Two-port Laparoscopic Cholecystectomy Research Articles

Two-port laparoscopic cholecystectomy with two traction sutures.

Two-port laparoscopic cholecystectomy with two traction sutures.

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

The Comparison of Two-port Laparoscopic Cholecystectomy Technique and Standard Four-port Technique

Modified technique for two ports laparoscopic cholecystectomy: combined safety and economic value

Context The surgeons have tried to reduce the size and number of ports to reduce morbidity and improve the cosmetic appearance in laparoscopic surgery. Aims Assessment of safety and economic value of two-port laparoscopic cholecystectomy using traction stitches after adding left-sided traction stitch to Hartman’s pouch (third stitch) to increase the range of movement (dynamicity) of gall bladder neck (puppet show technique). Patients and methods Between July 2017 and January 2019, 50 patients with symptomatic cholelithiasis were involved into this study (36 females and 14 males) their age 18–65 years (mean±SD=41.6±11.4 years). All the cases were done using two ports; umbilical and epigastric. Three traction stitches were used; one to the fundus and two to the Hartman’s pouch to its right and left sides to increase its range of movement during dissection of the Calot’s triangle (puppet show technique). Statistical analysis used The decreptive data were presented as mean & standard deviation (SD). Data were analyzed using the SPSS package for Windows, version 23, SPSS Inc., Chicago, Illinois, USA. Results The mean operative time was 55.80±18.60 min (30–120 min). There was no need for more trocars or conversion to open surgery. Intraoperative complications occurred in three cases; one had a small liver tear in the gall bladder fossa. The second case had a small diaphragmatic injury (was repaired) and the third case had bleeding from the posterior branch of the cystic artery (was controlled) and spillage of gall stones (were extracted). The postoperative pain was mild in majority of patients (48 cases) and moderate in two patients. All patients started oral feeding and movements 4 h postoperative. The mean hospital stay was 0.950±0.35 days (0.5–2 days). Economically, about $600 were saved for every case (the price of unused disposable two trocars and two graspers). Conclusion Two ports laparoscopic cholecystectomy with three traction stitches (after adding third stitch) (puppet show technique), is an applicable and a safe technique with more patients’ satisfaction due to less scars and better economic value.

Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) & conversion were required in 3(6%) with some accepted complications like epigastric port infection & herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage & biloma, significant epigastric port pain postoperatively & stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis.
 Objectives: To see the outcome of two port laparoscopic cholecystectomy.
 Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually.
 Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy & successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size & shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection & 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage & biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks.
 Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure & cosmetically rewarding.
 TAJ 2018; 31(1): 29-37

Reduced Port Laparoscopic Cholecystectomy: Single and a Half Incision Lap Chole.

In our technique of single and a half incision laparoscopic cholecystectomy patients' safety is as much as in a conventional four-port surgery. Surgeon is comfortable to perform this operation. Cosmetically, it is better than four-port laparoscopic cholecystectomy without increase in cost. So, in our opinion, our technique should be acceptable to all surgeons and can give benefits of minimal access surgery to masses of people.

Two-Port Laparoscopic Cholecystectomy: 18 Patients Human Experience Using the Dynamic Laparoscopic NovaTract Retractor.

The concept of reducing the number of transabdominal access ports has been criticized for violating basic tenets of traditional multiport laparoscopy. Potential benefits of reduced port surgery may include decreased pain, improved cosmesis, less hernia formation, and fewer wound complications. However, technical challenges associated with these access methods have not been adequately addressed by advancement in instrumentations. We describe our initial experience with the NovaTract™ Laparoscopic Dynamic Retractor. A retrospective review of all patients who underwent two-port laparoscopic cholecystectomy between 2013 and 2014 using the NovaTract retractor was performed. The patients were equally divided into three groups (Group A, B, C) based on the order of case performed. Eighteen consecutive patients underwent successful two-port laparoscopic cholecystectomy for symptomatic cholelithiasis. Mean age was 39.9 years and mean body mass index was 28.1 kg/m(2) (range 21-39.4). Overall mean operative time was 65 minutes (range 42-105), with Group A of 70 minutes, Group B of 65 minutes, and Group C of 58 minutes (P = .58). All cases were completed laparoscopically using the retraction system, without a need for additional ports or open conversion. No intra- or postoperative complications were seen. All patients were discharged on the same day of surgery. No mortality found in this series. The NovaTract laparoscopic dynamic retractor is safe and easy to use, which is reflected by acceptable operative time for a laparoscopic cholecystectomy using only two ports. The system allows surgical approach to mimic the conventional laparoscopic techniques, while eliminating or reducing the number of retraction ports.

