.6 ± 3.1 (4 - 20) minutes, respectively. There was no conversion, additional port insertion, bleeding, or intra-operative complication; however, one patient had wound seroma. CONCLUSIONS RSSC for uncomplicated gallbladder disease may serve as an excellent alternative to SILC or conventional laparoscopic cholecystectomy because of its low complication rates, good cosmesis, and ease of reproducibility without a substantial learning curve.
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Affiliation(s)
- Eun Jeong Jang
- Department of Surgery, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Korea
| | - Sung Hwa Kang
- Department of Surgery, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Korea
| | - Kwan Woo Kim
- Department of Surgery, Dong-A University College of Medicine, Dong-A University Medical Center, Busan, Korea
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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] [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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