Conventional Laparoscopic Cholecystectomy Group Research Articles

A Systematic Review and Meta-Analysis of Single-Incision Laparoscopic Cholecystectomy Versus Conventional Four-Port Laparoscopic Cholecystectomy.

The present systematic review compares single-incision laparoscopic cholecystectomy (SILC) with conventional laparoscopic cholecystectomy (CLC) with the aim of assessing early postoperative pain and morbidity. The secondary outcomes assessed were the duration of surgery, length of hospital stay, and conversion to open surgery. A systematic search for medical records was conducted on PubMed, Embase, Medline, and the Cochrane Library. Meta-analysis was conducted using Review Manager 5.4. A total of 14 randomized control trials met the eligibility criteria, involving a total of 1762 patients. Early postoperative pain (four to six hours) (mean difference (MD): -0.86; 95%; confidence interval (CI): -1.16 to -0.55) showed significantly better results in the SILC group but showed no difference on the first or second postoperative day. There were significantly fewer complications (relative risk (RR): 1.7; 95%; CI: 1.16-2.50)recorded in the CLC group as compared to the SILC group. Operative time (MD: 19.66; 95% CI: 13.21-26.11) was significantly longer in the SILC group, while the duration of hospital stay (MD: -0.01; 95% CI: -0.28-0.26) and conversion to open surgery (RR: 0.99; 95% CI: 0.20-4.82) showed no significant difference. SILC had a significantly longer operative time and more complications as compared to CLC. However, it was associated with significantly lower early post-operative pain.

The effectiveness of extremely low-pressure pneumoperitoneum on pain reduction after robot-assisted cholecystectomy

BackgroundThe robot-assisted cholecystectomy could provide a sufficient surgical field with the extremely low-pressure pneumoperitoneum (ELPP; 4 mmHg) by the robot arm lifting the abdominal wall upward. This study aimed to investigate the effect of ELPP on the postoperative outcomes in benign gallbladder disease. MethodsA retrospective study was designed to compare the postoperative pain in addition with operation time, estimated blood loss, length of hospital stay, and complication of three types of cholecystectomy for benign gallbladder disease: 75 ELPP single site robot-assisted cholecystectomy (SSRC), 114 standard-pressure pneumoperitoneum (SPP) SSRC and 110 SPP conventional laparoscopic cholecystectomy (CLC). ResultsThere was no difference in whole operation time between ELPP SSRC and SPP SSRC group (p = 0.159). Postoperative pain score was significantly less in ELPP SSRC group as compared to SPP SSRC or SPP CLC group at 6, 12, and 24 h postoperatively (p = 0.004, p = 0.004, and p = 0.013 respectively). The incidence of shoulder pain was also significantly lower in ELPP SSRC group (p < 0.001). The rate of postoperative complication and length of stay were not different among the three groups. ConclusionsThis study shows that ELPP technique using robot is feasible without increasing postoperative complications in the process of cholecystectomy and the use of the ELPP can reduce postoperative pain and shoulder pain compared to the use of the SPP.

A Randomized Control Study to Compare the Clipless Laparoscopic Cholecystectomy (CLLC) and Conventional Laparoscopic Cholecystectomy (CLC)

Background: Present study was undertaken to compare the advantages of Clipless Laparoscopic Cholecystectomy (CLLC) over conventional laparoscopic cholecystectomy (CLC). Material and methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent CLLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: In the present study among 100 patients, 19 were males and 81 were females. Among them, 5 males and 45 females underwent CLC using electrocautery while 14 males and 36 females underwent CLLC. Mean age of males were 47.60 ± 3.36 years and females were 45.20 ± 15.82 years in CLC group and mean age of males were 53.07 ± 18.96 and females were 44.44 ± 15.41 in CLLC group. Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage and less Use of Drain in CLLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy and Post op. Complications in both groups. Conclusion: Study concluded that CLLC had significant advantage over CLC in terms of operative time ,intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and Use of Drain

