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Elghadban H, Mahmoud A, Negm A, Dawoud IES, Taki-Eldin A. Evaluation of Safety and Feasibility of Using LigaSure During Clipless Single-Incision Laparoscopic Cholecystectomy: A Prospective Clinical Study. J Laparoendosc Adv Surg Tech A 2024. [PMID: 39083433 DOI: 10.1089/lap.2024.0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024] Open
Abstract
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.
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Affiliation(s)
- Hosam Elghadban
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Abdallah Mahmoud
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Negm
- General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed Taki-Eldin
- General Surgery Department, Faculty of Medicine, Horus University-Egypt, New Damietta, Egypt
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Choi SH, Won S, Lee N, Shim SH, Kim MK, Kim ML, Jung YW, Yun BS, Jun HS, Seong SJ. Robotic Single-Site Plus One-Port Myomectomy versus Robotic Single-Site Plus Two-Port Myomectomy: A Propensity Score Matching Analysis. Yonsei Med J 2024; 65:406-412. [PMID: 38910303 PMCID: PMC11199179 DOI: 10.3349/ymj.2023.0434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/17/2024] [Accepted: 01/30/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Robotic single-site plus one-port myomectomy (RSOM) was designed to reduce the number of incision sites for greater cosmetic satisfaction of patients while retaining the benefits of conventional robotic multi-site myomectomy (CRM). Robotic single-site plus two-port myomectomy (RSTM) eliminated one port relative to conventional CRM, and RSOM achieved the same advantage with respect to RSTM. This study aimed to compare RSOM with RSTM in terms of their respective methodologies and surgical outcomes. MATERIALS AND METHODS The medical records of 230 patients who had undergone RSOM and 146 patients who had undergone RSTM were reviewed. The groups' surgical outcomes were compared using propensity score matching (PSM) analysis. RESULTS In the total data, RSOM had a shorter operative time (135.1±57.4 min vs. 149.9±46.2 min, p=0.009) and a shorter hospital stay (5.2±0.5 days vs. 5.4±0.7 days, p=0.033) relative to RSTM. The PSM analysis showed that there were no statistically significant intergroup differences in the patients' baseline characteristics. Regarding the surgical outcomes, the RSOM group showed shorter operative time (129.2±49.3 min vs. 148.7±46.3 min, p=0.001) compared to the RSTM group. CONCLUSION Compared with RSTM, RSOM was associated with shorter operative time. Additionally, more detailed comparative and prospective studies are needed to evaluate RSOM relative to RSTM.
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Affiliation(s)
- Su Hyeon Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seyeon Won
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Nara Lee
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - So Hyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi Kyoung Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Bo Seong Yun
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Hye Sun Jun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, Korea.
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Hassan A, Arujunan K, Mohamed A, Katheria V, Ashton K, Ahmed R, Subar D. Incidence of incisional hernia following liver surgery for colorectal liver metastases. Does the laparoscopic approach reduce the risk? A comparative study. Ann Hepatobiliary Pancreat Surg 2024; 28:155-160. [PMID: 38433531 PMCID: PMC11128795 DOI: 10.14701/ahbps.23-138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/15/2024] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Backgrounds/Aims No reports to compare incisional hernia (IH) incidence between laparoscopic and open colorectal liver metastases (CRLM) resections have previously been made. This is the first comparative study. Methods Single-center retrospective review of patients who underwent CRLM surgery between January 2011 and December 2018. IH relating to liver surgery was confirmed by computed tomography. Patients were divided into laparoscopic liver resection (LLR) and open liver resection (OLR) groups. Data collection included age, sex, presence of diabetes mellitus, steroid intake, history of previous hernia or liver resection, subcutaneous and peri-renal fat thickness, preoperative creatinine and albumin, American Society of Anesthesiologists (ASA) score, major liver resection, surgical site infection, synchronous presentation, and preoperative chemotherapy. Results Two hundred and forty-seven patients were included with a mean follow-up period of 41 ± 29 months (mean ± standard deviation). Eighty seven (35%) patients had LLR and 160 patients had OLR. No significant difference in the incidence of IH between LLR and OLR was found at 1 and 3 years, respectively ([10%, 19%] vs. [10%, 19%], p = 0.95). On multivariate analysis, previous hernia history (hazard ratio [HR], 2.22; 95% confidence interval [CI], 1.56-4.86) and subcutaneous fat thickness (HR, 2.22; 95% CI, 1.19-4.13) were independent risk factors. Length of hospital stay was shorter in LLR (6 ± 4 days vs. 10 ± 8 days, p < 0.001), in comparison to OLR. Conclusions In CRLM, no difference in the incidence of IH between LLR and OLR was found. Previous hernia and subcutaneous fat thickness were risk factors. Further studies are needed to assess modifiable risk factors to develop IH in LLR.
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Affiliation(s)
- Ahmed Hassan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
| | - Kalaiyarasi Arujunan
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Ali Mohamed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Vickey Katheria
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Kevin Ashton
- University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Rami Ahmed
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
| | - Daren Subar
- Department of General & HPB Surgery, East Lancashire Hospitals NHS Trust, Royal Blackburn Hospital, Blackburn, UK
- Blackburn Research Innovation Development Group in General Surgery (BRIDGES), Royal Blackburn Hospital, Blackburn, UK
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Alshammary SA, Boumarah DN. Systematic Review of Utilized Ports in Laparoscopic Cholecystectomy: Pushing the Boundaries. Minim Invasive Surg 2024; 2024:9961528. [PMID: 38826773 PMCID: PMC11139527 DOI: 10.1155/2024/9961528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Surgical procedures have undergone a paradigm shift in the last 3 decades, with minimally invasive surgery becoming standard of care for a number of surgeries, including the treatment of benign gallbladder diseases. By providing a thorough and impartial summary of the earlier published systematic reviews, the current systematic review is the first to present comparison results. This review illustrates the data of intraoperative and postoperative results of each laparoscopic cholecystectomy technique. Materials and Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was meticulously followed to conduct the present systematic review. MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, and Web of Science were searched for eligible publications, and a total of 14 systematic reviews were included. A newly developed extraction table was utilized to obtain the predefined parameters from eligible systematic reviews, including operative time, conversion rate, estimated blood loss, bile leak, length of hospital stay, postoperative pain, and cosmetic results. All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software, version 26.0. The analysis of dichotomous results was summarized using relative risks and 95% confidence intervals (95% CI), and continuous results were summarized using mean differences and 95% CIs. The proportions were compared using a single proportion z-test. Results The analysis of our primary and secondary outcomes revealed a statistically significant improvement in aesthetic results after single-incision laparoscopic cholecystectomy (SILC) in comparison to the multiport approach of laparoscopic cholecystectomy. This, however, is accompanied by extended operative timing and subsequently, prolonged exposure to anesthesia. Conclusion Patients should be carefully selected for SILC to minimize technical difficulties and prevent complications both intraoperatively and shortly after the procedure. This trial is registered with CRD42023392037.
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Affiliation(s)
- Shadi A. Alshammary
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Dhuha N. Boumarah
- Department of Surgery, King Fahd Hospital of the University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Krollmann N, Hunger R, Paasch C, Mantke R. Incidence of incisional hernias and cosmetic outcome after laparoscopic single-incision cholecystectomy: a long-term follow-up cohort study of 125 patients. Ann Med Surg (Lond) 2024; 86:50-55. [PMID: 38222712 PMCID: PMC10783355 DOI: 10.1097/ms9.0000000000001442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 10/17/2023] [Indexed: 01/16/2024] Open
Abstract
Background Studies have evaluated long-term occurrence of incisional hernia, cosmesis, and postoperative pain after single-incision laparoscopic cholecystectomy (SILC). However, the follow-up periods were rarely defined longer than 12 months. The authors performed a cohort study to evaluate hernia rate and cosmesis in a prolonged follow-up period. Methods All patients that underwent SILC at the University Hospital Brandenburg an der Havel Hospital between December 2008 and November 2014 were evaluated in terms of postoperative complications, and a follow-up telephone interview including the existence of hernias and chronic pain was performed. Cosmesis and the overall satisfaction of the scar was measured by POSAS (Patient and Observer Scar Assessment Scale). Results In total 125 patients underwent SILC. The single-incision approach was completed in 94.4%, an additional trocar was necessary in 3.2% (n=4) and a conversion to 4 trocar cholecystectomy was required in 2.4% (n=3). Intraoperative complications occurred in 0.8% and postoperative complication in 12.8% of all patients. Follow-up telephone interview was performed in 49.6% of 125 patients. The mean follow-up period was 138.9 months (11.6 years). Overall, in 3.6%, an incisional hernia was diagnosed. A total of 3.6% reported pain in the region of the umbilicus with a mean VAS (visual analog scale) of 2/10. The mean POSAS score was 7.8. Overall, 82.3% of this cohort rate their satisfaction of the scar with a 1/7, resembling the best possible result of the scar. Conclusion The present study demonstrates that SILC is a safe alternative in terms of incisional hernia rate and complications with a high satisfaction of the scar even after one decade after surgery. In comparison to shorter follow-up period and multiport laparoscopic cholecystectomy, our result is comparable.
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Affiliation(s)
- Niklas Krollmann
- Department of General Surgery, University Hospital Brandenburg an der Havel, Brandenburg, Germany
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Cheng X, Huang C, Jia W, Guo Z, Shi Y, Song Z, Feng H, Huang H, Xu S, Li H, Wang S, Zhang Y, Zhang T, Liu K, Ji X, Zhao R. Clinical status and future prospects of single-incision robotic-assisted surgery: a review. Int J Surg 2023; 109:4221-4237. [PMID: 37988410 PMCID: PMC10720873 DOI: 10.1097/js9.0000000000000944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Abstract
Since the advent of conventional multiport laparoscopic surgery, the prosperity of minimally invasive surgery has been thriving on the advancement of endoscopic techniques. Cosmetic superiority, recovery benefits, and noninferior surgical outcomes weigh single-incision laparoscopic surgery as a promising modality. Although there are surgical challenges posed by steep learning curve and technological difficulties, such as instruments collision, triangulation loss and limited retraction, the establishment of robotic surgical platform as a solution to all is inspiring. Furthermore, with enhanced instrument maneuverability and stability, robotic ergonomic innovations adopt the advantages of single-incision laparoscopic surgery and surmount its recognized barriers by introducing a novel combination, single-incision robotic-assisted surgery. As was gradually diffused in general surgery and other specialties, single-incision robotic-assisted surgery manifests privileges in noninferior clinical outcomes an satisfactory cosmetic effect among strictly selected patients, and has the potential of a preferable surgical option for minimally invasive surgery.
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Affiliation(s)
- Xi Cheng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenhao Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenqing Jia
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zichao Guo
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqing Shi
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijia Song
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haoran Feng
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Huang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuiyu Xu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haosheng Li
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaodong Wang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaqi Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Zhang
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kun Liu
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaopin Ji
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ren Zhao
- Department of General Surgery
- Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Igami T, Asai Y, Minami T, Seita K, Yokoyama Y, Mizuno T, Yamaguchi J, Onoe S, Watanabe N, Ebata T. Clinical value of fluorescent cholangiography for the infraportal type of right posterior bile duct. MINIM INVASIV THER 2023; 32:256-263. [PMID: 37288773 DOI: 10.1080/13645706.2023.2217915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/18/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The infraportal type of the right posterior bile duct (infraportal RPBD) is a well-known anatomical variation that increases the potential risk of intraoperative biliary injury. The aim of this study is to clarify the clinical value of fluorescent cholangiography during single-incision laparoscopic cholecystectomy (SILC) for patients with infraportal RPBD. MATERIAL AND METHODS Our procedure for SILC utilized the SILS-Port, and another 5-mm forceps was inserted via an umbilical incision. A laparoscopic fluorescence imaging system developed by Karl Storz Endoskope was utilized for fluorescent cholangiography. Between July 2010 and March 2022, 41 patients with infraportal RPBD underwent SILC. We conducted retrospective reviews of patient data, focusing on the clinical value of fluorescent cholangiography. RESULTS Thirty-one patients underwent fluorescent cholangiography during SILC, but the remaining ten did not. Only one patient who did not undergo fluorescent cholangiography developed an intraoperative biliary injury. The detectability of infraportal RPBD before and during the dissection of Calot's triangle was 16.1% and 45.2%, respectively. These visible infraportal RPBDs were characterized as connections to the common bile duct. The confluence pattern of infraportal RPBD significantly influenced its detectability during the dissection of Calot's triangle (p < 0.001). CONCLUSIONS The application of fluorescent cholangiography can lead to safe SILC, even for patients with infraportal RPBD. Its benefit is emphasized when infraportal RPBD is connected to the common bile duct.
