Port Laparoscopic Cholecystectomy Research Articles

Is the trocar through which the gallbladder is removed during cholecystectomy important for potential complications?

Objective: Laparoscopic cholecystectomy is considered the gold standard for the treatment of gallstone disease and complications can develop at trocar sites following laparoscopic cholecystectomy. This study aims to evaluate the impact of extracting the gallbladder through either the umbilical or epigastric ports during laparoscopic cholecystectomy on the complications observed after gallbladder extraction. Methods: Symptomatic cholelithiasis patients who had four port laparoscopic cholecystectomy included to the study. Individuals were divided into two groups based on gallbladder removal site: umbilical or epigastric. Medical records were reviewed for post-surgical complications within 30 days and incisional hernias within one year. The age, gender, operation duration, BMI and the largest stone dimentions of the patients were also noted. Results: A total of 112 patients were included in the study, with 45 patients in the umbilical group and 67 patients in the epigastric group. No significant differences were observed in age, gender, body mass index and stone dimentions between groups. Port site hernia and port site infection developed more frequently but not significantly in umblical group. When examined the stone dimention and BMI based on the presence of a port site hernia and port site infection, BMI and stone dimention were significantly higher in port site infection and hernia patients. Conclusion: Using umbilical port for removing gallbladder, carried a higher risk of infection and hernia development. Additionally, regardless of which trocar is used, patients with a high BMI and large stone dimensions have a higher risk of port site infection and hernia. Patients should be informed about these risks during the preoperative period.

Three port laparoscopic cholecystectomy with or without a marionette sling: A randomized controlled trial.

Three port laparoscopic cholecystectomy with or without a marionette sling: A randomized controlled trial.

Evaluation of Safety and Feasibility of Using LigaSure During Clipless Single-Incision Laparoscopic Cholecystectomy: A Prospective Clinical Study.

Background: Single-incision laparoscopic cholecystectomy (SILC) is a minimally invasive procedure designed to minimize the number and size of the incisions needed for cholecystectomy. Titanium clips are traditionally used to close the cystic duct and artery. Although it is considered safe, dislodgement can result in bleeding and biliary leakage. Using LigaSure for duct sealing is still controversial. The aim of this study was to evaluate the safety and feasibility of using LigaSure to close the cystic duct during SILC. Methods: A prospective study over two years was conducted at the General Surgery Department, Mansoura University Hospital, on 102 patients, 51 in each group. They underwent SILC using LigaSure (Group 1) or titanium clips (Group 2) to control the cystic duct and artery. Results: The data analyzed included demographic data, operative time, intra- and postoperative complications, postoperative pain, and hospital stay. The operative time was significantly shorter in LigaSure group (68.5 ± 9.8 versus 72.9 ± 10.6 minutes in the clips group, P .03). There was no significant difference between the two groups regarding postoperative bile leak or bleeding. However, two cases in Group 1 and four cases in Group 2 were converted to multiple port laparoscopic cholecystectomy; this was statistically nonsignificant. Postoperative pain and hospital stay showed no significant difference between the two groups. Two patients in each group developed port-site incisional hernia. Conclusions: Clipless SILC using LigaSure is a feasible and safe procedure with acceptable morbidity with shorter operative time than SILC using clips. Nevertheless, the risk of port-site incisional hernia should be explained to the patients.

A new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy improves patients’ postoperative quality of life