A Comparative Study of Single Clip Laparoscopic Cholecystectomy (SCLC) and Conventional Laparoscopic Cholecystectomy (CLC)

Background: Theoretical benefits for use of one clip laparoscopic cholecystectomy are Less operative time, Less bleeding, Early post operative recovery, Cost factor , Less spillage of stones, Less chances of converting into open cholecystectomy , Less pain post operatively and Less amount of CO2 used. Thus, a study was undertaken to compare the advantages of Single clip laparoscopic cholecystectomy (SCLC) over conventional laparoscopic cholecystectomy (CLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent SCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: Out of 100 patients 15 were males and 85 were females. Among them, 5 males and 45 females underwent CLC using electrocautery while 10 males and 40 females underwent SCLC. Mean age of males were 47.60 ± 3.36 and females were 45.20 ± 15.82 in CLC group and mean age of males were 48.50 ± 14.49 and females were 46.73 ± 16.16 in SCLC group . Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage, less Use of Drain and Post op. Complications in SCLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy in both groups. Conclusion: Study showed clear cut benefits of SCLC over CLC in terms of operative time , intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and post operative complications

Advantages of Two Clips Laparoscopic Cholecystectomy (TCLC) and Conventional Laparoscopic Cholecystectomy (CLC): A Comparative Study

Background: Laparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. Thus, a study was undertaken to compare the advantages of Two Clips Laparoscopic Cholecystectomy (TCLC) over conventional laparoscopic cholecystectomy (CLC). Material and Methods: This prospective randomized study was conducted in the Department of Surgery IGMC, Shimla over a period of 1 year starting from 1st july 2019 to 30th june 2020. In this study 100 consecutive patients of symptomatic cholelithiasis confirmed by USG reporting were participated and randomized into 2 groups of 50 each. Group 1 patients underwent CLC and Group 2 patients underwent TCLC. Outcomes were measured in terms of operative time, intra operative stone spillage, intra operative blood loss, amount of CO2 used , post operative pain , conversion into open cholecystectomy and post operative complications. Results: In the present study among 100 patients, 19 were males and 81 were females. Among them,5 males and 45 females underwent CLC using electrocautery while 14 males and 36 females underwent TCLC.Mean age of males were 47.60 ± 3.36 years and females were 45.20 ± 15.82 years in CLC group and mean age of males were 45.36 ± 14.53 and females were 45.25 ± 15.97 in TCLC group. Present study showed that there was significant less Operative Time, Less Mean CO2 used, less Approx. Blood Loss, less Average pain score at 6 and 24 hours, less Average Length of hospital stay, less Intra Op. Stone spillage, less Use of Drain and Post op. Complications in TCLC as compared to CLC but there was no significant difference in Conversion to Open Cholecystectomy in both groups. Conclusion: Study concluded that TCLC had advantage over CLC in terms of operative time ,intra operative stone spillage , intra operative blood loss , amount of CO2 used , post operative pain and post operative complications

The Safety and Feasibility of Single Incision Laparoscopic Cholecystectomy for Acute Cholecystitis: Comparison with Conventional Laparoscopic Cholecystectomy

Introduction: Single incision laparoscopic cholecystectomy (SILC) is a considerable option in benign gallbladder surgery. However, the safety and feasibility of SILC in acute cholecystitis has not been confirmed. We report our surgical outcomes of SILC in acute cholecystitis compared with conventional laparoscopic cholecystectomy (CLC). Methods: 386 patients who underwent SILC and 592 patients who underwent CLC for acute cholecystitis between April 2010 and December 2018 in single institution were retrospectively reviewed the preoperative characteristics and surgical outcomes. Results: The patients in CLC group were older (55.1 vs 65.0 years, p< 0.001), higher ASA score (12.7 vs 35.5% in over III, p< 0.001), and higher incidence of preoperative percutaneous transhepatic gallbladder drainage (PTGBD) than the patients in SILC group. According to Tokyo guideline 18, the patients above grade 2 were more common in the CLC group (15.8 VS 24.3%, p=0.001). There is no statistical significance in operative time, Blood loss, intra-operative transfusion, adjacent organ injury, open conversion, postoperative complication, incisional hernia, and mortality. The length of postoperative hospital stay was significantly shorter in SILC group. On multivariable analysis, grade II or III acute cholecystitis according to Tokyo guideline 18 (TG18), was risk factor for major complication and prolonged operative time. Conclusion: In our experience, SILC can be a safe and feasible treatment for acute cholecystitis, if appropriate experience and when expertise is available. However, in case of grade II or III acute cholecystitis according to TG18, SILC should be selected carefully.