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Affiliation(s)
- Tsuyoshi Igami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Asai
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Minami
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuaki Seita
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yukihiro Yokoyama
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takashi Mizuno
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Junpei Yamaguchi
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Onoe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuyuki Watanabe
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoki Ebata
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Seo JW, Park KB, Chin HM, Jun KH. Is single incision laparoscopic surgery (SILS) for gastric gastrointestinal stromal tumor (GIST) dependent on the location of the tumor? BMC Surg 2023; 23:247. [PMID: 37605202 PMCID: PMC10441706 DOI: 10.1186/s12893-023-02141-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/05/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND We compared the surgical outcomes of single-incision laparoscopic surgery (SILS) and conventional laparoscopic surgery (CLS) for gastric gastrointestinal stromal tumor (GIST). METHODS We performed single-incision gastric wedge resection on prospectively-enrolled 15 consecutive patients with gastric GIST between November 2020 and April 2022 in a single tertiary center. The early perioperative outcomes of these patients were compared to those of patients who underwent CLS. The indications did not differ from those for conventional laparoscopic procedures for gastric GIST. RESULTS In total, 30 patients were assigned to the SILS (n = 15) and CLS (n = 15) groups. There were no significant differences in the estimated blood loss and intraoperative blood transfusion between the SILS and CLS groups. There were no intraoperative complications or conversions to multiple-port or open surgery in the SILS group. Proximally located tumors were more commonly treated with CLS than with SILS (P = 0.045). GISTs located in the greater curvature were more commonly treated with SILS than with CLS, although the difference was not statistically significant (P = 0.08). The mean incision length in the SILS group was 4.1 cm shorter than that in the CLS group (3.2 ± 0.7 and 7.3 ± 5.2 cm, respectively, P = 0.01). The postoperative analgesic dose was significantly lower in the SILS than in the CLS group (0.4 ± 1.4 and 2.1 ± 2.3, respectively P = 0.01). Also, the duration of postoperative use of analgesic was shorter in SILS than in CLS (0.4 ± 0.7 and 2.0 ± 1.8, respectively, P = 0.01). There were no significant differences in the early postoperative complications between the groups. CONCLUSIONS SILS is as safe, feasible, and effective for the treatment of gastric GIST as CLS with comparable postoperative complications, pain, and cosmesis. Moreover, SILS can be considered without being affected by the type or location of the tumor.
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Affiliation(s)
- Ji Won Seo
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki Bum Park
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Min Chin
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyong-Hwa Jun
- Department of Surgery, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
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Yang N, Tao QY, Niu JY, Sun H, He Y, Hou YB, Luo H, Zhang Z, Yu JM. Effect of a Local Anesthetic Injection Kit on Pain Relief and Postoperative Recovery After Transumbilical Single-Incision Laparoscopic Cholecystectomy. J Pain Res 2023; 16:2791-2801. [PMID: 37588778 PMCID: PMC10426734 DOI: 10.2147/jpr.s422454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/07/2023] [Indexed: 08/18/2023] Open
Abstract
Purpose This study was conducted to explore whether incisional infiltration using a local anesthetic injection kit could better relieve postoperative pain and enhance the quality of recovery compared with ultrasound-guided rectus sheath block (RSB) or conventional local anesthetic infiltration in patients undergoing transumbilical single-incision laparoscopic cholecystectomy (SILC). Patients and Methods A total of 60 patients undergoing SILC with American Society of Anesthesiology functional status scores of I-II were randomized into the rectus sheath block group (RSB group), conventional local wound infiltration group (LAI-I group) and incisional infiltration using a local anesthetic injection kit group (LAI-II group). The primary outcomes were the patient-controlled intravenous analgesia (PCIA) demand frequency within 48 hours after the operation and postoperative pain measured by a visual analog scale (VAS) at 2 h, 4 h, 8 h, 24 h, and 48 h after surgery. Secondary outcomes were the total procedure times, cumulative consumption of anesthetic drugs, duration of surgery, duration and awaking time of anesthesia, early recovery indicator and side effects. Results The PCIA demand frequency in LAI-II group was significantly lower compared with patients in the RSB and LAI-I group (both P < 0.001). Moreover, the total procedure times in LAI-I and LAI-II group was significantly shorter than that in the RSB group (P < 0.001, respectively), but it was comparable between LAI-I and LAI-II group (P = 0.471). Though lower at 2h and 4h postoperative in LAI-II group, pain scores at each time point had no statistical differences among three groups. There were no significant differences among three groups for other outcomes as well. Conclusion The effect of ultrasound-guided RSB and conventional local anesthetic infiltration in SILC patients were found to be similar in terms of relieving postoperative pain and promoting recovery. Incisional infiltration using a local anesthetic injection kit can significantly reduce the demand frequency of PCIA, which serves as a rescue analgesic.
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Affiliation(s)
- Na Yang
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
| | - Qing-Yu Tao
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
| | - Jing-Yi Niu
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
| | - Hao Sun
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
| | - Yan He
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
| | - Yong-Bo Hou
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Wannan Medical College, Wuhu, Anhui, People’s Republic of China
| | - Hong Luo
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
| | - Zhi Zhang
- Department of Biophysics and Neurobiology, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China
| | - Jun-Ma Yu
- Department of Anesthesiology, the Third Affiliated Hospital of Anhui Medical University (The First People’s Hospital of Hefei), Hefei, Anhui, People’s Republic of China
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Kang JH, Chang CS, Noh JJ, Kim TJ. Does Robot Assisted Laparoscopy (RAL) Have an Advantage in Preservation of Ovarian Reserve in Endometriosis Surgery? Comparison of Single-Port Access (SPA) RAL and SPA Laparoscopy. J Clin Med 2023; 12:4673. [PMID: 37510787 PMCID: PMC10380253 DOI: 10.3390/jcm12144673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/12/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The purpose of this study was to compare single-port access (SPA) laparoscopy and SPA robot assisted laparoscopy (RAL) for endometriosis with respect to ovarian reserve preservation and surgical outcomes. Clinical factors affecting any reduction in ovarian function after surgery were also evaluated. Patients with endometriosis who underwent SPA laparoscopy (n = 87) or RAL (n = 78) were retrospectively reviewed. Patients' baseline characteristics, including the severity of endometriosis and surgical outcomes including surgical complexity, were collected. To assess the preservation of ovarian reserve after surgery, serum anti-Müllerian hormone (AMH) levels before surgery, at two weeks, and at three months after surgery were collected. Age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. The severity of endometriosis was higher in the RAL group than in the SPA group. There were no significant differences in other clinical baseline characteristics, including preoperative AMH levels. For surgical outcomes, radical surgery was more frequently performed in the RAL group. In univariate and multivariate linear regression analyses, age, ovarian cyst size, location of cyst, complexity of surgery, and the severity of endometriosis were associated with the reduction in AMH levels after surgery. Incorporating surgical approaches and risk factors for postoperative ovarian function decrease, RAL was more beneficial than SPA laparoscopy for the preservation of ovarian reserve in patients with mild endometriosis (stage I/II) (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 33.51 ± 19.98 vs. 23.58 ± 14.98, p = 0.04) and in patients who underwent non-complex surgery (postoperative 3 month AMH reduction rate (%), SPA laparoscopy vs. RAL, 37.89 ± 22.37 vs. 22.37 ± 17.49, p = 0.022). SPA RAL may have advantages over SPA laparoscopy in ovarian function preservation, especially in patients with mild endometriosis and patients who have undergone a non-complex surgery.
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Affiliation(s)
- Jun-Hyeok Kang
- Department of Obstetrics and Gynecology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Gyeonggi-do, Republic of Korea
| | - Chi-Son Chang
- Department of Obstetrics and Gynecology, Chung-Ang University Gwang-Myung Hospital, Chung-Ang University College of Medicine, Gwangmyeong-si 14353, Gyeonggi-do, Republic of Korea
| | - Joseph J Noh
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Tae-Joong Kim
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
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11
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Jiang Z, Zhang Z, Feng T, Cheng Y, Zhang G, Zhong M, Hu S. Trocar number and placement for laparoscopic sleeve gastrectomy and comparison of single-incision and conventional laparoscopic sleeve gastrectomy: a systematic review and meta-analysis. Int J Surg 2023; 109:1783-1795. [PMID: 37068794 PMCID: PMC10389429 DOI: 10.1097/js9.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND Conventional laparoscopic sleeve gastrectomy (CLSG) has been conducted in multiple centers for treating morbid obesity, however, there are no standard criteria for (1) placing the trocar; and (2) how many trocars should be used. Single-incision laparoscopic sleeve gastrectomy (SLSG), a newly emerged technique in 2008, has been proposed as an alternative to CLSG in recent years, however, there is no definite evidence for this. MATERIALS AND METHODS A systematic literature search was performed using the PubMed, Embase, Web of Science, and Cochrane Library databases for laparoscopic sleeve gastrectomy cases from January 2006 to October 2022. We then summarized the trocar numbers and placement patterns among these studies. A meta-analysis was conducted to compare the difference between SLSG and CLSG in the perioperative and postoperative indices. RESULTS A total of 61 studies involving 20 180 patients who underwent laparoscopic sleeve gastrectomy for treating morbid obesity were included in the systematic review, including 11 on SLSG, 35 on CLSG, and 15 studies comparing SLSG and CLSG. A systematic review showed that the trocar number varied in different CLSG studies, mainly using four or five trocars. The trocars were mainly placed in position, presenting an inverted trapezoid pattern and a left-predominant pattern. Meta-analysis showed that the operative time in the SLSG was significantly higher than that in the CLSG, and the pain Visual Analog Scale rating on postoperative day 1 in the CLSG was significantly higher than in the SLSG. There were no statistical significances in the other complications or surgical efficiency. CONCLUSIONS In the CLSG, the majority of the trocars were arranged in an inverted trapezoid pattern and were of the left-predominant type. Although SLSG is a feasible technique in selected patients, there is insufficient evidence to recommend its widespread use compared with CLSG. High-quality randomized controlled trials with large study populations and long follow-up periods will be required in the future.
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Affiliation(s)
- Zhengchen Jiang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Zhao Zhang
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Tianyi Feng
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
| | - Yugang Cheng
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Guangyong Zhang
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Mingwei Zhong
- Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Jinan, Shandong Province, China
| | - Sanyuan Hu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University
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12
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Jung JH, Kim HC, Cho JY, Jang JY, Lee JH, Lee H, Han IW, Lee HK, Heo JS. 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. MINIM INVASIV THER 2023:1-8. [PMID: 36930866 DOI: 10.1080/13645706.2022.2153341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Abstract
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.
