Technique Of Laparoscopic Cholecystectomy Research Articles

Anestesia venosa total libre de opiáceos, con infusiones de propofol, dexmedetomidina y lidocaína para la colecistectomía laparoscópica: estudio prospectivo, aleatorizado y doble ciego

Background and objectivesIntraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. MethodsEighty ASA I-II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into 2 groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver intravenous fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. ResultsFentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59μg and 120±94μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. ConclusionOpioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

Techniques of laparoscopic cholecystectomy: Nomenclature and selection

There are more than 50 different techniques of laparoscopic cholecystectomy (LC) available in literature mainly due to modifications by surgeons in aim to improve postoperative outcome and cosmesis. These modifications include reduction in port size and/or number than what is used in standard LC. There is no uniform nomenclature to describe these different techniques so that it is not possible to compare the outcomes of different techniques. We brief the advantages and disadvantages of each of these techniques and suggest the situation where particular technique would be useful. We also propose a nomenclature which is easy to remember and apply, so that any future comparison will be possible between the techniques.

New minimally invasive approaches for cholecystectomy: Review of literature.

Laparoscopic cholecystectomy is the most commonly performed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy (SILC), minilaparoscopic cholecystectomy (MLC) and natural orifice transluminal endoscopic surgery (NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.

A comparative study between two techniques of subtotal laparoscopic cholecystectomy in goats

A comparison between two techniques of subtotal laparoscopic cholecystectomy was studied to find the best technique for treating severe cholecystitis and to study the fate of the remaining part of the gallbladder. All experimental animals had inducing cholecystitis by clipping the cystic duct for five days which was enough for inducing cholecystitis in goats. 24 adult female goats were used in this study, which were divided randomly into two equal groups; subtotal laparoscopic cholecystectomy with cystic duct and cystic artery clipping by titanium clips (group A) and laparoscopic subtotal cholecystectomy with cystic duct clipping only (group B). Operations were performed under general anesthesia by using thiopental sodium at a dose of 15 mg/Kg. B.W. intravenously to maintain the inhalation anesthesia by endotracheal tube with a mixture of halothane (1.5- 2.5 %) and oxygen (2-3 %). The intraabdominal pressure with CO2 was used at a low pressure 8-10 mmHg. The liver function tests including; alkaline phosphates (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total serum bilirubin and C- reactive protein were measured in different intervals; before operation (zero day) and at 1hr, 1st, 3rd, 5th and 7th postoperative day. The liver function tests showed a significant elevation (P< 0.05) in alkaline phosphates (ALP) and in the total bilirubin values in group B (P> 0.05) comparison with group A and no significant difference in alanine aminotransferase (ALT), aspartate aminotransferase (AST) and C- reactive protein between all experimental groups as well as time intervals. The biopsies were taken at the 3rd, 7th and 15th postoperative day for histopathological of the remaining part of gallbladder which showed that subtotal cholecystectomies could be performed successfully with the two techniques, appeared degeneration in the remaining part of the gallbladder and offers best in the healing stages.