Harmonic scalpel, the tool for new age laparoscopic cholecystectomy

Background: Among the various abdominal procedures, operations performed on the biliary tract are the most common and cholecystectomy is the commonest performed surgical procedure amongst them. Currently laparoscopic cholecystectomy (LC) is considered the gold standard treatment for symptomatic gallstone disease. Cholecystectomy done by harmonic scalpel is an attractive alternative technique being more cost effective and having equivalent results in regard to post-operative recovery and pain as compared to standard laparoscopic procedure. The objective of this study was to compare Clipless (Harmonic scalpel assisted) and Conventional Laparoscopic Cholecystectomy.Methods: Patients with a diagnosis of symptomatic cholelithiasis were included in the present study. Patients were divided randomly into two groups. The control group (Group-A) underwent conventional LC using mono-polar electro-surgery for dissection of gallbladder bed and clips for ligation of cystic duct and artery while the study group (Group-B) underwent LC using the harmonic scalpel. The harmonic scalpel was used as the sole instrument for division of the cystic duct and artery as well as dissection of the gallbladder bed.Results: The mean duration of surgery in the conventional LC group was found to be 46 min 50 sec and 33 min 10 sec in the clipless LC group, the difference being statistically significant (p &lt;0.05). Perforation of gall bladder occurred in 12 cases in conventional LC group as compared to 2 cases in clipless laparoscopic (P &lt;0.05).Conclusions: The clipless LC approach has a definite edge over conventional LC, in regard to lesser duration of surgery, fewer operative complications and shorter post-operative hospital stay.

Harmonic Scalpel-Assisted Laparoscopic Cholecystectomy vs. Conventional Laparoscopic Cholecystectomy - A Non-randomized Control Trial.

IntroductionLaparoscopic cholecystectomy (LC) is the most commonly done, minimally invasive surgical procedure. Routinely used electrocautery produces more smoke, which masks the operating field, thereby prolongs the surgery and posing an increased risk of gallbladder (GB) perforation. The titanium clips used for clipping the cystic artery and cystic duct have a risk of slippage, which may lead to bleeding, and an increased risk for bile leakage. In addition, it may act as a nidus for stone formation. Advanced energy sources, such as the harmonic scalpel, though expensive, may provide the advantage of shorter operating time by reducing smoke, bloodless dissection in the GB bed, lower risk of bleeding from the cystic artery due to secure vessel sealing, and avoiding the use of a larger number of titanium clips. However, evidence to substantiate this advantage is limited.AimTo compare the operating time and perioperative complications between conventional laparoscopic cholecystectomy (CLC) and harmonic scalpel assisted laparoscopic cholecystectomy (HLC).MethodologyAll consecutive patients who underwent elective LC were included. Patients with acute infection, impaired liver function tests, concomitant common bile duct calculi, chronic liver disease/cirrhosis, suspected GB carcinoma, and pregnant women were excluded from the study. Patients were allocated into two groups. In the CLC group, both the cystic duct and the cystic artery were divided after conventional titanium clip application and electrocautery was used for thermal energy. In the HLC group, the cystic duct was clipped with a titanium clip and the rest of the procedure was carried out using Harmonic Ace (Ethicon, New Jersey, United States) and Harmonic Hook (Ethicon, New Jersey, United States). Outcome parameters analyzed were operating time in minutes, post-operative pain using visual analogue scale (VAS) scoring, frequency and route of analgesic requirement after 24 hours, and intraoperative complications, including bleeding, bile duct injury, GB perforation, and surgical site infection (SSI) in the postoperative period, per the Centers for Disease Control (CDC) criteria.ResultsBoth the groups were comparable with respect to age, gender, body mass index (BMI), and the presence of comorbidity and an indication of cholecystectomy. The duration of surgery did not significantly differ between the groups (67.3 vs. 64.3 mins; p = 0.30). Other parameters, such as analgesic required on postoperative Day 1 (3.2 vs. 3; p = 0.67), VAS scores on Day 0 (4.55 vs. 4.65; p = 0.59), VAS scores on Day 1 (2.3 vs. 2.2; p = 0.84), superficial SSI (15% vs. 10%; p = 0.63), intraoperative GB perforation (30% vs. 20%; p = 0.71), and intraperitoneal drain (30% vs. 20%; p = 0.71) did not significantly differ between the groups.ConclusionHLC has no significant advantage over CLC with respect to operating time, postoperative pain, and perioperative complications.