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Affiliation(s)
- Ji Hye Jung
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyung Chul Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jin Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Huisong Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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13
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Zhu S, Yang B, Wang Y. Visceral obesity is associated with incisional hernia in patients with single-port laparoscopic gynecologic surgery. Asian J Surg 2023:S1015-9584(23)00292-0. [PMID: 36894456 DOI: 10.1016/j.asjsur.2023.02.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Affiliation(s)
- Shouqiang Zhu
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China
| | - Bo Yang
- Department of Anesthesiology and Perioperative Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, 710032, China; Department of Interventional Radiology and Pain Management, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, China
| | - Yingfeng Wang
- Department of Interventional Radiology and Pain Management, The 940th Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, Lanzhou, 730050, China.
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Güngördük K, Gülseren V, Özdemir İA. Laparoscopic surgery of large adnexal masses (>12 cm): Single port or conventional? Asian J Endosc Surg 2023. [PMID: 36793236 DOI: 10.1111/ases.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/28/2022] [Accepted: 02/02/2023] [Indexed: 02/17/2023]
Abstract
INTRODUCTION We aimed to compare single-port laparoscopic surgery (SPLS) and conventional multiport laparoscopic surgery (CMLS) for large adnexal mass (AM). METHODS Patients undergoing laparoscopy (LS) due to huge AMs (≥12 cm) between 2016 and 2021 were evaluated retrospectively. The SPLS procedure was applied in 25 cases, and CMLS was performed in 32 cases. The premier result was the grade of the postoperative improvement according to the Quality of Recovery (QoR)-40 questionnaire score (24 h after the surgical procedure; postoperative day 1). Observer Scar Assessment Scale (OSAS) and Patient Observer Scar Assessment Scale (PSAS) were also evaluated. RESULTS A total of 57 cases undergoing SPLS (n = 25) or CMLS (n = 32) due to a large AM (≥12 cm) were analyzed. No meaningful distinctions in age, menopausal status, body mass index, or mass size were observed between the two cohorts. The operation time was shorter in the SPLS than CPLS cohort (42.2 ± 3.3 vs. 47.6 ± 6.2; p < 0.001). Unilateral salpingo-oophorectomy was performed in 84.0% of cases in the SPLS cohort and 90.6% of patients in the CMLS cohort (p = 0.360). The QoR-40 points were significantly higher in the SPLS than the CMLS group (154.9 ± 12.0 vs. 146.2 ± 17.1; p = 0.035). The OSAS and PSAS scores were lower in the SPLS than the CMLS group. CONCLUSION LS can be used for large cysts that are not considered to be at risk of malignancy. The postoperative recovery time was shorter in patients undergoing SPLS compared to CMLS.
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Affiliation(s)
- Kemal Güngördük
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Sıtkı Koçman University, Muğla, Turkey
| | - Varol Gülseren
- Faculty of Medicine, Department of Obstetrics and Gynecology, Division of gynecologic oncology, Erciyes University, Kayseri, Turkey
| | - İsa Aykut Özdemir
- Department of Obstetrics and Gynecology, Division of gynecologic oncology, Medipol University, İstanbul, Turkey
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15
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Visceral obesity as a risk factor of incisional hernia after single-port laparoscopic gynecologic surgery. Asian J Surg 2023; 46:829-833. [PMID: 36096929 DOI: 10.1016/j.asjsur.2022.08.085] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/24/2022] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE We aimed to evaluate associations between abdominal fat distribution (AFD) parameters and incisional hernia (IH) in patients who underwent transumbilical single-port laparoscopic surgery (SPLS) for gynecological disease. METHODS Medical records of 2116 patients who underwent SPLS for gynecological disease at Daejeon St. Mary's Hospital between March 2014 and February 2021 were reviewed. Among 21 (1.0%) patients who developed IH requiring surgical treatment after SPLS, 18 had preoperative abdominopelvic computed tomography (CT) images. As a control group, we randomly selected 72 patients who did not develop IH and who had undergone preoperative abdominopelvic CT scan, matched to test patients by type of surgery. Total fat area (TFA), visceral fat area (VFA), subcutaneous fat area (SFA), visceral-to-subcutaneous fat ratio (VSR), and waist circumference (WC) were measured at the level of the third lumbar vertebral body on the preoperative abdominopelvic CT images, using National Institutes of Health (NIH) ImageJ version 1.53 k. RESULTS Receiver operating curve analysis showed that VFA has the highest predictive value for IH among AFD parameters (AUC = 0.749, 95% CI 0.630-0.869, p < 0.001). Univariate analysis showed that age, BMI, hypertension, dyslipidemia, TFA, VFA, VSR and WC were significant factors for IH. In multivariate analysis, only high VFA was identified as an independent risk factor for IH (HR 6.18, 95% CI 1.13-33.87, p = 0.04), whereas BMI, TFA, SFA, VSR, and WC failed to show statistical significance. CONCLUSION We could find high VFA as an independent risk factor of IH in patients who underwent SPLS for gynecologic disease.
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16
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Bianco FM, Dreifuss NH, Chang B, Schlottmann F, Cubisino A, Mangano A, Pavelko Y, Masrur MA, Giulianotti PC. Robotic single-port surgery: Preliminary experience in general surgery. Int J Med Robot 2022; 18:e2453. [PMID: 35962708 PMCID: PMC9788012 DOI: 10.1002/rcs.2453] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/24/2022] [Accepted: 08/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND We aim to analyse the safety and feasibility of the DaVinci Single Port (SP) platform in general surgery. METHODS A prospective series of robotic SP transabdominal pre-peritoneal inguinal hernia repairs (SP-TAPP) and cholecystectomies (SP-C) (off-label) were analysed. Primary endpoints were safety and feasibility defined by the need for conversion and incidence of perioperative complications. RESULTS A total of 225 SP procedures were performed; 84 (37.3%) SP-TAPP (70 unilateral, 7 bilateral), and 141 (62.7%) SP-C. There were no conversions or additional ports placed. Mean console time was 17.6, 31.9, and 54 min for SP-C, unilateral, and bilateral SP-TAPP, respectively. There was no mortality, intraoperative or major postoperative complications. Mean LOS was 2.7 h for elective SP-TAPP and 2.3 h for SP-C. CONCLUSION Robotic SP surgery is safe and feasible for two of the most performed general surgery operations. Further experience might allow expanding the applications of robotic single-incision surgery for other procedures.
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Affiliation(s)
- Francesco M. Bianco
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Nicolas H. Dreifuss
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Betty Chang
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Francisco Schlottmann
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Antonio Cubisino
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Alberto Mangano
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Yevhen Pavelko
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Mario A. Masrur
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
| | - Pier C. Giulianotti
- Division of GeneralMinimally Invasive, and Robotic SurgeryDepartment of SurgeryUniversity of Illinois at ChicagoChicagoIllinoisUS
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Comparison of three midline ports versus conventional four ports laparoscopic cholecystectomy to reduce postoperative pain: A prospective observational study. Asian J Surg 2022; 45:2431-2432. [PMID: 35688764 DOI: 10.1016/j.asjsur.2022.05.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/13/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Laparoscopic cholecystectomy remains the gold standard for treating symptomatic cholelithiasis. There have been many modifications to achieve less postoperative pain and cosmesis by reducing the number of ports and varying placement. We aim to compare three midline port against conventional four port cholecystectomy in terms of postoperative pain and safety profile. METHOD An observational prospective single centre study was carried out in symptomatic cholelithiasis patients undergoing elective laparoscopic cholecystectomy. A total of 61 patients were divided into two groups: Group A (three midline port) and Group B (four ports). There were 30 patients in Group A and 31 patients in Group B. Outcomes were compared in terms of postoperative pain score at 6, 12, 24 and 48 h, operative time, conversion rate, need for additional analgesia and complications between the two groups. RESULTS The mean pain score was less in Group A but was only statistically significant at the 24 h point (p = 0.022). Group A required less additional analgesia as well (p = 0.001). The operative time, conversion rate and complications, had no difference between the groups. CONCLUSION This study shows that the three midline ports laparoscopic cholecystectomy is a safe and practical technique to help reduce the need for additional analgesia to control postoperative pain when performed by trained surgeons. The significantly less pain score at 24 h seen in our study also makes this technique a potentially great option for day care surgery.
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18
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Single incision laparoscopic surgery (SILS) versus conventional laparoscopic technique for ileostomy: a retrospective cohort study. Langenbecks Arch Surg 2022; 407:1757-1763. [PMID: 35639135 DOI: 10.1007/s00423-022-02473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Minimal-invasive surgery has gained wide acceptance in colorectal surgery. Single incision laparoscopic surgery (SILS) was designed to minimize surgical trauma and improve postoperative outcome. However, the role of SILS in ileostomy formation is unclear. METHODS In this retrospective cohort study 26 patients were included. Six patients were operated with SILS and 20 with conventional laparoscopic technique for ileostomy. We retrospectively evaluated patient charts for baseline characteristics including prior abdominal surgeries and combination of surgeries. Our primary efficacy objectives were operation time and postoperative hospitalization days. Our safety objectives included the prevalence of postoperative pain, parastomal hernia, incisional hernia, perforation, wound infection, ileus, and infections in general. RESULTS Baseline characteristics including previous abdominal surgery and concomitant surgeries were comparable in both groups. Total operation time using SILS (37.5 ± 6.2 min [mean ± SD]), compared to laparoscopic surgery (82.2 ± 54.8 min [mean ± SD]) was significantly shorter (p = 0.0002). In a sensitivity analysis excluding patients with combined surgery, ileostomy formation by SILS was shorter (36.5 ± 6.2 min [mean ± SD]), compared to laparoscopy (59.7 ± 28.7 min [mean ± SD]; p = 0.024). Length of postoperative stay was not statistically different between the groups (SILS: 5.5 ± 2.4 days [mean ± SD]; laparoscopic: 13.8 ± 17.3 days [mean ± SD], p = 0.193). Postoperative complication rates were low and comparable in both groups. CONCLUSION Placement of a loop ileostomy using SILS technique not only reduces surgical trauma but also operation time without affecting postoperative hospital stay or postoperative complication rates. Single-incision laparoscopic surgery for ileostomy is an appealing approach for ileostomy in selected patients.
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Furukawa K, Asaoka T, Mikamori M, Hyuga S, Iwamoto K, Nakahara Y, Naito A, Ohtsuka M, Moon J, Imasato M, Kishi K, Mizushima T. Single-Incision Laparoscopic Cholecystectomy: a Single-Centre Experience of 1469 Cases. J Gastrointest Surg 2022; 26:831-836. [PMID: 35048257 DOI: 10.1007/s11605-021-05231-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite having once been extensively used for cosmetics or pain reduction, the use of single-incision laparoscopic cholecystectomy (SILC) has declined in recent years due to technical difficulties and a reported increase in complications. Since the introduction of SILC in 2009, our hospital has been actively involved with this technique. Our experience suggests that SILC is not a difficult procedure and can be safe and useful, with particularly excellent cosmetic outcomes. This study retrospectively details the outcomes of SILC at our hospital. METHOD Data on 1469 cases of SILC performed on a waitlist basis at Osaka Police Hospital from May 2009 to December 2020 were collected and retrospectively analysed. RESULTS The median operative time and blood loss were 96 min and 0 mL, respectively. A total of 46 patients (3.1%) required conversion surgery, including 36 needing additional ports and 10 requiring laparotomy. Intraoperative complications included common bile duct injury in 1 patient (0.07%) and right hepatic artery injury in 1 patient (0.07%), with no other organ injury. Postoperative Clavien-Dindo 3 or higher complications were observed in 18 patients (1.2%). Incisional hernias occurred in 15 patients (1.0%). The median postoperative hospital stay was 3 days. CONCLUSION This study showed that SILC can be performed safely without any increase in complications, as reported previously. Granted that it is performed safely, SILC may be a useful technique due to its superior cosmetic outcomes or pain reduction.