A Novel Technique of Laparoscopic Liver Resection Using Radiofrequency Ablation

Introduction: The gold standard treatment of early gallbladder carcinoma is radical cholecystectomy. This procedure involves en-block resection of the adjoining liver bed. Hemostasis control is the major concern during liver resection, particularly in laparoscopic approach. Mortality and morbidity are clearly associated with the amount of blood loss.1 The harmonic scalpel is commonly used for liver resection during the laparoscopic approach. However, this technique has been shown to have more incidence of bile leakage.2 Radiofrequency (RF) energy has been broadly used to ablate local unresectable liver tumor by causing coagulative necrosis of the liver parenchyma tissues.3 This alternating current also causes thrombosis and coagulation of the small blood vessels, which exhibits its potential in bloodless liver resection. RF-assisted liver resection shows minimal blood loss in human and animal model experiences.4–6 This novel technique is utilized during laparoscopic radical cholecystectomy to minimize blood loss in liver bed resection. The patient was a 38-year-old lady who presented with epigastric pain for 3 years. The pain was worsening. Abdominal ultrasound showed a large polypoidal mass measuring 2 cm within the gallbladder. Computed tomography of the abdomen confirmed the ultrasound finding showing a large polypoidal mass within the gallbladder without invasion to the liver. RF energy-assisted laparoscopic radical cholecystectomy was performed for her. Methods: This video illustrates the technique of laparoscopic radical cholecystectomy assisted by RF energy. First, the procedure was proceeded as laparoscopic cholecystectomy. The fundus of the gallbladder was retracted. Callot's triangle was dissected. Once the cystic vessels and duct were identified, they were clipped and divided. Endoloop was applied to the neck of gallbladder for better retraction later. Resection margin was marked with hook by electrocautery, which is 2 cm around the liver bed margin. RF energy was applied to the planned resection margin. Coagulative desiccation was performed using a cooled-tip RF probe and a 500 kHz generator (Radionics Europe, NV, Wettdren, Belgium). The RF probe was inserted 2 cm in depth. Once coagulative desiccation had been achieved, the probe was then advanced 1 cm along the resection margin. When hemostasis was secured with complete ablation of the resection margin, a sharp transaction of the coagulated plane was done by using scissors. No clamping of the vascular pedicles was necessary. Any bleeding from the resection margin during scissor transection was ablated again until satisfactory hemostasis was achieved. The estimated blood loss was less than 10 mL. Results: Postoperatively, patient's recovery was uneventful. No significant drop in hemoglobin was noted. The total ward stay was 3 days. The patient was back to normal daily activity in 5 days. Histopathologically, polyps within the gallbladder were consistent with a well-differentiated (polypoidal) adenocarcinoma. The gallbladder showed chronic cholecystitis with cholesterol polyps. Liver tissue showed no evidence of malignancy. The patient did not require any adjuvant therapy. Conclusion: RF ablation can be a useful adjunct in laparoscopic radical cholecystectomy during liver bed resection. This safe, fast, and simple technique is effective in minimizing blood loss. It potentially reduces the conversion rate from laparoscopic approach to open method once suspected early gallbladder is encountered during laparoscopic cholecystectomy. No competing financial interests exist. Runtime of video: 7 mins 10 secs

Anestesia venosa total livre de opioides, com infusões de propofol, dexmedetomidina e lidocaína para colecistectomia laparoscópica: estudo prospectivo, randomizado e duplo‐cego

Background and objectivesIntraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. Methods80 Anesthesiologists I–II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid‐free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid‐based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. ResultsFentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59μg and 120±94μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. ConclusionOpioid‐free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

Opioid-free total intravenous anesthesia with propofol, dexmedetomidine and lidocaine infusions for laparoscopic cholecystectomy: a prospective, randomized, double-blinded study

Background and objectivesIntraoperative use of opioids may be associated with postoperative hyperalgesia and increased analgesic consumption. Side effects due to perioperative use of opioids, such as postoperative nausea and vomiting may delay discharge. We hypothesized that total intravenous anesthesia consisting of lidocaine and dexmedetomidine as an opioid substitute may be an alternative technique for laparoscopic cholecystectomy and would be associated with lower fentanyl requirements in the postoperative period and less incidence of postoperative nausea and vomiting. Methods80 Anesthesiologists I–II adults were scheduled for elective laparoscopic cholecystectomy. Patients were randomly allocated into two groups to have either opioid-free anesthesia with dexmedetomidine, lidocaine, and propofol infusions (Group DL) or opioid-based anesthesia with remifentanil, and propofol infusions (Group RF). All patients received a standard multimodal analgesia regimen. A patient controlled analgesia device was set to deliver IV fentanyl for 6h after surgery. The primary outcome variable was postoperative fentanyl consumption. ResultsFentanyl consumption at postoperative 2nd hour was statistically significantly less in Group DL, compared with Group RF, which were 75±59μg and 120±94μg respectively, while it was comparable at postoperative 6th hour. During anesthesia, there were more hypotensive events in Group RF, while there were more hypertensive events in Group DL, which were both statistically significant. Despite higher recovery times, Group DL had significantly lower pain scores, rescue analgesic and ondansetron need. ConclusionOpioid-free anesthesia with dexmedetomidine, lidocaine and propofol infusions may be an alternative technique for laparoscopic cholecystectomy especially in patients with high risk for postoperative nausea and vomiting.