A large-cohort comparison between single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy from a single center; 2080 cases.

Backgrounds/AimsThis study was conducted to verify and compare the safety and feasibility of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC).MethodsA total of 2,080 patients underwent laparoscopic cholecystectomy in a single center, Konyang University Hospital, between 2010 and 2016. We retrospectively compared the demographics, perioperative outcome, and postoperative complication results between the CLC and SILC groups.ResultsAmong the 2,080 patients who underwent laparoscopic cholecystectomy, 1,080 had CLC and 1,000 had SILC. When retrospectively reviewed, the SILC group had significantly higher percentages of patients who were aged under 80 years, who were women, and had the American Society of Anesthesiologist score of lower than 3 points compared to those of the CLC group. Furthermore, the CLC group had a higher percentage of patients with acute cholecystitis or empyema, whereas the SILC group had a higher percentage of patients with chronic cholecystitis. Preoperative percutaneous transhepatic gallbladder drainage insertion or H-vac insertion was more frequently conducted, bleeding loss was more common, and hospital stay was longer in the CLC group. Postoperative complications such as wound infection, biloma, bile duct injury, and duodenal perforation were not significantly different between the two groups.ConclusionsIn conclusion, if performed after preoperative patient selection such as in younger and female patients with no abdominal operation history at the time of benign gallbladder surgery, SILC can be considered feasible and safe without additional complications when compared with CLC.

Comparative study of pain in women submitted to conventional laparoscopic cholecystectomy versus single-port laparoscopic cholecystectomy

To evaluate postoperative pain in patients submitted to conventional laparoscopic cholecystectomy with four ports versus single-port laparoscopic cholecystectomy with only one port. Twenty-one patients were included in the conventional laparoscopic cholecystectomy group and 19 other patients in the single-port laparoscopic cholecystectomy group. A VAS was used for the assessment of postoperative pain at three time points. Differences were considered statistically significant when p<0.05. Intergroup analysis showed no significant difference in VAS scores between the conventional laparoscopic cholecystectomy and single-port laparoscopic cholecystectomy groups at any of the time points studied. This study found no significant difference in postoperative pain between the two groups.