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Affiliation(s)
- Kenta Furukawa
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan.
| | - Tadafumi Asaoka
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Satoshi Hyuga
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Kazuya Iwamoto
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Yujiro Nakahara
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Jeongho Moon
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
| | - Tsunekazu Mizushima
- Department of Surgery, Osaka Police Hospital, 10-31 Kitayama-cho Tennoji-Ku, Osaka, 543-0035, Japan
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20
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Ozbasli E, Takmaz O, Albayrak N, Gungor Md M. Cosmetic Outcome of Robotic Surgery Compared to Laparoscopic Surgery for Benign Gynecologic Disease. JSLS 2022; 26:JSLS.2021.00081. [PMID: 35509304 PMCID: PMC9033169 DOI: 10.4293/jsls.2021.00081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: This study was designed to compare patients who have undergone conventional laparoscopic surgery with those who undergone multiport robot-assisted laparoscopic surgery for benign gynecological diseases regarding cosmetic results, patient satisfaction, and quality of life. Methods: Sixty-four patients who underwent either robot-assisted or conventional laparoscopic surgery for benign gynecological diseases from July 1, 2019 to March 31, 2020 at Acibadem Mehmet Ali Aydinlar University Hospital were enrolled. Patients were evaluated using the Patient and Observer Scar Assessment Scale, visual analog scale for cosmetic satisfaction, body image questionnaire, and 12-item Short Form Survey six months postoperatively. Results: The median patient assessment scale and observer assessment scale (general) values were significantly higher in the robotic group than in the laparoscopic group. The mean body image questionnaire (cosmetic section) and visual analog scale values were significantly higher in the laparoscopic group than in the robotic group. No significant differences in body image scale, body image questionnaire 9–10, and 12-item Short Form Survey values were observed between the groups. The number of patients with previous surgical history was significantly higher in the laparoscopic group than in the robotic group. Conclusion: Although esthetic concerns are not a priority consideration when deciding an appropriate surgical method, the higher cosmetic satisfaction rate in the laparoscopic group than in the robotic group suggests that cosmetic results should be discussed with patients after evaluating other factors.
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Affiliation(s)
- Esra Ozbasli
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Ozguc Takmaz
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Nazlı Albayrak
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
| | - Mete Gungor Md
- Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University School of Medicine, Istanbul, Turkey
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21
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Berlet M, Jell A, Bulian D, Friess H, Wilhelm D. [Clinical value of alternative technologies to standard laparoscopic cholecystectomy - single port, reduced port, robotics, NOTES]. Chirurg 2022; 93:566-576. [PMID: 35226123 DOI: 10.1007/s00104-022-01608-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 11/25/2022]
Abstract
Surgical interventions should ideally treat an existing disease curatively and achieve this with a low complication rate and minimal trauma. In this sense, laparoscopic cholecystectomy has become established as the recognized standard for the treatment of cholecystolithiasis. Newer procedures, such as single-port surgery or natural orifice transluminal endoscopic surgery (NOTES) have recently emerged to reduce the already low interventional trauma even further and to provide a better cosmetic outcome. With all new methods the main aim is the reduction of the transabdominal access points. Based on published results and diagnosis-related groups (DRG) data, this article examines whether this goal has been achieved, also with respect to the overall quality of treatment and the complication rates. In this context and in addition to the already mentioned approaches, robotic cholecystectomy and the reduced port approach are also considered.
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Affiliation(s)
- M Berlet
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - A Jell
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland
| | - D Bulian
- Klinik für Viszeral‑, Tumor‑, Transplantations- und Gefäßchirurgie, Zentrum für interdisziplinäre Viszeralmedizin (ZIV), Kliniken der Stadt Köln gGmbH, Köln, Deutschland
| | - H Friess
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland
| | - D Wilhelm
- Fakultät für Medizin, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, 81675, München, Deutschland.
- Forschungsgruppe MITI, Klinik und Poliklinik für Chirurgie, Klinikum rechts der Isar, München, Deutschland.
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Zhao L, Kong X, Li J, Huang L, Xia C, Xu J. Transumbilical single-incision laparoscopic pancreatoduodenectomy. Asian J Surg 2022; 45:888-889. [PMID: 35000853 DOI: 10.1016/j.asjsur.2021.11.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/26/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Lei Zhao
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China
| | - Xiangke Kong
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China
| | - Jun Li
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China
| | - Lan Huang
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China
| | - Chunmei Xia
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China
| | - Jun Xu
- Oncological and Laparoscopic Surgery Department, First Hospital of Harbin Medical University, China.
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Tadokoro T, Misumi T, Itamoto T, Nakahara H, Matsugu Y, Ikeda S, Oshita A, Hotta R, Miguchi M, Chogahara I, Nishikawa S, Hiroi S, Nishisaka T. Retroperitoneal Bronchogenic Cyst Resected by Single-Incision Laparoscopic Surgery in an Adolescent Female: A Case Report. Asian J Endosc Surg 2022; 15:206-210. [PMID: 34369650 DOI: 10.1111/ases.12973] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 01/01/2023]
Abstract
A 16-y-old Japanese female was referred to our hospital with a suspicion of infected retroperitoneal cyst. Abdominal CT MRI revealed a 38-mm diameter retroperitoneal cyst under the left diaphragm. Because a retroperitoneal bronchogenic cyst was suspected, total resection was planned. In addition, preoperative 3D reconstruction using multidetector CT provided a detailed location of the lesion. Based on the anatomical position, we decided that single-incision laparoscopic surgery with an anterior approach through the umbilicus would be the optimal choice. The lesion was completely resected without intraoperative complications. Histopathological examination confirmed the diagnosis of bronchogenic cyst. Postoperatively, the surgical wound became completely unnoticeable, and there was no incisional hernia or cyst recurrence at the 2-y follow-up.
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Affiliation(s)
- Takeshi Tadokoro
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Toshihiro Misumi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Toshiyuki Itamoto
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan.,Department of Gastroenterological and Transplant Surgery, Faculty of Medicine, Hiroshima University, Hiroshima, Japan
| | - Hideki Nakahara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Yasuhiro Matsugu
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Satoshi Ikeda
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Akihiko Oshita
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Ryuichi Hotta
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Masashi Miguchi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Ichiya Chogahara
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Saki Nishikawa
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Sawako Hiroi
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Takashi Nishisaka
- Department of Pathology, Hiroshima Prefectural Hospital, Hiroshima, Japan
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24
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Um MH, Lee SJ, Choi IS, Moon JI, Lee SE, Sung NS, Kwon SU, Bae IE, Rho SJ, Kim SG, Yoon DS, Choi WJ. Completion of single-incision laparoscopic cholecystectomy using the modified Konyang standard method. Surg Endosc 2021; 36:4992-5001. [PMID: 34734302 DOI: 10.1007/s00464-021-08856-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 10/21/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND To date, a surgical method for single-incision laparoscopic cholecystectomy (SILC) has not been standardized. Therefore, this study aimed to introduce a standardized surgical method for SILC, in addition to reporting our experience over 10 years. METHODS Patients who underwent SILC at a single institution between April 2010 and December 2019 were included in this study. We analyzed the patient demographics and surgical outcomes according to the surgical method used: phase 1 (Konyang standard method, KSM) comprising initial 3-channel SILC, phase 2 (modified KSM, mKSM) comprising 4-channel SILC with a snake retractor, and phase 3 (commercial mKSM, C-mKSM) using a commercial 4-channel port. RESULTS Of 1372 patients (mean age, 51.3 years; 781 [56.9%] women), 418 (30.5%) surgeries were performed for acute cholecystitis (AC), 33 (2.4%) were converted to multiport or open cholecystectomy, and 49 (3.6%) developed postoperative complications. The mean operation time (OT) and length of postoperative hospital stay (LOS) were 51.9 min and 2.6 days, respectively. Overall, 325 patients underwent SILC with the KSM, 660 with the mKSM, and 387 with the C-mKSM. In the C-mKSM group, the number of patients with AC was the lowest (26.8% vs. 38.2% vs. 20.4%, p < 0.001) and the OT (51.7 min vs. 55.4 min vs. 46.1 min, p < 0.001), estimated blood loss (24.5 mL vs. 15.5 mL vs. 6.1 mL, p < 0.001), and LOS (2.8 days vs. 2.5 days vs. 2.3 days, p = 0.001) were significantly improved. The surgical outcomes were better in the non-AC group than in the AC group. CONCLUSION Based on our 10 year experience, C-mKSM is a safe and feasible method of SILC in selected patients, although there were lower percentage of patients with AC compared to other groups.
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Affiliation(s)
- Min Ho Um
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seung Jae Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea.
| | - In Seok Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Nak Song Sung
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seong Uk Kwon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Seung Jae Rho
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Sung Gon Kim
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, 158, Gwanjeodong-ro, Seo-gu, Daejeon, Korea
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Prediction model of laparoendoscopic single-site surgery in gynecology using machine learning algorithm. Wideochir Inne Tech Maloinwazyjne 2021; 16:587-596. [PMID: 34691310 PMCID: PMC8512514 DOI: 10.5114/wiitm.2021.106081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Minimally invasive surgery has been widely used in gynecology. The laparoendoscopic single-site surgery (LESS) risk prediction model can provide evidence-based references for preoperative surgical procedure selection. Aim To determine whether the patients are suitable for LESS and to provide guidance for the clinical operation plan, we aimed to compare the clinical outcomes of LESS and conventional laparoscopic surgery (CLS) in gynecology. We constructed a LESS risk prediction model and predicted surgical conditions for the preoperative evaluation system. Material and methods A retrospective analysis was carried out among patients undergoing LESS (n = 1019) and CLS (n = 1055). Various clinical indicators were compared. Multiple machine model algorithms were evaluated. The optimal results were chosen as the model to form the risk prediction model. Results The LESS group showed advantages in the postoperative 12/24 h visual analog scale and Vancouver scar score compared with the CLS group (p < 0.05). The comparisons in other clinical indicators between the two groups showed that each group had advantages and the difference was statistically significant (p < 0.05), including operative time, estimated blood loss, and hospital stay. We evaluated the predictive value for various models using AUC values of 0.77, 0.77, 0.76, and 0.67 for XGBoost, random forest, GBDT, and logistic regression, respectively. The decision tree model was shown to be the optimal model. Conclusions LESS can reduce postoperative pain, shorten hospital stay and make scars acceptable. The risk prediction model based on a machine learning algorithm has manifested a high degree of accuracy and can satisfy the doctors’ demand for individualized preoperative evaluation and surgical safety in LESS.