ObjectiveLaparoscopic surgery has become a routine general surgery with many advantages, such as alleviating abdominal pain. However, postoperative pain caused by abdominal drainage tubes has attracted little attention from medical staff. The aim of this study was to explore the influence of a new abdominal drainage tube fixation method for 3-port laparoscopic cholecystectomy (LC) on patients’ postoperative quality of life. MethodsPatients who underwent 3-port LC with abdominal drainage tubes in the Department of Hepatobiliary Surgery of Linyi People’s Hospital from March 1, 2023 to October 31, 2023 due to gallstones with chronic cholecystitis were selected for this study. The patients were randomly divided into an experimental group and a control group. In the experimental group, the new abdominal drainage tube fixation method was used, while in the control group, the traditional method was used. Afterward, the quality of life of patient in terms of pain, activity, recovery time, and mental health status was evaluated. The exudate around the patient’s drainage tube was collected for bacterial culture and analysis. ResultsA total of 139 patients were randomly divided into an experimental group (70 patients) and a control group (69 patients). The patients’ baseline characteristics were not significantly different. The patients in the experimental group had better outcomes in quality of life, with higher pain scores (24.03 ± 2.37 vs. 15.48 ± 2.29, p < 0.001) and activity scores (20.57 ± 1.78 vs. 14.13 ± 1.43, p < 0.001), and a shorter postoperative recovery time (2.36 ± 0.68 d vs. 2.96 ± 1.34 d, p < 0.001). The same results were shown in linear regression analysis scores of the 2 groups. The positive rate of bacterial culture in the exudate around the patient’s drainage tube in the experimental group was significantly lower than that in the control group (12.9% vs. 43.5%, p < 0.001); and furthermore, the positive rate of conditional pathogenic bacteria was even lower (7.1% vs. 33.3%, p < 0.001) in the experimental group than in the control group. ConclusionThis new abdominal drainage tube fixation method can effectively promote patient rehabilitation and improve the quality of life for patient following 3-port LC with abdominal drainage tubes.

Comparison of three-port versus four-port laparoscopic cholecystectomy

Background: In the era of laparoscopic surgery, early recovery and less post-operative pain are major goals to improve patient care and cut down cost. Several studies have demonstrated less post-operative pain and early recovery with the reduction in size and number of ports. Aims and Objectives: To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, intraoperative difficulties, post-operative pain, incidence of complications, and cosmetic results. Materials and Methods: The study was done in Maharani Laxmi Bal Medical College, Jhansi, between April 2021 and November 2022, including 2 groups of patients (Group A-50 patients of three-port LC and Group B-50 patients of four-port LC). Results: Most of the participants were from 18 to 30 years (32%, 38%) and 31 to 40 years (30%, 12%) in both the groups. The mean duration of surgery in three-port and four-port group was 41.64±6.972 and 42.22±13.784 min, respectively (p=0.79). Hospital stay was three-port and four-port group was 3.33±0.789 and 3.86±0.707 days, respectively (p=0.0001). 100 patients were included, with 2085 patients. The mean age of the studied patients was 46.38 years with female preponderance. The mean operative time for three ports was 66.90 min and for four ports, it was 75.45 min. The mean duration of post-operative stay for three-port was 4.66, and for the conventional group, it was 5.30. Conclusion: Three-port lap cholecystectomy can be advocated to be better than the 4-port technique, but especially in experienced hands, and 4-port LC is better for beginners.

Comparison between single incision laparoscopic cholecystectomy using conventional laparoscopic instruments vs. four port laparoscopic cholecystectomy in patients of symptomatic cholelithiasis: a prospective randomised study

Background: The desire to reduce invasiveness, pain, discomfort and improve cosmesis and early return of patient to normal activities is the basis for single incision laparoscopic surgery. The primary aim was to compare post-operative pain and the secondary aim to compare duration of surgery, intraoperative bile spill or stone spill, duration of hospital stay, any postoperative complications and cosmetic outcome between SILC and the gold standard for symptomatic gall stone disease, FPLC (Four port laparoscopic cholecystectomy). Methods: A total of 150 patients were randomized into two groups, A (SILC) and B (FPLC). Post-operative pain and other intra-operative and post -operative parameters were compared. Results: The age ranged between 20 years to 76 years most of them being females with body mass index ranging between 19 and 35 kg/m2. Comparison of pain score was done using MEWS scale; which was found to be statistically significantly SILC at 6 hours, mean difference (MD)-0.833 while at 24 hours the difference was not significant (MD- 0.234). Duration of surgery was significantly more (MD-12.17 minutes) in SILC. No addition of port or conversion to open cholecystectomy was required. There were no significant difference between post-operative complications between the two groups. Cosmesis was significantly better in terms of look of the scar (MD-0.867) and recommending it to their relatives (MD-0.700) in SILC group. Conclusions: SILC is a safe and easily learnable procedure which can be safely be done using conventional laparoscopic instruments in low risk patients. Duration of surgery even after expertise is gained remains to be more than FPLC.