Robotic versus conventional laparoscopic cholecystectomy: A comparative study of medical resource utilization and clinical outcomes

Conventional laparoscopic cholecystectomy (CLC) is currently the standard of surgical procedure for gallstone disease. Robotic cholecystectomy (RC) has revolutionized the field of minimally invasive surgery; it is safe and ergonomic, but expensive. The aim of this study is to compare the medical resource utilization and clinical outcomes between the two procedures. This study was conducted retrospectively by assessing data of the clinical outcomes and medical resource of 78 patients receiving RC and 367 patients receiving CLC. We reviewed the data of operation times, length of hospital stay, hospital charges, outpatient department visits, outpatient department service charges, and postoperative complications, which were retrieved from the health information system (HIS) database in this hospital. Patients in both groups had similar demographic and clinical features. The RC group had longer length of hospital stay (p=0.056), significantly longer operation time (p=0.035), and much more hospital charges (p=0.001). The RC group, however, experienced less postoperative complication rates (average 3.8% vs. 20.4%, p=0.001). Conversion rate was 1.9% in the CLC group versus 0% in the RC group (p=0.611). Most complications were mild, and following the Clavien-Dindo classification, there were two cases (2.5%) Grade I for the RC group; 50 cases (13.6%) Grade I and 14 cases (3.81%) Grade II for the CLC group (p<0.001 and 0.001, respectively). Procedure-related complications of Grade IIIa status were encountered in nine patients (2.45%) in the CLC group and none in the RC group (p=0.002).The RC group consumed more medical resources in the index hospitalization; however, they experienced significantly less postoperative complications.

Comparison of single incision laparoscopic cholecystectomy with conventional laparoscopic cholecystectomy using conventional laparoscopic instrument: a prospective observational study

Background: Laparoscopic surgery is one of the most significant surgical advances of twentieth century. Laparoscopic cholecystectomy is criterion standard for the treatment of benign gall bladder diseases, and it is the most common laparoscopic surgery worldwide. The aim of the study was to compare the intra-operative and post-operative complication, conversion rate and outcome of single incision laparoscopic cholecystectomy and conventional laparoscopic cholecystectomy on short term follow up.Methods: This prospective analytical observational design study was carried out in Tertiary Health care centre. As per convenience sampling 60 consecutive patients of cholelithiasis. Data obtained was analyzed and inferences were drawn regarding the outcomes of the SILC in terms of cosmesis, post-operative pain and any other complications and compare the outcomes against the conventional four port laparoscopic cholecystectomy.Results: In our study we found the mean operating time for SILC was 90.5±16.37 minutes, whereas the mean operating time for CLC was 74±17.83 (p = 0.0004). Intra-operative blood loss for SILC and CLC was comparable and statistically insignificant. Pain in the SILC group was found to be significantly low than CLC group (p ≤0.0001). The median cosmetic scale score for SILC group was 20 with range 13-21 and in conventional laparoscopic cholecystectomy group it was 16 with range 12-18 (p &lt;0.0001).Conclusions: The major advantage of SILC is cosmetic satisfaction, while the disadvantages of SILS are longer operative time. There was no statistically significant difference in the intra-operative blood loss and conversion rate, and complications in both the techniques. Single incision laparoscopic cholecystectomy (SILC) was developed with the aim of reducing the invasiveness of traditional laparoscopy.

Removing gallbladder from intra abdominal area by a different technique

Aim: Laparoscopic cholecystectomy is a widely performed technique worldwide. The use of laparoscopic threaded holders for this is routine but takes a lot of time and may tear the gallbladder. There are no wide-mouthed and short endoscopic instruments that can be used for removing the gallbladder without perforation. We look at gallbladder removal methods that are quick and do not involve damage at the end of laparoscopic cholecystectomy.Materials and Methods: This prospective study was conducted on 30 laparoscopic cholecystectomy patients divided into two equal groups, one employing conventional laparoscopic cholecystectomy (CLC) and the other using a sponge holding forceps (SHF) (n=15, both groups) to demonstrate the effectiveness of our management. In the CLC group, the number of male patients was two (13.3 %) and female patients 13 (86.7%); in the SHF group, number of male patients was six (40%) and female patients nine (60%). When we compared the results statistically for bladder removal time, total operation time, gallbladder perforation, and wound infection, the p values were found to be 0.016, 0.182, 0.169, and 1, respectively.Results: Thirty patients were analyzed. The SHF group showed significantly better results than the CLC group for gallbladder removal time and better although not significantly better results for perforation of bladder, while there was no difference between the groups for wound infection.Conclusion: Removing the gallbladder with an SHF significantly shortens the duration of removal and also reduces perforations as compared to CLC.Keywords: Laparoscopic Cholecystectomy; Forceps; Techniques.