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Kang SI, Woo IT, Bae SU, Yang CS. Single-Incision Versus Conventional Laparoscopic Appendectomy: A Multi-Center Randomized Controlled Trial (SCAR trial). Int J Surg Protoc 2021; 25:201-208. [PMID: 34541430 PMCID: PMC8415183 DOI: 10.29337/ijsp.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 08/01/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction: Although single-incision laparoscopic appendectomy (SILA) was introduced decades ago, it is still considered a difficult technique to perform compared to conventional laparoscopic appendectomy (CLA). In addition, controversy about the benefits of SILA compared to CLA abound and no definite criteria for choosing SILA over CLA in patients with appendicitis currently exist. Therefore, we have planned a multi-center randomized controlled trial to compare SILA with CLA in terms of cosmetic satisfaction and pain reduction. Methods and analysis: Patients diagnosed with appendicitis at the participating centers will be recruited and allocated into either a CLA or an SILA groups using a 1:1 randomization. Patients in the CLA group will receive a conventional 3-port laparoscopic appendectomy and patients in the SILA group will receive a laparoscopic appendectomy using a single-incision at the umbilicus. The primary trial endpoint is cosmetic satisfaction assessed using the Patients and Observer Scar Assessment Scale (POSAS) administered 6 weeks post-surgery. Secondary trial endpoints include cosmetic satisfaction assessed via the Body Image Questionnaire, pain levels assessed via the Visual Analog Scale and International Pain Outcomes questionnaire, and the presence of postoperative complications. The target sample size of this superiority trial is 120 patients, as this will provide 80% power at the 2.5% level of significance to detect a 3-point difference in POSAS. Discussion: The results of this planned multi-center randomized controlled trial will provide substantive evidence to help surgeons choose when to use SILA over CLA in patients with appendicitis. Ethics and dissemination: This trial was approved by the institutional review board at Daegu joint on February 27, 2020 (No: 19-12-001-001) and registered with the clinical research information service (CRIS) (KCT0005048). The results of the study will be published and presented at appropriate conferences. Highlights
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Affiliation(s)
- Sung Il Kang
- Department of Surgery, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu, KR
| | - In Teak Woo
- Department of Surgery, Pohang Medical Center, Pohang, KR
| | - Sung Uk Bae
- Department of Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, KR
| | - Chun-Seok Yang
- Department of Surgery, Daegu Catholic University Medical Center, Catholic University of Daegu School of Medicine, Daegu, KR
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Risk factors of incisional hernia after single-incision cholecystectomy and safety of barbed suture material for wound closurewound closure. JOURNAL OF MINIMALLY INVASIVE SURGERY 2021; 24:145-151. [PMID: 35600106 PMCID: PMC8977384 DOI: 10.7602/jmis.2021.24.3.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 09/13/2021] [Indexed: 12/04/2022]
Abstract
Purpose Single-incision cholecystectomy is a surgical method that offers comparable results to conventional laparoscopic cholecystectomy. However, a high risk of postoperative incisional hernia is an issue in single-incision cholecystectomy. This study evaluated the risk factors and incidences of incisional hernia after single-incision cholecystectomy and the advantage issue of using barbed suture material during wound closures. Methods A total of 1,111 patients underwent laparoscopic or robotic single-incision cholecystectomy between March 2014 and February 2020 at our institution at CHA Bundang Medical Center. During this period, there were 693 patients who underwent wound closure with monofilament suture material (Monosyn 2-0; B. Braun) and the other 418 patients used barbed suture material (Stratafix 2-0; Ethicon). Results The two patient groups were comparable in age, body mass index, and diagnosis. The total incidence of incisional hernia after single-incision cholecystectomy was 0.5% (five cases). All patients who developed incisional hernia were in the monofilament suture material group (0.7% vs. 0%, p = 0.021). The influence of predictive and possible risk factors on incisional hernia rate was analyzed. Among these factors, only old age was an independent predictive risk factor of incisional hernia. Conclusion Our study showed a low incidence of incisional hernia, all of which occurred in the monofilament suture material group. If technically appropriate, single-incision cholecystectomy does not appear to present a high incidence of hernia. Barbed suture material can be safely applied in wound closure showing comparable incisional hernia incidence to monofilament suture material.
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Watrowski R, Kostov S, Alkatout I. Complications in laparoscopic and robotic-assisted surgery: definitions, classifications, incidence and risk factors - an up-to-date review. Wideochir Inne Tech Maloinwazyjne 2021; 16:501-525. [PMID: 34691301 PMCID: PMC8512506 DOI: 10.5114/wiitm.2021.108800] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/30/2021] [Indexed: 11/26/2022] Open
Abstract
Almost all gynecological and general-surgical operations are - or can be - performed laparoscopically. In comparison to an abdominal approach, the minimally invasive access offers several advantages; however, laparoscopy (both conventional and robotic-assisted) can be associated with a number of approach-specific complications. Although the majority of them are related to the laparoscopic entry, adverse events may also occur due to the presence of pneumoperitoneum or the use of laparoscopic instruments. Unfortunately, a high proportion of complications (especially affecting the bowel and ureter) remain unrecognized during surgery. This narrative review provides comprehensive up-to-date information about definitions, classifications, risk factors and incidence of surgical complications in conventional and robotic-assisted laparoscopy, with a special focus on gynecology. The topic is discussed from various perspectives, e.g. in the context of stage of surgery, injured organs, involved instruments, and in relation to malpractice claims.
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Affiliation(s)
- Rafał Watrowski
- St. Josefskrankenhaus, Teaching Hospital of the University of Freiburg, Freiburg, Germany
| | - Stoyan Kostov
- Department of Gynecology, Medical University Varna, Varna, Bulgaria
| | - Ibrahim Alkatout
- Department of Gynecology and Obstetrics, Kiel School of Gynecological Endoscopy, University Hospitals Schleswig-Holstein, Kiel, Germany
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29
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Lacitignola L, Guadalupi M, Massari F. Single Incision Laparoscopic Surgery (SILS) in Small Animals: A Systematic Review and Meta-Analysis of Current Veterinary Literature. Vet Sci 2021; 8:vetsci8080144. [PMID: 34437466 PMCID: PMC8402624 DOI: 10.3390/vetsci8080144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/18/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022] Open
Abstract
In veterinary surgery, single incision laparoscopic surgery (SILS) techniques have been described since 2009, and, in recent decades, many authors have reported the application of SILS in small animals, thus, promoting the wide dissemination of this novel approach among veterinary laparoscopists. The aim of this literature review is to provide a critical evaluation of the scientific reports on SILS in the field of small animal laparoscopic surgery. A comprehensive literature review was performed including from 1 January 2009 to 1 July 2020. The following data were recorded from each study: the design, year of publication, surgical procedure, species, number of animals included, and surgical time. The type of SILS technique and type of control group technique were evaluated. In total, 90 articles were identified through database searches and manual searches. The qualitative analysis showed that most of the articles were retrospective studies, without a control group or case series. A meta-analysis was performed on the eight controlled studies, showing that SILS ovariectomy and gastrointestinal procedures had a comparable surgical time to multiport techniques. The study of the articles available in the veterinary literature did not allow for an adequate meta-analysis of the published results, especially regarding post-operative pain, evaluations of surgical times, and post-operative complications in comparison to multiport techniques. Therefore, veterinary surgeons who want to employ these techniques must consider the real advantages of SILS techniques.
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Affiliation(s)
- Luca Lacitignola
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università Degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy;
- Correspondence:
| | - Marta Guadalupi
- Dipartimento dell’Emergenze e Trapianti di Organi (D.E.T.O.), Sezione di Cliniche Veterinarie e Produzioni Animali, Università Degli Studi di Bari “Aldo Moro”, 70010 Bari, Italy;
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Holländer S, von Heesen M, von Heesen A, Spiliotis AE, Gäbelein G, Scherber PR, Glanemann M. Minimally Invasive Cholecystectomy: Transvaginal or Transabdominal Approach-Which Technique Is Preferred by Female Hospital Employees? J Laparoendosc Adv Surg Tech A 2021; 32:515-521. [PMID: 34283667 DOI: 10.1089/lap.2021.0389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Evidence is lacking concerning a clear benefit of single-port laparoscopic cholecystectomy (SILC) and transvaginal cholecystectomy (TVC) over the classical laparoscopic cholecystectomy (CLC). In this study, we investigated the preferences of the operation techniques among female employees in a tertiary university clinic. Materials and Methods: Study participants in the department of general surgery and gynecology were interviewed regarding their personal felt preferences for the mentioned procedures using a standardized illustrated questionnaire. Results: A total of 111 participants were included in the study. In 70.3% of cases, the transvaginal approach was unknown. The classical techniques were preferred in 95.2% of respondents. Participants with a wish for children showed a higher preference for nontransvaginal techniques (P = .011). The acceptance rate of transvaginal techniques among employees of the department of gynecology was higher than those of the department of general surgery (P = .028). Conclusions: The overall acceptance rate for TVC is low. Especially in case of a wish for children, SILC and CLC represent the preferred techniques. The lack of popularity of TVC could be an explanation for the refusal of this technique. Among employees of the gynecologic department, a transvaginal approach was significantly more often accepted. The cosmetic outcome and the knowledge about an operation technique certainly influence the decision making for the preferred surgical method.
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Affiliation(s)
- Sebastian Holländer
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Maximilian von Heesen
- Department of General- and Visceral Surgery, University Hospital Göttingen, Göttingen, Germany
| | - Anika von Heesen
- Department of Gynecology, University Hospital Göttingen, Göttingen, Germany
| | - Antonios E Spiliotis
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Gereon Gäbelein
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Philipp Robert Scherber
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General Surgery, Vascular-, Visceral- and Pediatric Surgery, Saarland University Medical Center, Homburg, Germany
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31
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Hamid HKS, Ahmed AY, Alhamo MA, Davis GN. Efficacy and Safety Profile of Rectus Sheath Block in Adult Laparoscopic Surgery: A Meta-analysis. J Surg Res 2021; 261:10-17. [PMID: 33387729 DOI: 10.1016/j.jss.2020.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rectus sheath block (RSB) has been increasingly used for pain management after laparoscopic procedures but with a conflicting data on its analgesic efficacy. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of RSB in adults undergoing laparoscopic surgery. METHODS A systematic literature search of the PubMed, Embase, CINAHL, and Cochrane Library databases was conducted from inception through October 1, 2020, to identify trials comparing RSB with a control group in laparoscopic surgery. The primary outcome was rest pain scores at 0-2 h postoperatively. Secondary outcomes included pain scores at rest at 10-12 and 24 h postoperatively, pain scores on movement at 0-2, 10-12, and 24 h postoperatively, 24- and 48-h opioid consumption, opioid-related side effects, and RSB-associated adverse events. RESULTS Nine trials with 698 patients were included. RSB was associated with significantly lower rest pain scores at 0-2 h postoperatively (standardized mean difference -1.83, 95% confidence interval [-2.70, -0.96], P < 0.001, I2 = 95%) than control. Furthermore, RSB significantly reduced pain scores at rest at 10-12 h postoperatively and on movement at 0-2 h postoperatively, 24-h opioid consumption, and opioid-related side effects. Other secondary outcomes were similar between groups. Preoperative RSB provided better pain control compared with postoperative block administration. None of the studies reported local or systemic complications related to RSB. CONCLUSIONS In the setting of laparoscopic surgery, RSB improves pain control for up to 12 h postoperatively and reduces opioid consumption, without major reported adverse events.
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Affiliation(s)
- Hytham K S Hamid
- Department of Surgery, Soba University Hospital, Khartoum, Sudan.
| | - Amjed Y Ahmed
- Department of Surgery, Soba University Hospital, Khartoum, Sudan
| | - Manhl A Alhamo
- Department of Nursing, Alexandria University, Alexandria, Egypt
| | - George N Davis
- Department of Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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Mittermair C, Weiss M, Schirnhofer J, Brunner E, Obrist C, Biebl M, Hell T, Weiss H. Dual trocar laparoscopy improves reduced-port surgery of the distal pancreas. MINIM INVASIV THER 2021; 31:753-759. [PMID: 33810777 DOI: 10.1080/13645706.2021.1904263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The technical feasibility of transumbilical single-incision surgery (SIL) for pancreatic resections has been demonstrated. However, this technique is hampered by the limited degrees of freedom for instrument handling. Dual-incision laparoscopy (DIL) with an additional trocar may simplify dissection and allow drainage. MATERIAL AND METHODS Between December 2009 and May 2017, 21 patients were treated with SIL (12/2009 to 01/2014) or DIL (02/2014 to 05/2017) pancreatic resection. All data were collected in a database and retrospectively analysed. RESULTS Demographic parameters of the patients did not differ significantly in the DIL or the SIL group. No conversion to open surgery was required. No intraoperative complication occurred in either group. The surgical difficulty score was significantly higher in the SIL group (4.4 ± 1.56 vs 2.18 ± 1.95; p = .006). Postoperative serum amylase levels were higher (101.9 U/l ± 50.11 vs 48.91 U/l ± 35.20; p = .01) and return to normal levels (6.4 ± 9.66 days vs 2.09 ± 1.98 days; p = .045) was later in the SIL group. Three complications requiring radiological or surgical intervention were witnessed in the SIL group and one complication in the DIL group (p = .42). CONCLUSION DIL surgery is a safe and feasible alternative to SIL surgery, facilitating key steps of distal pancreatic tail resection.