Comparison between Open Cholecystectomy, 4-Port Laparoscopic Cholecystectomy and One-Port Laparoscopic Cholecystectomy: A Literature Review

Cholecystectomy is the most commonly performed surgical procedure to treat gallbladder disease. In recent decades, the technique of laparoscopic cholecystectomy has been developed, which has proven to be a less invasive alternative with better results compared to traditional open cholecystectomy. However, laparoscopic one-port cholecystectomy has recently been introduced as an even less invasive variant. In this literature review article, a comprehensive comparison is made between open cholecystectomy, 4-port laparoscopic cholecystectomy and one-port laparoscopic cholecystectomy, evaluating the epidemiology, clinical significance, definition, surgical technique, advantages and complications of each approach.

Impact of patient body mass index on surgical outcome after single port laparoscopic cholecystectomy

Impact of patient body mass index on surgical outcome after single port laparoscopic cholecystectomy

A Comparative Study of Feasibility of Three Port Laparoscopic Cholecystectomy Over Four Port Laparoscopic Cholecystectomy

A Comparative Study of Feasibility of Three Port Laparoscopic Cholecystectomy Over Four Port Laparoscopic Cholecystectomy

Propensity score matching analysis of perioperative outcomes including quality of life after multi-port vs. single port laparoscopic cholecystectomy: a nationwide prospective multicenter study in Korea

Introduction The usefulness of single-port laparoscopic cholecystectomy (SPLC) as compared to multi-port laparoscopic cholecystectomy (MPLC) remains controversial. Between SPLC and MPLC, we compared outcomes, especially subjective aspects, such as quality of life (QoL). Material and methods This multi-center study, involving 20 institutions from 2016 to 2017, enrolled 2507 patients who underwent laparoscopic cholecystectomy. Various perioperative outcomes, pain assessed by the numeric rating scale (NRS) score, and QoL evaluated by the gastrointestinal QoL index (GIQLI) questionnaire, were compared between the two procedures. We generated balanced groups after propensity score matching (PSM) using preoperative factors that influence the decision to perform MPLC or SPLC. Results MPLC and SPLC were performed in 2176 and 331 patients, respectively. Nine hundred and twelve and 329 patients, respectively, were selected from the two groups by PSM. Operation time was longer and surgical difficulty was lower in SPLC. There were no significant differences in most outcomes, including biliary complications. Significant superiority of SPLC over MPLC was shorter hospitalization, lower NRS score, and favorable GIQLI. Conclusions From nationwide prospective data, SPLC showed outcomes comparable to MPLC. In SPLC, morbidity was not high and postoperative QoL was favorable. In the future, more implementations and studies are needed to ensure the safety and feasibility of SPLC.

Clinical Outcome in Two Incision, Three Port Laparoscopic Cholecystectomy in Gall Stone Disease

Background Conventional laparoscopic cholecystectomy requires four different incisions to insert the four ports for various instruments. It has been seen that fourth trocar which is used to retract fundus of gall bladder is not required at all and laparoscopic cholecystectomy can be performed without using it. Various modification have been done in this regard. The present study is designed to evaluate the feasibility of two incision three port laparoscopic and its outcome in term of postoperative recovery. Methods A prospective study was conducted in a unit in Department of General Surgery, Government Medical College and Hospital, Chandigarh, India. 100 patients of either sex undergoing two incision laparoscopic surgery in gallstone disease from January 2018 to October 2019. Results In the study, two incision, three port laparoscopic cholecystectomy is safe and feasible technique with added advantage of significantly less port site pain, good satisfaction score and less operative time with experienced surgeon. Conclusions Two incision, three port laparoscopic cholecystectomy is feasible, safe and with good aesthetic results using the same instruments of conventional laparoscopic cholecystectomy, without increasing operative time and compromising safety. It could be recommended for routine laparoscopic cholecystectomy in place of conventional four port or three incision laparoscopic cholecystectomy.

Experience of single port laparoscopic cholecystectomy in primary clinic

Experience of single port laparoscopic cholecystectomy in primary clinic

Review of 3,665 cases of single port laparoscopic cholecystectomy performed in 7 years in single community hospital by single surgeon

Review of 3,665 cases of single port laparoscopic cholecystectomy performed in 7 years in single community hospital by single surgeon