Less pain after transvaginal cholecystectomy: single-center pooled analysis.

We previously reported outcome after transvaginal cholecystectomy (TVC) from two cohort studies and a randomized controlled trial. We now present a pooled analysis of postoperative pain scores. Single-center data of postoperative pain after TVC from a level II hospital between October 2007 and June 2012. Female patients, above 18years with symptomatic cholecystolithiasis, received either TVC or conventional laparoscopic cholecystectomy (CLC). Follow up 4days. The primary outcome of the study was pain after surgery. Pain was measured via a visual rating scale. Descriptive statistics include age, body mass index (BMI), ASA grade, surgical times, number of trocars, complications and hospital stay as well as pain medication. Pain data were assessed against histologic findings. The combined register included 316 patients. Of these, 7 patients were excluded from analysis due to conversion to open surgery, complications and denial of follow-up. There were 141 patients in the TVC and 168 in the CLC group. There was no difference in age, ASA grade, surgical times, complications or hospital stay. BMI was significantly different with an average BMI of 27.1 in the TVC and 28.7 in the CLC group (p=0.027). The numbers of trocars were significantly different as expected. There was no difference in postoperative pain medication. Pain scores were significantly different on day two to four. Multivariate testing revealed no dependence between postoperative pain and histologic findings. On smaller patient numbers, we were previously unable to demonstrate a consistently, significant difference for postoperative pain in our cohort and randomized studies. The pooled analysis suggests that there is an advantage with less postoperative pain after transvaginal compared to standard laparoscopic cholecystectomy.

Impact of miniport laparoscopic cholecystectomy versus standard port laparoscopic cholecystectomy on recovery of physical activity: a randomized trial.

We conducted a randomized trial comparing minilaparoscopic cholecystectomy (MLC) to conventional laparoscopic cholecystectomy (CLC) to determine whether MLC accelerated recovery of physical activity after elective surgery (NCT01397565). A total of 115 patients scheduled for elective cholecystectomy were randomized to either CLC or MLC. Both procedures used a 10-mm umbilical port, but the three upper abdominal ports were 5mm in CLC and 3mm in MLC. Primary outcome was self-reported physical activity 1month after surgery as estimated by Community Health Activities Model Program for Seniors questionnaire (kcal/kg/week). Secondary outcomes were umbilical pain, abdominal pain, nausea and fatigue (VAS, 1-10), and cosmetic result at one and 3months. Patients received identical surgical dressings for 1week, and assessors were blinded to group allocation. Forty-two patients randomized to CLC group and 33 patients randomized to MLC remained in the trial and were analyzed. Both groups were similar at baseline characteristics. In the MLC group, at least one 5-mm port was used in 17 (51.5%) mainly due to unavailability of ML equipment. Median (IQR) physical activity for the CLC and MLC groups was similar at baseline (23.4 [13.1, 44.6] vs 23.6 [14.2, 66.9] kcal/kg/week, p=0.35) and at 1month (20 [7.9, 52.5] vs 16.8 [11.8, 28.6] kcal/kg/week, p=0.90). One month post-op, umbilical pain and abdominal pain were similar, but the CLC group reported higher fatigue (4 [1-5] vs 1 [0-4], p=0.05) and worse scar appearance scores (4 [3, 4] vs 4.5 [4, 5], p=0.009). At 3months, the CLC group had worse scar appearance (4 [3-5] vs 5 [4-5], p=0.02) and lower scar satisfaction scores (4 [3, 4] vs 4 [3.5-4], p=0.04). Recovery of physical activity was similar after MLC and CLC. MLC resulted in less fatigue and better scar appearance and satisfaction. These benefits were seen despite the need to upsize one or more ports in more than half of patients related to availability of the miniature instruments.