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Affiliation(s)
- Christof Mittermair
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Michael Weiss
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Jan Schirnhofer
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Eberhard Brunner
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christian Obrist
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Matthias Biebl
- Department of Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Hell
- Department of Mathematics, University of Innsbruck, Innsbruck, Austria
| | - Helmut Weiss
- Department of Surgery, Saint John of God Hospital, Teaching Hospital of the Paracelsus Medical University Salzburg, Salzburg, Austria
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Suzuki Y, Tei M, Wakasugi M, Nakahara Y, Naito A, Mikamori M, Furukawa K, Ohtsuka M, Moon JH, Imasato M, Asaoka T, Kishi K, Akamatsu H. Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis. Surg Endosc 2021; 36:1027-1036. [PMID: 33638106 DOI: 10.1007/s00464-021-08367-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 02/09/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Long-term outcomes of single-incision laparoscopic colectomy (SILC) for colon cancer (CC), as practiced in real-world settings, especially in relation to disease stage, have not been established. We examined, retrospectively, both short- and long-term outcomes of SILC versus those of multiport laparoscopic colectomy (MPLC) performed for CC in a propensity-score-matched cohort. METHODS The study involved 263 patient pairs matched 1:1 from among 691 patients who, between January 2008 and May 2014, underwent either SILC or MPLC for a primary solitary CC at our hospital. Short-term and long-term operative outcomes were compared between the two groups. RESULTS Operation time was the only surgical outcome that varied significantly between the two groups (p = 0.0004). Overall 5-year cancer-specific survival (CSS) in the SILC group was 93.7 (95% CI 89.6-96.2)%, and CSS per pathological stage (I, II and III) was 98.5 (90.0-99.8)%, 96.0 (88.2-98.7)%, and 88.3 (79.6-93.6)%, respectively, whereas overall 5-year CSS in the MPLC group was 93.3 (89.4-95.9)%, and CSS per pathological stage was 100%, 95.4 (88.3-98.3)%, and 84.1 (74.1-90.8)% (p = 0.5278, 0.2679, 0.7666, and 0.9073), respectively. Overall 3-year disease-free survival (DFS) in the SILC group was 94.0 (90.2-96.4)%, and 3-year DFS per pathological stage was 98.6 (90.4-99.8)%, 90.1 (81.4-95.0)%, and 79.0 (69.4-86.2)%, respectively, whereas overall 3-year DFS in the MPLC group was 93.2 (89.4-95.7)%, and 3-year DFS per pathological disease stage was 100%, 94.5 (87.4-97.7)% and 75.5 (64.7-83.8)% (p = 0.2829, 0.7401, 0.4335 and 0.8518), respectively. Thus, oncological outcomes did not differ significantly between groups. Incisional hernia occurred in 21 (8.0%) SILC group patients and 17 (6.5%) MPLC group patients, without a significant between-group difference (p = 0.6139). CONCLUSION Our data indicate that perioperative and oncological outcomes of SILC performed for CC are comparable to those of MPLC performed for CC.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan. .,Department of Gastroenterological Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai, Osaka, 591-8025, Japan
| | - Yujiro Nakahara
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Atsushi Naito
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Jeong Ho Moon
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka, Osaka, 543-0035, Japan
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Jensen SAMS, Fonnes S, Gram-Hanssen A, Andresen K, Rosenberg J. Low long-term incidence of incisional hernia after cholecystectomy: A systematic review with meta-analysis. Surgery 2021; 169:1268-1277. [PMID: 33610340 DOI: 10.1016/j.surg.2020.12.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Various surgical approaches are available for cholecystectomy, but their long-term outcomes, such as incidence of incisional hernia, are largely unknown. Our aim was to investigate the long-term incidence of incisional hernia after cholecystectomy for different surgical approaches. METHODS This systematic review and meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A protocol was registered on PROSPERO (CRD42020178906). Three databases were searched for original studies on long-term complications of cholecystectomy with n > 40 and follow-up ≥6 months for incisional hernia. Risk of bias within the studies was assessed using the Newcastle-Ottawa Scale and the Cochrane "risk of bias" tool. Meta-analysis of the incidence of incisional hernia after 6 and 12 months was conducted when possible. RESULTS We included 89 studies. Of these, 77 reported on multiport or single-incision laparoscopic cholecystectomy. Twelve studies reported on open cholecystectomy and 4 studies on robotic cholecystectomy. Weighted mean incidence proportion of incisional hernia after multi-port laparoscopic cholecystectomy was 0.3% (95% confidence interval 0-0.6) after 6 months and 0.2% after 12 months (95% confidence interval 0.1-0.3). Weighted mean incidence of incisional hernia 12 months postoperatively was 1.5% (95% confidence interval 0.4-2.6) after open cholecystectomy and 4.5% (95% confidence interval 0.4-8.6) after single-incision laparoscopic cholecystectomy. No meta-analysis could be conducted for robotic cholecystectomy, but incidences ranged from 0% to 16.7%. CONCLUSION We found low 1-year incidences of incisional hernia after multiport laparoscopic and open cholecystectomy, whereas risks of incisional hernia were considerably higher after single-incision laparoscopic and robotic cholecystectomy.
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Affiliation(s)
- Sofie Anne-Marie Skovbo Jensen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark.
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Anders Gram-Hanssen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark. https://twitter.com/andresenCPH
| | - Kristoffer Andresen
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Herlev Hospital, University of Copenhagen, Herlev, Denmark. https://twitter.com/JacobRosenberg2
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Nishi Y, Ishizuka M, Sakuraoka Y, Takagi K, Hachiya H, Shibuya N, Suzuki T, Aoki T, Kubota K. A Simple, Low-Cost Technique for Difficult-to-Close Laparoscopic Port Sites. Am Surg 2021:3134821995080. [PMID: 33565892 DOI: 10.1177/0003134821995080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yusuke Nishi
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Mitsuru Ishizuka
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Yuhki Sakuraoka
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Kazutoshi Takagi
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Hiroyuki Hachiya
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Norisuke Shibuya
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Takashi Suzuki
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Taku Aoki
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
| | - Keiichi Kubota
- Department of Gastroenterological Surgery, 12756Dokkyo Medical University, Tochigi, Japan
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Özkurt E, Barbaros U, Aksakal N, Doğan S, Bozbora A. Single incision laparoscopic abdominal surgeries: case series of 155 various procedures, an observational cohort study. Turk J Surg 2020; 36:353-358. [PMID: 33778394 DOI: 10.47717/turkjsurg.2020.4795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/12/2020] [Indexed: 11/23/2022]
Abstract
Objectives Over the last decade, surgeons have started to think of the ways in which to further reduce the trauma of surgery and improve cosmesis. Consequently, many surgeons have yielded to single incision laparoscopic surgeries (SILS) in order to maximize operative and postoperative outcomes. This study aimed to highlight the feasibility and challenges of different procedures by presenting our data about different fields of abdominal SILS practices with long term follow-up. Material and Methods We retrospectively analysed an observational cohort of 155 patients who underwent surgery for different indications using the SILS technique. Results Of the 155 SILS procedures: 75 (48.4%) were cholecystectomies; 22 (14.2%) were splenectomies; 17 (11%) were hernia repairs; 11 (7.1%) were appendectomies; 8 (5.2%) were partial colon resections; 8 (5.2%) were adrenalectomies; 6 (3.8%) were distal pancreatectomy & splenectomies; 3 (1.9%) were subtotal gastrectomies; 3 (1.9%) were partial liver resections; and 2 (1.3%) were Nissen fundoplications. Ten (6.5%) early and 3 (1.9%) late postoperative complications were detected. No mortality or late morbidity (> 30 days) was detected due to SILS procedures. Conclusion SILS is a feasible technique in experienced hands for specific procedures. Meticulous patient selection is also important for good cosmetic results and outcomes.
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Affiliation(s)
- Enver Özkurt
- Department of General Surgery, Dana Farber Cancer Institute Harvard Medical School, Boston, United States
| | - Umut Barbaros
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Nihat Aksakal
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul University, İstanbul, Turkey
| | - Selim Doğan
- Department of General Surgery, Istanbul Training and Research Hospital, İstanbul, Turkey
| | - Alp Bozbora
- Department of General Surgery, Istanbul University Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Ohuchida K. Robotic Surgery in Gastrointestinal Surgery. CYBORG AND BIONIC SYSTEMS 2020; 2020:9724807. [PMID: 37063412 PMCID: PMC10097416 DOI: 10.34133/2020/9724807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
Robotic surgery is expanding in the minimally invasive treatment of gastrointestinal cancer. In the field of gastrointestinal cancer, robotic surgery is performed using a robot-assisted surgery system. In this system, the robot does not operate automatically but is controlled by the surgeon. The surgery assistant robot currently used in clinical practice worldwide is the leader-follower type, including the da Vinci® Surgical System (Intuitive Surgical). This review describes the current state of robotic surgery in the treatment of gastrointestinal cancer and discusses the future development of robotic systems in gastrointestinal surgery.
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Affiliation(s)
- Kenoki Ohuchida
- Department of Oncology and Surgery, Kyushu University, Fukuoka, Japan
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Noh JJ, Kim TH, Kim CJ, Kim TJ. Incisional hernia after 2498 single-port access (SPA) gynecologic surgery over a 10-year period. Sci Rep 2020; 10:17388. [PMID: 33060799 PMCID: PMC7562698 DOI: 10.1038/s41598-020-74471-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/01/2020] [Indexed: 11/29/2022] Open
Abstract
The present study was conducted to report the perioperative outcomes of single-port access (SPA) laparoscopic gynecologic surgeries with focus on the incidence of postoperative incisional hernia from our cumulative data of 2498 patients. A retrospective review was performed on the women who had received SPA surgeries from 2008 to 2018. Patient characteristics and perioperative outcomes including the incidence of postoperative incisional hernia were analyzed. There were 2498 Korean patients who received SPA surgeries for various gynecologic diseases. The median age of the patients was 40.3 ± 9.2 years, and the mean body mass index (BMI) was 22.6 ± 3.2 kg/m2. A total of 3 postoperative incisional hernia occurred during the study period. Two patients whose fascial layers were closed in running sutures developed hernias 6 and 8 months after their operations. One patient whose fascial layers were closed in interrupted sutures developed hernia 11 months after her operation. The incidence of postoperative incisional hernia following SPA surgery is low in Asian women whose BMI is relatively lower than other patient populations. Interrupted suture technique may reduce postoperative incisional hernia by providing a distinct visualization of fascial layers during closure. Detailed descriptions of our surgical techniques of closing the port incision are provided.
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Affiliation(s)
- Joseph J Noh
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Tae-Hyun Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University School of Medicine, Taejon, South Korea
| | - Chul-Jung Kim
- Department of Obstetrics and Gynecology, Konyang University Hospital, Konyang University School of Medicine, Taejon, South Korea
| | - Tae-Joong Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, South Korea.