Evolution of Laparoscopic Cholecystectomy: From Multiport to Single Port

Context: Laparoscopic approach with its several techniques has become the standard method for cholecystectomy over the past decades. As technical instruments have improved and varied, the interest in endoscopic surgery has turned towards minimal invasive single site access surgery with fewer instruments, thus resulting in minimal pain, minimal scarring and better cosmesis. Evidence Acquisition: A systematic literature searching of databases MEDLINE, EMBASE, and Google Scholar was done from 1982 and updated in December 2015. Search terms were “cholecystectomy”, “laparoscopic cholecystectomy”, “four port laparoscopic cholecystectomy”, “single-incision laparoscopic surgery”. Results: Four-port laparoscopic cholecystectomy was accepted as the “gold standard” in the treatment of patients with cholelithiasis before millennium. Thereafter, two-port laparoscopic cholecystectomy was reported as a novel, safe and rapid method of gallbladder removal in consecutive reports. Single-site laparoscopic cholecystectomy with non-conventional multi-channel port method was first introduced as an alternative to the standard multi-port laparoscopic cholecystectomy in adult patients in the last decade. Success rates of performing conventional four-port laparoscopic cholecystectomy were ranging from 93% to 100% and single site laparoscopic cholecystectomy was ranging from 84% to 100%. Conclusions: Currently, it has been widely accepted that laparoscopic cholecystectomy is the gold standard for cholecystectomy. Although single site laparoscopic cholecystectomy is becoming more popular with the recent advancements, conventional multiport laparoscopic cholecystectomy is being widely used as the primary treatment modality for the gallbladder removal.

Two-port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique

Background: In Nepal, it is quite common to find patients with large stone burden and thick gallbladder wall which often leads to incision extension. We have used this extended incision to our advantage. The present technique of two-port Laparoscopic cholecystectomy not only helps overcoming the specimen extraction difficulties but also contributes to better cosmesis. Patients and methods: Total of 25 patients were underwent the surgery in 2008 to 2010. Results: The mean operating time was 50 minutes. None had significant procedural blood loss, iatrogenic injury, perforation of gallbladder, bile spillage, significant gas leak or subcutaneous emphysema at either port site. All patients were comfortable in the postoperative period and were routinely discharged on 2nd postoperative day except for 2 patients who has surgical site infection and fever respectively. Although 3 cases were converted to standard four-port technique, none required conversion to open cholecystectomy. Out of 25 patients, 7 cases have completed 3 months follow up and did not show any complication like port site hernia.

Two-port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique

Two-port Laparoscopic Cholecystectomy: An Initial Experience of 25 Cases with a New Technique

A comparative study of two-port versus three-port laparoscopic cholecystectomy.

BACKGROUND:Conventionally, laparoscopic cholecystectomy (LC) is performed by using three or four ports of various sizes. As cosmesis is an important aspect of LC, the trend is now towards use of fewer ports, thereby resulting in better cosmesis for patients. The aim of this study was to compare three-port against two-port LC techniques and to see whether there is any advantage in using one technique over the other.SETTINGS AND DESIGN:The study was conducted in the Department of General Surgery of North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) hospital in Northeast India. A prospective comparative type of study was designed. An odd number of patients were operated on by using the three-port technique (Group A), whereas an even number of patients were operated on by the two-port technique (Group B).MATERIALS AND METHODS:Sixty patients with symptomatic gallstone disease were included in the study after obtaining informed consent from each of the patients. All patients were operated on under general anaesthesia.STATISTICAL ANALYSIS USED:Statistical analysis was done using SPSS software version 22.RESULTS:There were 51 female patients and 9 male patients. The mean patient age was 38.67 years. There was less operative time in group A but less postoperative pain in group B. Cosmetic appearance and patient satisfaction for the scar were better in group B.CONCLUSIONS:The two-port method appeared to have better acceptability among patients due to lower pain score and better cosmesis.