A Prospective Study Comparing Quality of Life and Cosmetic Results between Single-Port and Conventional Laparoscopic Cholecystectomy

Background: Multiple studies from the last five years have demonstrated that single-incision laparoscopic surgery cholecystectomy (SILS) is not only feasible but also produces a result comparable with that of conventional laparoscopic cholecystectomy (CLC). Methods and results: In this bicentric study, we used the Short Form (36) (SF-36) and Nottingham Health Profile (NHP) surveys to estimate and compare the post-operative quality of life up to the 28th post-operative day for 66 patients who had undergone either CLC (n = 32) or SILS (n = 34). Additionally, we investigated patient satisfaction with the cosmetic results after one year. The curves summarizing the eight sections in the physical sum scale and in the mental sum scale (SF-36) were the same within the confidence interval with a confidence level of 95%. Thus, post-operative quality of life could be assumed to be equivalent for the two groups. Evaluation of the NHP survey produced similar results. The perceived cosmetic results were significantly better for the SILS group (1.3 on a scale of 1 - 5 with 1 being the best) than for the CLC group (1.9) (p = 0.016). Conclusions: This study did not demonstrate better quality of life for the single-port procedure as it had been expected. Instead, the single-port procedure produced subjectively better cosmetic results.

Transvaginal cholecystectomy vs conventional laparoscopic cholecystectomy for gallbladder disease: A meta-analysis.

To compare the results of transvaginal cholecystectomy (TVC) and conventional laparoscopic cholecystectomy (CLC) for gallbladder disease. We performed a literature search of PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Google Scholar, MetaRegister of Controlled Trials, Chinese Medical Journal database and Wanfang Data for trials comparing outcomes between TVC and CLC. Data were extracted by two authors. Mean difference (MD), standardized mean difference (SMD), odds ratios and risk rate with 95%CIs were calculated using fixed- or random-effects models. Statistical heterogeneity was evaluated with the χ(2) test. The fixed-effects model was used in the absence of statistically significant heterogeneity. The random-effects model was chosen when heterogeneity was found. There were 730 patients in nine controlled clinical trials. No significant difference was found regarding demographic characteristics (P > 0.5), including anesthetic risk score, age, body mass index, and abdominal surgical history between the TVC and CLC groups. Both groups had similar mortality, morbidity, and return to work after surgery. Patients in the TVC group had a lower pain score on postoperative day 1 (SMD: -0.957, 95%CI: -1.488 to -0.426, P < 0.001), needed less postoperative analgesic medication (SMD: -0.574, 95%CI: -0.807 to -0.341, P < 0.001) and stayed for a shorter time in hospital (MD: -1.004 d, 95%CI: -1.779 to 0.228, P = 0.011), but had longer operative time (MD: 17.307 min, 95%CI: 6.789 to 27.826, P = 0.001). TVC had no significant influence on postoperative sexual function and quality of life. Better cosmetic results and satisfaction were achieved in the TVC group. TVC is safe and effective for gallbladder disease. However, vaginal injury might occur, and further trials are needed to compare TVC with CLC.

Evaluation of pain scores after single‐incision and conventional laparoscopic cholecystectomy: A randomized control trial in a rural Indian population