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Lyu Y, Cheng Y, Wang B, Zhao S, Chen L. Single-incision versus conventional multiport laparoscopic cholecystectomy: a current meta-analysis of randomized controlled trials. Surg Endosc 2020; 34:4315-4329. [PMID: 31620914 DOI: 10.1007/s00464-019-07198-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/09/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND We performed this study to compare the safety and feasibility of single-incision laparoscopic cholecystectomy (SILC) with conventional multiple-port laparoscopic cholecystectomy (MPLC). METHODS We searched PubMed, Embase, Web of Science, the Cochrane Controlled Register of Trials (CENTRAL), and ClinicalTrials.gov for randomized controlled trials comparing SILC versus MPLC. We evaluated the pooled outcomes for complications, pain scores, and surgery-related events. This study was performed in accordance with PRISMA guidelines. RESULTS A total of 48 randomized controlled trials involving 2838 patients in the SILC group and 2956 patients in the MPLC group were included in this study. Our results showed that SILC was associated with a higher incidence of incisional hernia (relative risk = 2.51; 95% confidence interval = 1.23-5.12; p = 0.01) and longer operation time (mean difference = 15.27 min; 95% confidence interval = 9.67-20.87; p < 0.00001). There were no significant differences between SILC and MPLC regarding bile duct injury, bile leakage, wound infection, conversion to open surgery, retained common bile duct stones, total complication rate, and estimated blood loss. No difference was observed in postoperative pain assessed by a visual analogue scale between the two groups at four time points (6 h, 8 h, 12 h, and 24 h postprocedure). CONCLUSIONS Based on the current evidence, SILC did not result in better outcomes compared with MPLC and both were equivalent regarding complications. Considering the additional surgical technology and longer operation time, SILC should be chosen with careful consideration.
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Affiliation(s)
- Yunxiao Lyu
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China. .,Department of General Surgery, Dongyang People's Hospital, 60 West Wuning Road, 322100, Dongyang, Zhejiang, China.
| | - Yunxiao Cheng
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Bin Wang
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Sicong Zhao
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
| | - Liang Chen
- Department of Hepatobiliary Surgery, Dongyang People's Hospital, 60 West Wuning Road, Dongyang, 322100, Zhejiang, China
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Lee J, Kim KH, Lee TY, Ahn J, Kim SJ. Robotic surgery enables safe and comfortable single-incision cholecystectomy: A comparison of robotic and laparoscopic approaches for single-incision surgery. J Minim Access Surg 2020; 18:65-71. [PMID: 33047682 PMCID: PMC8830563 DOI: 10.4103/jmas.jmas_274_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Although single-incision robotic cholecystectomy (SIRC) overcomes various limitations of single-incision laparoscopic cholecystectomy (SILC), it is associated with high cost. In this study, we intended to investigate if SIRC is recommendable and advantageous to patients despite its high cost. Materials and Methods: We prospectively collected and analysed data of patients who had undergone either SILC (n = 25) or SIRC (n = 50) for benign gallbladder diseases, with identical inclusion criteria, between November 2017 and February 2019. Results: SILC and SIRC showed similar operative outcomes in terms of intra- and post-operative complications and verbal numerical rating scale (VNRS) for pain. However, the SIRC group exhibited significantly longer operation time than the SILC group (83.2 ± 32.6 vs. 66.4 ± 32.8, P = 0.002). The SIRC group also showed longer hospital stay (2.4 ± 0.7 vs. 2.2 ± 0.6, P = 0.053). Although the SILC and SIRC groups showed no significant difference in VNRS, the SIRC group required a higher amount (126.0 ± 88.8 mg vs. 87.5 ± 79.7 mg, P = 0.063) and frequency (3.0 ± 2.1 vs. 2.0 ± 1.8, P = 0.033) of intravenous opioid analgesic administration. During surgery, the critical view of safety (CVS), the prerequisite for safe cholecystectomy, was identified in only 24% (n = 6) of patients undergoing SILC and in 100% (n = 50) of patients undergoing SIRC (P < 0.05). Conclusion: We conclude that although SILC and SIRC have similar operative outcomes, SIRC is advantageous over SILC because of its potential to markedly enhance the safety of patients by proficiently acquiring CVS.
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Affiliation(s)
- Jaeim Lee
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kee-Hwan Kim
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Yoon Lee
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joseph Ahn
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Say-June Kim
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine; Catholic Central Laboratory of Surgery, Institute of Biomedical Industry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Learning curve of surgical novices using the single-port platform SymphonX: minimizing OR trauma to only one 15-mm incision. Surg Endosc 2020; 35:5338-5351. [PMID: 32968918 PMCID: PMC8346421 DOI: 10.1007/s00464-020-07998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 09/14/2020] [Indexed: 12/28/2022]
Abstract
Background Minimally invasive single-port surgery is always associated with large incisions up to 2–3 cm, complicated handling due to the lack of triangulation, and instrument crossing. The aim of this prospective study was to report how medical students without any laparoscopic experience perform several laparoscopic tasks (rope pass, paper cut, peg transfer, recapping, and needle threading) with the new SymphonX single-port platform and to examine the learning curves in comparison to the laparoscopic multi-port technique. Methods A set of 5 laparoscopic skill tests (Rope Pass, Paper cut, Peg Transfer, Recapping, Needle Thread) were performed with 3 repetitions. Medical students performed all tests with both standard laparoscopic instruments and the new platform. Time and errors were recorded. Results A total of 114 medical students (61 females) with a median age of 23 years completed the study. All subjects were able to perform the skill tests with both standard laparoscopic multi-port and the single-port laparoscopic system and were able to significantly improve their performance over the three trials for all five tasks—rope pass (p < 0.001), paper cut (p < 0.001), peg transfer (p < 0.001), needle threading (p < 0.001), and recapping (p < 0.001). In 3 out of 5 tasks, medical students performed the tasks faster using the standard multi-port system—rope pass (p < 0.001), paper cut (p < 0.001), and peg transfer (p < 0.001). In the task recapping, medical students performed the task faster using the new single-port system (p = 0.003). In the task needle threading, there was no significant difference between the standard multi-port system and the new single-port system (p > 0.05). Conclusion This is the first study analyzing learning curves of the commercially available SymphonX platform for abdominal laparoscopic surgery when used by novices. The learning curve and the error rate are promising.
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Chen QL, Chen K, Huang DY, Pan Y, Yan JF, Wang XF, Cai XY. Trans-umbilical single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty of inguinal hernia by self-made glove port. Medicine (Baltimore) 2020; 99:e21787. [PMID: 32846810 PMCID: PMC7447498 DOI: 10.1097/md.0000000000021787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Laparoscopic inguinal herniorrhaphy has been well established for the management of primary and recurrent inguinal hernias. Single-incision laparoscopic surgery (SILS) has now been accepted as a less invasive alternative to conventional laparoscopic surgery. However, commercially available access devices for SILS had disadvantages such as rigidness and crowding. This series aimed to analyze the feasibility and safety of single-incision laparoscopic trans-abdominal pre-peritoneal hernioplasty (SILS-TAPP) by applying our self-made device for managing inguinal hernia.We collected and reviewed the medical records of patients who received SILS-TAPP using a self-made glove-port device between January 2014 and January 2016. All operations were performed by the same surgical team. The demographics and intra- and perioperative outcomes were evaluated.SILS-TAPP was successfully performed in 105 patients (131 inguinal hernia repairs). No major intra- and postoperative morbidities were encountered, and no conversion to a conventional 3-port approach or open surgery was required. The mean operative time was 73.5 min and the mean postoperative hospital stay was 2.1 days. Three minor short-term complications were noted, which were resolved without surgical intervention. One recurrence was diagnosed during follow-up and treated using a second TAPP procedure.SILS-TAPP was shown to be a feasible, safe procedure in patients with an inguinal hernia. A simple self-made glove-port device was proven as a practical method of SILS-TAPP.
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Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up. Langenbecks Arch Surg 2020; 405:551-561. [PMID: 32602079 PMCID: PMC7449947 DOI: 10.1007/s00423-020-01911-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 06/12/2020] [Indexed: 02/07/2023]
Abstract
Background Within the last years, single-incision laparoscopic cholecystectomy (SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain. Methods A randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long-term follow-up after surgery was added. Results Ninety-eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups. Conclusions Taking into account a follow-up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates. Trial registration German Registry of Clinical Trials DRKS00012447
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The chronological change of indications and outcomes for single-incision laparoscopic cholecystectomy: a Korean multicenter study. Surg Endosc 2020; 35:3025-3032. [PMID: 32583067 DOI: 10.1007/s00464-020-07748-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 06/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although single-incision laparoscopic cholecystectomy (SILC) is a common procedure, the change in its surgical indications and perioperative outcomes has not been analyzed. METHODS We collected the clinical data of patients who underwent pure SILC in 9 centers between 2009 and 2018 and compared the perioperative outcomes. RESULTS In this period, 6497 patients underwent SILC. Of these, 2583 were for gallbladder (GB) stone (39.7%), 774 were for GB polyp (11.9%), 994 were for chronic cholecystitis (15.3%), and 1492 were for acute cholecystitis (AC) (23%). 162 patients (2.5%) experienced complication, including 20 patients (0.2%) suffering from biliary leakage. The number of patients who underwent SILC for AC increased over time (p = 0.028), leading to an accumulation of experience (27.4 vs 23.7%, p = 0.002). The patients in late period were more likely to have undergone a previous laparotomy (29.5 vs 20.2%, p = 0.006), and to have a shorter operation time (47.0 vs 58.8 min, p < 0.001). Male (odds ratio [OR]; 1.673, 95% confidence interval [CI] 1.090-2.569, p = 0.019) and moderate or severe acute cholecystitis (OR; 2.602, 95% CI 1.677-4.037, p < 0.001) were independent predictive factors for gallbladder perforation during surgery, and open conversion (OR; 5.793, 95% CI 3.130-10.721, p < 0.001) and pathologically proven acute cholecystitis or empyema (OR; 4.107, 95% CI 2.461-6.854, p < 0.001) were related with intraoperative gallbladder perforation CONCLUSION: SILC has expanded indication in late period. In this period, the patients had shorter operation times and a similar rate of severe complications, despite there being more numerous patients with AC.
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Suzuki Y, Tei M, Wakasugi M, Masuzawa T, Ohtsuka M, Mikamori M, Saito T, Furukawa K, Imasato M, Kishi K, Tanemura M, Akamatsu H. Role of single-incision laparoscopic surgery in the management of small bowel obstruction. Surg Endosc 2020; 35:2558-2565. [PMID: 32468265 DOI: 10.1007/s00464-020-07671-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 05/22/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Small bowel obstruction (SBO) arises on various backgrounds, and the surgical procedure is often modified intraoperatively as needed. Single-incision laparoscopic surgery (SILS) is less invasive than conventional multiport laparoscopic surgery (MPS) and reported to be equally safe and efficient. We have been applying SILS to SBO requiring surgical treatment, and we conducted a retrospective study to clarify the role of SILS in the management of SBO. METHODS Thirty-four consecutive patients were identified for inclusion in the study through a review of hospital records of patients having undergone surgery for SBO between May 2013 and June 2018. Patients with tumor- or hernia-related SBO were excluded. We also identified, for comparison, a group of patients who had undergone open surgery for SBO during the preceeding 5-year period. The primary study endpoint was the SILS completion rate, and analyses were performed to identify risk factors for conversion to open surgery and perioperative complications. RESULTS The SILS completion rate was 70.6% (24/34 patients), with conversion open surgery required for the remaining 10 (29.4%) patients. Conversion was necessitated by limited working space in 5 (50%) patients, discovery of massive necrosis in 3 (30%), and non-detection of the responsible lesion in 2 (20%). Univariable analysis showed an American Society of Anesthesiologists Physical Status score (p = 0.020) and severe intra-abdominal adhesions (p = 0.007) to be risk factors for conversion. Conversion to open surgery (vs complete SILS) was significantly associated with increased operation time (p = 0.018), blood loss (p = 0.021), postoperative stay (p = 0.010), and postoperative complications (p = 0.004). Open surgery was significantly associated with increased postoperative stay (p = 0.026) and postoperative complications (p = 0.011). CONCLUSION SILS appears to be a reasonable surgical treatment option for selected patients with SBO.