Three Port Laparoscopic Cholecystectomy by a Modified Technique

Introduction:Since the introduction of laparoscopic cholecystectomy (LC) several modifications have been introduced to its procedure. Main aim of these modifications is to improve cosmesis &amp; reduce pain. Several institutes are routinely performing conventional 3 ports laparoscopic. In modified 3 ports LC, the third port was moved from right hypochondrium to umbilicus, to conceal it in the umbilical scar, thereby giving the three port comfort to the surgeon and two port benefits to the patient. Methods: This observational study was conducted in the Department of Surgery of Shaheed Suhrawardy Medical College &amp; Hospital from September 2015 to October 2016. After taking valid consent a total 45 patients were selected for modified 3 ports LC. Here we tried to see the safety and benefit of this modified technique by assessing operating time, intra-operative complications, open conversion rate, postoperative wound infection, post-operative hospital stay, pain score and satisfaction with cosmetic outcome. Results: 3 patients were excluded from study due to different reasons. So, among total 42 (N) patients 30 (71.4%) were female &amp; 12 (28.6%) were male. Operative time was 58.48 ± 32.52 minutes (range 34 to 180 minutes). 2 patients required conversion to open surgery. Pain score was 2.07 ±1.71 and cosmetic score was 8.67 ± 1.99. Conclusion: Modified 3 port laparoscopic cholecystectomy can be performed safely with a higher cosmetic satisfaction in selected cases by expert surgeon. J Shaheed Suhrawardy Med Coll 2020; 12(2): 90-94

Comparison of three port laparoscopic cholecystectomy with four port laparoscopic cholecystectomy

Objective: Laparoscopic cholecystectomy, gold standard treatment for cholelithiasis, has traditionally been done using 4 ports. We compared four port procedure with newer 3-port cholecystectomy. Methods: Sixty patients were operated by equally dividing them into two groups and using two procedures mentioned in the objective. Results and Discussion: Assessment was carried out using parameters like operative time, cosmetic appearance and complications. Results were similar except operative time which was much less with 4-port procedure. Conclusion: It will require lot of training before three port laparoscopic cholecystectomy can become popular and beneficial compared to four-port procedure. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 151-157

Gall Bladder Retrieval through Umbilical versus Epigastric Port in Conventional Four Ports Laparoscopic Cholecystectomy.

Introduction: Laparoscopic cholecystectomy has become the gold standard treatment for symptomatic gall stone disease all over the world. In laparoscopic cholecystectomy gall bladder is traditionally removed through umbilical port. In this approach surgeon has to change his position and telescope has to be changed in xiphoid port. Another approach to remove the gallbladder is through 10mm xiphoid port without changing position of telescope and surgeon. Both approaches are compared for their pros and cons regarding post-operative pain at site of removal. Study Design: Randomized control study. Setting: Department of surgery of Allama Iqbal medical college/ Jinnah hospital Lahore. Period: August 2017 to February 2018. Material &amp; Methods: To compare mean post-operative pain in gall bladder retrieval through umbilical versus xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis. Patient were divided in two equal groups with first group had their gall bladder retrieved through umbilical port while the other underwent retrieval through xiphoid port. Standard analgesia was used in both groups and post-operative outcome was noted. Results: A total 70 patient with equal distribution in two groups were enrolled to compare post-operative pain at port site comparing umbilical versus xiphoid process. Mean post-operative pain visual analogue scale (VAS) was as lower (p&lt;0.0001) at 1, 6, 12 &amp; 24 hrs. In umbilical port group as compared to xiphoid port group. Conclusion: Mean post-operative pain in gall bladder retrieval umbilical port give advantage in post-operative period regarding significantly reduced pain when compared with xiphoid port in four ports laparoscopic cholecystectomy for acute cholecystitis in selective cases.

COMPARATIVE EVALUATION OF COSMETIC OUTCOME BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY &amp; SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Aim: Comparative analysis of cosmetic outcome between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy.&#x0D; Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included cosmetic outcome,&#x0D; Results: The body image score for SILC group ranged from 30 to 44 with mean score of 40.76 ± 2.773 while that for cLC group ranged from 33 to 42 with mean score of 38.28 ± 1.969. p-value for the comparison stands 0.001 which shows that patients undergoing SILC had better cosmetic perception of their body image compared to cLC group&#x0D; Conclusion: SILC is better cosmetic perception as compare to cLC&#x0D; Keywords: SILC, cLC, Cosmetic outcome

COMPARATIVE EVALUATION OF POST-OPERATIVE PAIN BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY &amp; SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

