Single-Port-Cholezystektomie: Ein Vergleich mit dem Goldstandard

Abstract

Currently multiport laparoscopic cholecystectomy (LC) represents the gold standard for gall bladder removal. However, a single-incision approach might succeed it as the future leading technique. To date, final proof for safety and applicability remain elusive. A retrospective analysis of prospectively collected data from 459 patients subjected to multiport (LC) or single incision laparoscopic cholecystectomy (SILC) was performed. From 2010 to 2011, 115 SILC (25 %) and 344 LC (75 %) interventious were performed. Mean follow-up was 13.2 (2.1/24.6) months. The SILC group comprised more females (SILC: m : f 1 : 3.4 vs. LC: 1 : 1.2) and younger patients (SILC: 44.7 vs. LC: 54.9 years) with a slightly lower (ASA) score (SILC:1.7 ± 0.3 vs. LC:1.9 ± 0.5). SIL cholecystectomy was performed more frequently in an elective setting (SILC: 81.7 vs. LC: 55.5 %). Complication rates were low and did not differ significantly between groups (wound infections: SILC: 2.3 vs. LC: 3.19 %; incisional hernias: SILC: 0.86 vs. LC: 2.3 %, bile leakage: SILC: 0.86 vs. LC: 0.57 %). SILC was associated with shorter operative times (SILC: 70 ± 31 vs. LC: 80 ± 27 minutes; p < 0.001) and reduced postoperative hospital stay (SILC: 3.02 ± 1.4 vs. LC: 4.6 ± 2.8 days; p < 0.001). No conversion to open surgery was required with SILC when compared to LC (6 %; 21/334). Within the SILC group, additional ports had to be placed in 2.6 % (3/115). SILC displays a minimised surgical trauma. Compared to LC, SILC showed no disadvantage concerning risk profiles, operative times or hospital stay. We believe that SILC can be regarded as a natural evolution in the era of minimally invasive surgery.