Using a standardized method for laparoscopic cholecystectomy to create a concept operation-specific checklist

ObjectivesPrevalences of bile duct injury (BDI) following laparoscopic cholecystectomy (LC) remain unacceptably high. There is no standardized method for performing an LC. This study aims to describe a standardized technique for LC that will allow for the development of a concept LC checklist, the use of which, it is hoped, will decrease the prevalence of BDI. MethodsA standardized method for LC was developed based on previously published expert analysis supplemented by video error analysis of operations in which BDI occurred. Established checklist methodology was then used to construct an LC-specific concept checklist. ResultsA five-step technique for the safe establishment of the critical view was created to guide the development of the checklist. The five steps are: (i) confirm the gallbladder lies in the hepatic principal plane and is retracted to the 10o'clock position; (ii) confirm Hartmann's pouch is lifted up and toward the segment IV pedicle; (iii) identify Rouvière's sulcus; (iv) confirm the release of the posterior leaf of the peritoneum covering the hepatobiliary triangle, and (v) confirm the critical view with or without intraoperative cholangiography. ConclusionsA standardized approach to LC would allow for the creation of an LC-specific checklist that has the potential to lower the prevalence of BDI.

The crucial role of biliary endoscopists in the management of bile leak after cholecystectomy.

The crucial role of biliary endoscopists in the management of bile leak after cholecystectomy.

Remains of the day: Biliary complications related to single-port laparoscopic cholecystectomy

To assess the rate of bile duct injuries (BDI) and overall biliary complications during single-port laparoscopic cholecystectomy (SPLC) compared to conventional laparoscopic cholecystectomy (CLC). SPLC has recently been proposed as an innovative surgical approach for gallbladder surgery. So far, its safety with respect to bile duct injuries has not been specifically evaluated. A systematic review of the literature published between January 1990 and November 2012 was performed. Randomized controlled trials (RCT) comparing SPLC versus CLC reporting BDI rate and overall biliary complications were included. The quality of RCT was assessed using the Jadad score. Analysis was made by performing a meta-analysis, using Review Manager 5.2. This study was based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A retrospective study including all retrospective reports on SPLC was also performed alongside. From 496 publications, 11 RCT including 898 patients were selected for meta-analysis. No studies were rated as high quality (Jadad score ≥ 4). Operative indications included benign gallbladder disease operated in an elective setting in all studies, excluding all emergency cases and acute cholecystitis. The median follow-up was 1 mo (range 0.03-18 mo). The incidence of BDI was 0.4% for SPLC and 0% for CLC; the difference was not statistically different (P = 0.36). The incidence of overall biliary complication was 1.6% for SPLC and 0.5% for CLC, the difference did not reached statistically significance (P = 0.21, 95%CI: 0.66-15). Sixty non-randomized trials including 3599 patients were also analysed. The incidence of BDI reported then was 0.7%. The safety of SPLC cannot be assumed, based on the current evidence. Hence, this new technology cannot be recommended as standard technique for laparoscopic cholecystectomy.

English

The modified three port laparoscopic cholecystectomy technique has the same comfort and feasibility to the surgeon similar to regular three or four port surgery along with added advantage of less pain and better cosmetic appearance to the patient. The procedure is simple and can be conducted in acute and chronic cholecystits in any laparoscopic centre practicing laparoscopy.

Gasless Laparoscopic Cholecystectomy in a Pig Using a Self-Designed Umbrella-Like Abdominal Wall-Lifting Device

Abstract Introduction: In laparoscopic surgery with CO2 pneumoperitoneum, serious complications often occur for elderly patients and those who undergo long operations.1 These complications mainly include respiratory and circulatory system changes.2–4 In patients with tumors, release of free tumor cells into the abdominal cavity is believed to be possible.5 Gasless laparoscopic techniques can avoid these complications of CO2 pneumoperitoneum. Currently, the main shortcoming of gasless laparoscopic techniques is the inadequate operative space. Because of this shortcoming, gasless techniques have not been widely applied in clinical practice. Case Report: In the video, we describe a new technique of gasless laparoscopic cholecystectomy in a pig using a self-designed umbrella-like abdominal wall-lifting device. The umbrella was constructed from stainless steel and was 150 mm in diameter. Ten spokes formed an umbrella through a folding movement. This device lifted up the anterior abdominal wall by opening the u...

Laparoscopic cholecystectomy technique in a patient with situs inversus totalis

Situs inversus totalis nadir bir kongenital anomalidir. Ozellikle laparoskopik cerrahideki ayna goruntusu nedeniyle bu durum abdominal patolojilerin tani ve tedavisinde zorluga neden olabilir. Biz bu yazida situs inversus totalis ve kolelitiasis'i olan olgunun basarili laparoskopik tedavisini sunmaktayiz.