Single-incision laparoscopic cholecystectomy (SILC) is considered to be less invasive and have less morbidity than conventional laparoscopic cholecystectomy (CLC). However, there is a relative paucity of data regarding postoperative pain scores in rural Indian populations following SILC. Also, data pertaining to the applicability of SILC in rural Indian population are scant. In the present randomized control trial, pain scores after SILC and CLC were evaluated. Sixty patients with gallstone disease were randomly assigned to one of two groups with 30 patients each: the CLC group and the SILC group. Postoperative pain scores were recorded on the visual analog scale at 8 hours, 24 hours and 7 days after surgery. The patients were comparable with respect to age, sex and BMI. Operative time was longer for the SILC group (47.73 ± 5.57 min vs 69.53 ± 8.96 min; P < 0.0001).The pain scores were similar in both groups at 8 hours (3.61 ± 0.41 vs 3.50 ± 0.51; P = 0.36) and 24 hours (3.30 ± 0.59 vs 3.20 ± 0.40; P = 0.44) postoperatively. On day 7, the SILC group had lower pain scores than the CLC group (2.56 ± 0.56 vs 1.16 ± 0.37; P < 0.01). There was no distinct advantage to SILC with regard to immediate postoperative pain. Pain was significantly less (P < 0.01) in the SILC group on postoperative day 7.

Effect of laparoscopic cholecystectomy techniques on postoperative pain: a prospective randomized study.

PurposeMinimally invasive surgical technics have benefits such as decreased pain, reduced surgical trauma, and increased potential to perform as day case surgery, and cost benefit. The primary aim of this prospective, randomized, controlled study was to compare the effects of single incision laparoscopic cholecystectomy (SILC) and conventional laparoscopic cholecystectomy (CLC) procedures regarding postoperative pain.MethodsNinety adult patients undergoing elective laparoscopic cholecystectomy were included in the study. Patients were randomized to either SILC or CLC. Patient characteristics, postoperative abdominal and shoulder pain scores, rescue analgesic use, and intraoperative and early postoperative complications were recorded.ResultsA total of 83 patients completed the study. Patient characteristics, postoperative abdominal and shoulder pain scores and rescue analgesic requirement were similar between each group except with the lower abdominal pain score in CLC group at 30th minute (P = 0.04). Wound infection was seen in 1 patient in each group. Nausea occurred in 13 of 43 patients (30%) in the SILC group and 8 of 40 patients (20%) in the CLC group (P > 0.05). Despite ondansetron treatment, 6 patients in SILC group and 7 patients in CLC group vomited (P > 0.05).ConclusionIn conclusion, in patients undergoing laparoscopic surgery, SILC or CLC techniques does not influence the postoperative pain and analgesic medication requirements. Our results also suggest that all laparoscopy patients suffer moderate and/or severe abdominal pain and nearly half of these patients also suffer from some form of shoulder pain.

Comparison Between Single Incision and Conventional Laparoscopic Cholecystectomy for Uncomplicated Cholelithiasis

Aim : To compare surgical outcomes of patients presenting with uncomplicated cholelithiasis and operated by single incision (SILC) or by conventional laparoscopic cholecystectomy (CLC).Methods : The series concerned 58 consecutive patients operated between October 2008 and October 2009. There were 11 men and 47 women with a mean age of 47 years and a BMI of 29. Six patients had a past surgical history with a midline incision. The main parameters analysed were duration of operation, morbidity, postoperative pain, return to normal activities and aesthetic result. One month and one year after surgery, the cosmetic result was assessed on a visual analogue scale (VAS), a score between 9 and 10 was considered as an excellent cosmetic result.Results : A SILC was performed in 26 and a CLC in 32 patients. Patients in the SILC group were characterised by a lower BMI: 25 versus 32 (p < 0.001) and by the absence of previous midline incision: 0/26 (0%) versus 6/32 (19%) (p < 0.028). Outcomes were similar between groups except the aesthetic result. Multivariate statistical analysis revealed that the percentage of excellent cosmetic result was higher in SILC than in CLC group: respectively 73% (19/26) vs. 28% (9/32) one month postoperatively (OR: 5.3, 95% CI: 1–23, p < 0.03) and 92% (22/24) versus 55% (17/31) one year postoperatively (OR: 6.9, 95% CI: 1–46, p < 0.04).Conclusions : Our study demonstrates that SILC is a feasible and safe procedure in a selected population. Compared to CLC, the only obvious benefit is a better cosmetic result that is still observed one year after surgery.