AIM: Comparative analysis of post-operative pain between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy.&#x0D; Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included duration of surgery, post-operative pain, For assessment of post-operative pain numeric pain scale scoring system was used and pain scoring done at four hours, twelve hours and twenty-four hours post-operatively.&#x0D; Results: The study included fifty patients operated upon from June, 2014 to May, 2014. Twenty-five patients were subjected to SILC and rest of the twenty-five underwent cLC. Pre-operative characteristics of two groups were similar and there was no significant difference between two groups based on age, sex and Body Mass Index. Post-operative pain score was higher for cLC compared to SILC at four, twelve and twenty-four hours post-operatively. The mean pain score at four hours was 4.64 ± 1.89 for SILC versus 7.72 ± 0.84 for cLC (p-value &lt; 0.0001). While the score at twelve and twenty-four hours were 2.96 ± 1.88 and 1.80 ± 1.44 for SILC compared to 5.08 ± 1.15 and 3.80 ± 1.11 for cLC respectively.&#x0D; Conclusion: SILC is superior to cLC compared to post-operative pain as per our study.&#x0D; Keywords: SILC, cLC, post-operative pain

Breast cancer with asymptomatic metastasis to the gallbladder

Breast cancer is the most frequent malignant tumors among female and it is usually associated with metastasis to lungs, bones, liver, and brain. The gallbladder as the site of metastasis from breast carcinoma is extremely rare, and only a few such case reports have been published to date. We report the case of a 59-year-old woman diagnosed with breast cancer who underwent cholecystectomy for an incidental finding of gallbladder wall thickening on computed tomography. A 59-year-old menopausal woman presented with a lump in her right breast for one months. Breast examination revealed an ill-defined palpable area in the right breast. Ultrasonography (US) of the right breast revealed 28 mm × 19 mm sized irregular hypoechoic mass in the retro-areolar area. This was followed by a US-guided Tru-cut biopsy of the right breast lesion and axillary nodes, which revealed invasive lobular carcinoma. The tumour was positive for oestrogen receptors. Computer tomography showed a wall a thickening in the fundus and body of the gallbladder with multiple gallstones. A single port laparoscopic cholecystectomy was performed, and the postoperative course was uneventful. Histopathology of the gallbladder revealed involvement by an invasive lobular carcinoma. Metastatic gallbladder involvement is rare, especially in a case of primary breast cancer and It is difficult to suspect a metastatic localization from primary breast cancer in the breast cancer. Even if there is no gastrointestinal symptoms, it is necessary to be well aware of the possibility of metastasis in patients with if imaging reveals gallbladder abnormalities.

Comparative Study of Standard Four-Port, Three Port and Single Incision Laparoscopic Cholecystectomy Performed by a Single Surgeon in Nobel Medical College Teaching Hospital, Nepal

Introduction: Laparoscopic Cholecystectomy is a standard operative procedure for patients with gallbladder diseases and is the most common laparoscopic procedure performed worldwide. The aim of this study is to analyze the different methods of laparoscopic cholecystectomies done by a single surgeon at Nobel Medical College Teaching Hospital.&#x0D; Objectives: The objective and aim of this study are comparing 4 port classic Laparoscopic Cholecystectomy (4PLC), 3 port (3PLC) and Laparo-Endoscopic Single-Site Cholecystectomy (LESC) performed by a single surgeon and correlate worldwide experience with outcomes in our institution.&#x0D; Methodology: The study includes retrospective analysis of 8192 patients who underwent elective laparoscopic Cholecystectomy (LC) from October 2010 to July 2020 performed by the single surgeon. All cases divided into 3 groups depending on the type of LC (4PLC, 3PLC, LESC). The data included the type of the surgery, gender, age, operative time, conversion and complication rate and duration of hospital stay.&#x0D; Results: The hospital stays, operation time and conversion rate decreased from group I to group III. Female patients out numbered the male ones (M:F=1:4). The hospital stays (3.4 days), operation time (35 min), conversion (0.4%) and complications (0.7%) rate decreased from Group of 4PLC to Group of LESC (1.5 days, 13 min, 0.1% conversion, 0.4% complication respectively) which is true for almost all other similar studies.&#x0D; Conclusion: The advantages of LESC include a better cosmetic effect and reduced chance of infections. It has been postulated to be superior in scarless surgery with added benefits of lower pain level and reduced need for analgesics, shorter hospital stays, quicker return to work and lower financial expenses.