Single-Incision Laparoscopic Cholecystectomy for Biliary Dyskinesia in Children: A Simple, Safe, and Inexpensive Technique

To evaluate a low-cost technique for single-incision laparoscopic cholecystectomy (SILC) in children with biliary dyskinesia. Eighteen children with biliary dyskinesia underwent SILC between March and September 2010. Two 5-mm trocars and a directly introduced grasper were inserted through a 2-cm vertical transumbilical incision. Instrument collisions were minimized by using low-profile trocars and a bariatric laparoscope with a right-angle light adaptor. An internally anchored retracting device suspended the gallbladder, obviating the need for an additional trocar. No other special equipment was used. There were 15 girls and 3 boys with a mean age of 15.9 years (range, 9-18 years). Sixteen (88.9%) underwent true SILC. One patient was converted to a four-port laparoscopic procedure because of uncertainty of ductal anatomy. Another required a 5-mm subxiphoid port for liver retraction. Mean operative time was 82 minutes (range, 42-105 minutes): 94 minutes (range, 75-105 minutes) for the first 6 patients, 85 minutes (range, 60-102 minutes) for the second 6, and 68 minutes (range, 42-90 minutes) for the last 6. Operative times between the first and last groups were significantly different (P=.02). Sixteen patients were discharged home the following day and the remaining 2 on the second postoperative day. There were no complications. The hospital costs of the disposable equipment needed to perform SILC at our institution was $205.05 less than that needed for the four-port operation ($516.32 versus $721.37), a 28.4% savings. SILC is safe and feasible in children with biliary dyskinesia. The operative time decreased with experience. The disposable equipment needed was less expensive than that used for the standard laparoscopic technique.

The EURO-NOTES clinical registry for natural orifice transluminal endoscopic surgery: a 2-year activity report

The EURO-NOTES Clinical Registry (ECR) was established as a European database to allow the monitoring and safe introduction of Natural Orifice Transluminal Endoscopic Surgery (NOTES). The aim of this study was to analyze different techniques applied and relative results during the first 2 years of the ECR. The ECR was designed as a voluntary database with online access. All members of the European Society for Gastrointestinal Endoscopy and the European Association for Endoscopic Surgery were requested to participate in the registry. Demographic and therapy data as well as data on the postoperative course are recorded in the ECR in an anonymous way. A total of 533 patients who underwent NOTES procedures were included in the study. Four different hybrid techniques for 435 cholecystectomies were described, registering postoperative complications in 2.8% of patients, addition of a single trocar in 5.3%, and conversions to laparoscopy in 0.5%. Both flexible endoscopic and rigid laparoscopic cholecystectomy techniques proved to be safe and effective with minor differences. There was a shorter operative time in the rigid laparoscopic group. Thirty-three appendectomies were reported by transgastric and transvaginal techniques, with transvaginal techniques scoring shorter operative time and hospital stay, but with a frequent need to add more trocars. Overall complications occurred in 14.7% of patients but they did not differ significantly among the different techniques. One transvaginal and 31 transanal sigmoidectomies were included for prolapse and diverticulitis, with four postoperative complications (12.5%), but none needing further treatment. Twenty peroral esophageal myotomies were included with three postoperative complications (15.0%), but none needing further treatment. Five years since the introduction of NOTES into clinical practice, hybrid techniques have gained considerable clinical application. Several NOTES hybrid cholecystectomy and appendectomy techniques are practicable and safe alternatives to laparoscopic procedures. Also, sigmoidectomies and peroral esophageal myotomies were described, proving feasibility and safety. Nevertheless, the real benefit of NOTES for patients still needs to be assessed.

Post operative analgesic technique in laparoscopic cholecystectomy: Comparison of local instillation with bupivacaine vs intravenous butorphanol vs intercostal nerve block with bupivacaine

The Sri Lankan Journal of Anaesthesiology is the official journal of the College of Anaesthesiologists of Sri Lanka. It publishes clinical investigations, research articles, audits, case reports, review articles and CME articles relating to anaesthesiology, critical care and pain. It is published bi annually in January and June. Sri Lankan Journal of Anaesthesiology is included on DOAJ and Scopus.