Two-port and four-port laparoscopic cholecystectomy: Differences in outcome

Background: Laparoscopic cholecystectomy has several advantages over open cholecystectomy. The purpose of this study was to compare the outcome between two-port and four-port laparoscopic cholecystectomy. Patients and Methods: Between October 2011 and September 2013, 200 patients with calculous cholecystitis were prospectively consecutively selected into two groups of 100 patients each for two-port and four-port laparoscopic cholecystectomy, respectively. Results: There were 39 males and 161 females. The mean operative time required in the two-port group was 46.66 ± 14.47 minutes and in four-port group was 48.79 ± 8.336 minutes (P value = 0.1297). Three patients were converted to four-port laparoscopic cholecystectomy in the two-port group. There were 25 minor complications (14 in the two-port group and 11 in the four-port group). The VAS scores were statistically significant at 1, 12, and 24 hours. An average requirement of 0.73 doses of analgesia in the two-port group and 1.36 doses in the four-port cohort was observed. The hospital stay was significantly shorter in the two-port group. Conclusion: The two-port laparoscopic cholecystectomy is safe and preferable due to fewer requirements of analgesics, better cosmesis, cost-effectiveness, shorter hospital stay, and reduced labor.

Two-port laparoscopic cholecystectomy with modified suture retraction of the fundus: A practical approach

CONTEXT:Although transumbilical single incision laparoscopic cholecystectomy (SILC) has been demonstrated to be superior cosmetic, it is only limited to simple cases at present. In complex cases, the standard four- or three-port LC is still the treatment of choice.AIM:To summarize the clinical effect of a modified technique in two-port LC.SETTINGS AND DESIGN:A consecutive series of patients with benign gallbladder diseases admitted to the provincial teaching hospital who underwent LC in the past 4 years were included. A modified two-port LC was the first choice except for those requiring laparoscopic common bile duct exploration (LCBDE).MATERIALS AND METHODS:The operation was done with suture retraction of the fundus by a needle-like retractor. The patients’ data, including the operative time, time consumed by gallbladder retraction, operative bleeding, conversion rate, rate of adding trocars, and postoperative complications were recorded.STATISTICAL ANALYSIS:Data were expressed as percentage and mean with standard deviation.RESULTS:Total 107 patients with chronic calculous cholecystitis (N = 61), acute calculous cholecystitis (N = 43), and cholecystic polyps (N = 3) received two-port LC. The procedure was successful in 99 out of 107 cases (success rate, 92.5%), and a third trocar was added in the remaining 8 cases (7.5%) due to severe pathological changes. The operative time was 47.2 (±13.21) min. There was no conversion to open surgery.CONCLUSION:Two-port LC using a needle-like retractor for suture retraction of the gallbladder fundus is a practical approach when considering the safety, convenience, and indications as well as relatively minimal invasion.

Two-port laparoscopic cholecystectomy: initial results of a modified technique.

Two-port laparoscopic cholecystectomy has been reported to be safe and feasible with a higher patient satisfaction score. However, it was technically difficult even in expert hands because of the small operating field. We have modified the operating telescope to achieve a wide field of view. Since September 2000, 14 patients have been enrolled for two-port laparoscopic cholecystectomy. The male to female ratio was 5:9. The median age was 54.5 years (interquartile range [IQR] 45-67.75 years). The median operative time was 53 minutes (IQR 38-61 minutes). Two patients required one additional 5-mm port or a traction suture because of dense adhesions. There was no conversion to open surgery. The median postoperative hospital stay was 2 days (IQR 1-2.25 days). The median oral postoperative analgesia requirement was 1 dose (IQR 0-3 doses). There were no major or minor complications, and there were no deaths. The modified two-port technique greatly facilitates two-port laparoscopic cholecystectomy and improves the clinical outcome.