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Affiliation(s)
- Yozo Suzuki
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan.
| | - Mitsuyoshi Tei
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8025, Japan
| | - Masaki Wakasugi
- Department of Gastroenterological Surgery, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Kita-ku, Sakai City, Osaka, 591-8025, Japan
| | - Toru Masuzawa
- Department of Gastroenterological Surgery, Kansai Rosai Hospital, 3-1-69 Inabaso, Amagasaki City, Hyogo, 660-8511, Japan
| | - Masahisa Ohtsuka
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
| | - Manabu Mikamori
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
| | - Takuro Saito
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita City, Osaka, 565-0871, Japan
| | - Kenta Furukawa
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
| | - Mitsunobu Imasato
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
| | - Kentaro Kishi
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
| | - Masahiro Tanemura
- Department of Gastroenterological Surgery, Rinku General Medical Center, 2-23 Rinku Ourai Kita, Izumisano City, Osaka, 598-8577, Japan
| | - Hiroki Akamatsu
- Department of Gastroenterological Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-Ku, Osaka City, Osaka, 543-0035, Japan
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Lainas P, Derienne J, Dammaro C, Schoucair N, Devaquet N, Dagher I. Single-port Laparoscopic Surgery for the Treatment of Severe Obesity: Review and Perspectives. Obes Surg 2020; 30:2781-2790. [DOI: 10.1007/s11695-020-04620-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kang SM, Cho JR, Oh HK, Lee EJ, Kim MH, Kim DW, Kang SB. Safety and Efficacy of Single-Port Laparoscopic Ileostomy in Palliative Settings. Ann Coloproctol 2020; 36:17-21. [PMID: 32146784 PMCID: PMC7069680 DOI: 10.3393/ac.2019.04.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/25/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Single-port laparoscopic techniques can be optimized with confined incisions. This approach has an intraoperative advantage of excellent visualization of the correct intestinal segment for exteriorization, along with direct visual control of the extraction to avoid twisting. However, only a few studies have verified the efficacy of the technique. Thus, this study assessed the results of single-port laparoscopic stoma creation for fecal diversion, specifically focusing on feasibility, safety, and efficacy. Methods Patients who underwent single-incision enterostomy performed by a single surgeon were included. Data on demographics, indications for and chosen procedure, and operation results were retrospectively collected and analyzed. Results Between April 2015 and January 2018, a total of 13 patients (8 males, 5 females) with a mean age of 57.7 years (range, 41–83 years) underwent single-port ileostomy creation. The most common reason for diversion was palliative ileostomy for colon obstruction or fistula from peritoneal malignancy (n = 12), followed by colonic fistula with necrotizing pancreatitis (n = 1). There were no cases of conversion to open or multiport laparoscopic surgery. The mean operative time was 54 minutes (range, 37–118 minutes), and the median length of hospital stay was 8 days (range, 2–211 days). A postoperative complication, aspiration pneumonia, was documented in 1 patient and treated conservatively. The mean duration of bowel movement was 0.7 days (range, 0–4 days). All stomas had good function, and there was no 30-day mortality. Conclusion Single-port laparoscopic ileostomy in patients with a palliative setting could be a safe and feasible option for fecal diversion.
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Affiliation(s)
- Seng-Muk Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Rae Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eun-Ju Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Min Hyun Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Wabitsch S, Schulz P, Fröschle F, Kästner A, Fehrenbach U, Benzing C, Haber PK, Denecke T, Pratschke J, Fikatas P, Schmelzle M. Incidence of incisional hernia after laparoscopic liver resection. Surg Endosc 2020; 35:1108-1115. [PMID: 32124059 DOI: 10.1007/s00464-020-07475-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/19/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Minimally invasive techniques have been broadly introduced to liver surgery during the last couple of years. In this study, we aimed to report the incidence and potential risk factors for incisional hernia (IH) as well as health-related quality of life (HRQoL) after laparoscopic liver resections (LLR). METHODS All patients undergoing LLR between January 2014 and June 2017 were contacted for an outpatient hernia examination. In all eligible patients, photo documentation of the scar was performed and IH was evaluated by clinical examination and by ultrasound. Patients also completed a questionnaire to evaluate IH-specific symptoms and HRQoL. Obtained results were retrospectively analyzed with regard to patients' characteristics, perioperative outcomes and applied minimally invasive techniques, such as multi-incision laparoscopic liver surgery or hand-assisted/single-incision laparoscopic surgery (HALS/SILS). RESULTS Of 184 patients undergoing surgery, 161 (87.5%) met the inclusion criteria and 49 patients (26.6%) participated in this study. After a median time of 26 months (range 19-50 months) after surgery, we observed an overall incidence of IH of 12%. Five of 6 patients were overweight or obese (BMI ≥ 25) and 5 of 6 hernias were located at the umbilical site. Univariate analysis suggested the performance status at time of operation (ASA score ≥ 3; HR 5.616, 95% CI 1.012-31.157, p = 0.048) and the approach (HALS/SILS, HR 6.571, 95% CI 1.097-39.379, p = 0.039) as potential risk factors for IH. A higher frequency of hernia-related physical restrictions (HRR; p = 0.058) and a decreased physical functioning (p = 0.17) were noted in patients with IH; however, both being short of statistical significance. CONCLUSION Advantages of laparoscopic surgery with regard to low rates of IH can be translated to minimally invasive liver surgery. Even though there are low rates of IH, patients with poor performance status at the time of operation should be monitored closely. While patients' characteristics are hard to influence, it might be worth focusing on surgical factors such as the approach and the closure of the umbilical site to further minimize the rate of IH.
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Affiliation(s)
- S Wabitsch
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Schulz
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - F Fröschle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Kästner
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U Fehrenbach
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - C Benzing
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P K Haber
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - T Denecke
- Department of Radiology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - J Pratschke
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - P Fikatas
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schmelzle
- Department of Surgery,, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Campus Charité Mitte
- Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
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Sahm M, Reinsch AK, Otto R, Mönch C, Gerdes M, Winde G, Lancee S, Meyer L, Mantke A, Lippert H, Croner R, Mantke R. [Morbidity and Mortality of Single Incision Cholecystectomy: Results of a 3-Year Register Analysis]. Zentralbl Chir 2020; 145:390-398. [PMID: 32016926 DOI: 10.1055/a-1071-8082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Two decades ago, single-incision surgery was established as a new concept in minimally invasive surgery. Single incision cholecystectomy is the most frequently performed procedure in clinical routine. Most of the results have been based on randomised trials. Large prospective multicentre observational datasets from clinical routine do not exist. This analysis of clinical health service research is based on the SILAP study (single-incision multiport/single port laparoscopic abdominal surgery study). PATIENTS AND METHODS The data of the register were collected in 47 hospitals in the period of 2012 to 2014. Overall morbidity and mortality were the primary outcome. Multiple linear and logistic regression analyses were performed. Statistical significance was set at p < 0.05. RESULTS Data from 975 patients in clinical routine with single incision cholecystectomy were collected. Intraoperative complications were recorded in 3.2% of cases. Bile duct injuries were registered in 0.1% of cases. Postoperative complications were detected in 3.7% of cases. The mortality rate was 0.2%.The median operating time dropped from 60.0 to 51.5 min (p < 0.001) during the study. The use of an extra trocar was necessary in 10.3% of cases. Conversion to open surgery was performed in 0.7% of cases. Body mass index (p = 0.024), male gender (p = 0.012) and operating time (p < 0.001) had a significant effect on intraoperative complications in multivariate analysis. Classification of ASA III (p = 0.001) and modification or conversion of single incision technique (p = 0.001) were significantly associated with postoperative complications. CONCLUSION The register analysis of the prospective multicentre data shows that single incision cholecystectomy is feasible in clinical routine even outside the selective criteria of randomised studies. The only limitation is a BMI > 30 kg/m2 which has a significant influence on the intraoperative rate of complications in mild adverse events.
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Affiliation(s)
- Maik Sahm
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland.,Klinik für Chirurgie, DRK Kliniken Berlin-Köpenick, Deutschland
| | - Anne-Katrin Reinsch
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
| | - Ronny Otto
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Christian Mönch
- Klinik für Chirurgie, Westpfalz Klinikum GmbH, Kaiserslautern, Deutschland
| | - Martin Gerdes
- Klinik für Chirurgie, Krankenhaus St. Raphael, Ostercappeln, Deutschland
| | - Günther Winde
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum Herford, Deutschland
| | - Steffen Lancee
- Klinik für Chirurgie, Kreiskrankenhaus des Vogelsbergkreises in Alsfeld GmbH, Deutschland
| | - Lutz Meyer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Helios Vogtland-Klinikum Plauen, Deutschland
| | - Anne Mantke
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
| | - Hans Lippert
- An-Institut für Qualitätssicherung in der operativen Medizin gGmbH, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Roland Croner
- Klinik für Allgemein-, Viszeral-, Gefäß und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg, Deutschland
| | - Rene Mantke
- Klinik für Chirurgie, Medizinische Hochschule Brandenburg Theodor Fontane, Brandenburg, Deutschland
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Single-port versus multiport laparoscopic surgery comparing long-term patient satisfaction and cosmetic outcome. Surg Endosc 2020; 34:5533-5539. [PMID: 31993818 PMCID: PMC7644529 DOI: 10.1007/s00464-019-07351-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022]
Abstract
Introduction Several studies and meta-analysis showed Single-port or Single-incision laparoscopic surgery (SPL) to be superior over Multiport laparoscopic surgery (MPL) mainly in terms of postoperative pain and cosmetic result. But very little is known whether these results are only a short-term effect or are persistent on the long run after SPL. We therefore evaluated and compared long-term outcomes regarding cosmesis and chronic pain after SPL and MPL. Methods We conducted a comparative study with propensity score matching of all patients undergoing SPL or MPL between October 2008 and December 2013 in terms of postoperative cosmetic results and chronic pain. Follow-up data were obtained from mailed patient questionnaires and telephone interviews. Postoperative cosmesis was assessed using the patients overall scar opinion on a 10-point scale and the Patients scale of the standardized Patient and Observer Scar assessment scale (POSAS). Chronic pain was assessed by 10-point scales for abdominal and umbilical scar pain. Results A total of 280 patients were included in the study with 188 patients (67.1%) after SPL and 92 patients (32.9%) following MPL. 141 patients (50.4%) underwent a cholecystectomy and 139 patients (49.6%) underwent an appendectomy. The mean follow-up time was 61.1 ± 19.1 months. The mean wound satisfaction assed by the overall scar and the PSOAS Patients scale score of the patients showed no significant difference between MPL and SPL. Patients after SPL reported more overall complains than after MPL (8.7% vs. 2.5%, respectively), but without statistical significance (p = 0.321). Umbilical pain scores were comparable between the two groups (1.4 ± 1.0 vs. 1.4 ± 1.0, p = 0.831). Conclusion We found no difference in long-term cosmetic outcomes after SPL and MPL. Chronic pain at the umbilical incision site was comparable on the long run.
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