Double incision laparoscopic cholecystectomy (DILC) with routinary intra-operative cholangiography (IOC)

Laparoscopic approach for cholecystectomy is, actually, the gold standard for gallbladder surgical benign diseases. Single transumbilical incision can further reduce abdominal wall trauma. Two main related issues are still to be enlighten: difficulty in obtaining a clear exposure of the Calot's triangle and routinely use of intra-operative cholangiography (IOC). A standardized technique of double incision laparoscopic cholecystectomy (DILC) with routine IOC is described. Between January and May 2012, 30 consecutive patients scheduled for elective cholecystectomy underwent DILC with IOC. Exclusion criteria were: clinical and/or radiological suspect of gallbladder malignancy/acute cholecystitis (AC)/common duct stones; ASA > 3; previous extensive abdominal surgery. Follow-up was performed at 7, 30 and 60 days postoperatively. Three 5-mm trocars through the umbilicus and one 3-mm subcostally on the right are used, along with a 30° laparoscopic camera. IOC is performed through the 3-mm channel. Median age was 49.5 years (range 24-78); female/male was 21/9. Median BMI was 27.4 (range 16.2-38.9). AC was encountered in five cases (17 %). Synchronous AC and choledocolithiasis occurred in one case (3 %), requiring conversion to laparoscopic choledocolithotomy. Additional ports were required in these latter five patients (17 %). IOC was routinely attempted in all patients, succeeding in 26 (86 %). Median operative 'skin to skin' time was 47.8 min (range 25-75). In the subgroup not receiving IOC, median operative time was 35 min (range 25-45); 51.5 min as median time (range 25-75) was reported for the subgroup undergone the entire planned procedure. No intraoperative complications occurred. Median length of stay was 1.51 days (range 1-5). Postoperative minor complications occurred in three patients (10 %) and wound umbilical infection occurred in one (3.4 %). DILC with the routine use of IOC seems to be repeatable and safe. Even if DILC seems more easily learnt, further studies are needed to address this issue.

Preliminary Study on the Application of an Umbrella-Like Abdominal Wall-Lifting Device in Gasless Laparoscopic Surgery

Abstract Background: In laparoscopic surgery with CO2 pneumoperitoneum, serious complications often occur for elderly patients and those who undergo long operations. These complications mainly include respiratory and circulatory system changes. In patients with tumors, release of free tumor cells into the abdominal cavity is believed to be possible. Gasless laparoscopic techniques can avoid these complications of CO2 pneumoperitoneum. Currently, the main shortcoming of gasless laparoscopic techniques is inadequate operative space. Because of this shortcoming, gasless techniques have not been widely applied in clinical practice. We herein describe a new technique of gasless laparoscopic cholecystectomy in pigs using a self-designed umbrella-like abdominal wall-lifting device. This device lifts up the anterior abdominal wall by opening the umbrella leaf in the abdominal cavity. Five pigs underwent laparoscopic cholecystectomy using this technique. The operation times were 85, 40, 28, 21, and 24 minutes. The corresponding bleeding volumes were 11, 20, 5, 2, and 8 mL. These preliminary outcomes suggest that the umbrella-like abdominal wall-lifting technique is safe and feasible in gasless laparoscopic surgery and can provide sufficient exposure of the operative field. Further study in the form of randomized controlled trials is needed to investigate the advantages of this new technique.

Laparoscopic cholecystectomy in a patient with total situs inversus – case report

For many years, laparoscopic cholecystectomy remains the method of choice for both the treatment of symptomatic cholelithiasis, and chronic and acute cholecystitis (1). The experience of the surgeon grows with each laparoscopic procedure, which enables to operate in case of difficult anatomical conditions and associated anatomical variants. The aim of the study was to present a case of a 47-year old male patient with total situs inversus and several months history of recurrent left epigastric pain, radiating to the left scapula, being accompanied by nausea and vomiting. The study presented the operative technique of laparoscopic cholecystectomy and postoperative period data. In conclusion, laparoscopic cholecystectomy in a patient with total situs inversus is possible and safe, providing relevant precautions. The main issues certainly include a good and feasible plan of the operation, discussion concerning the possible intraoperative and postoperative complications, a good plan considering the localization of the trocars, as well as an experienced surgical team. One should also not forget that early conversion to classical cholecystectomy is not considered as failure, but might prevent accidental damage of the biliary ducts and long-term complications.

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.