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Mudgway R, Tran Z, Quispe Espíritu JC, Bong WB, Schultz H, Vemireddy V, Kannappan A, Michelotti M, Mukherjee K, Quigley J, Scharf K, Srikureja D, Lum SS, Wu E. A Medium-Term Comparison of Quality of Life and Pain After Robotic or Laparoscopic Cholecystectomy. J Surg Res 2024; 295:47-52. [PMID: 37988906 DOI: 10.1016/j.jss.2023.08.031] [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: 12/13/2022] [Revised: 07/29/2023] [Accepted: 08/29/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION We sought to compare medium-term outcomes between robotic-assisted cholecystectomy (RC) and laparoscopic cholecystectomy (LC) using validated quality of life (QoL) and pain assessments. MATERIALS AND METHODS Patients who underwent RC or LC between 2012 and 2017 at a single academic institution were examined. Cases converted to open were excluded. Patients were contacted by telephone in 2019 and completed two standardized surveys to rate their QoL and pain. RESULTS Of those screened, 122 (35.8%) completed both surveys. Ninety three (76.2%) underwent RC and 29 (23.8%) underwent LC. The groups (RC versus LC) were similar based on mean age (47.9 versus 45.5 y, P = 0.48), gender (66.7% versus 72.4% female, P = 0.56), race (86.0% White/5.4% Black versus 72.4% White/13.8% Black, P = 0.2), insurance status (98.9% versus 100.0% insured, P = 0.58), median body mass index (31.8 versus 31.3, P = 0.43), and median Charlson Comorbidity Index (1 versus 0, P = 0.14). Fewer RC patients had a history of steroid use compared to LC (16.1% versus 34.5%, P = 0.03). No overall significant difference in QoL was demonstrated. LC group had higher severity of "tiring-exhausting pain" (P = 0.04), "electric-shock pain" (P = 0.003), and "shooting pain" (P = 0.05). The "overall intensity" of pain in the "gallbladder region" between the groups was similar at the time of follow-up (P = 0.31). CONCLUSIONS QoL over 2-7 y following time of surgery is comparable for robotic-assisted versus conventional laparoscopic cholecystectomies. The laparoscopic approach may be associated with a higher severity of subset categories of pain, but overall pain between the two approaches is comparable.
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Affiliation(s)
- Ross Mudgway
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Zachary Tran
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | | | - Woo Bin Bong
- Loma Linda University School of Medicine, Loma Linda, California
| | - Hayden Schultz
- Loma Linda University School of Medicine, Loma Linda, California
| | - Vamsi Vemireddy
- Loma Linda University School of Medicine, Loma Linda, California
| | - Aarthy Kannappan
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Marcos Michelotti
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Kaushik Mukherjee
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Jeffrey Quigley
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Keith Scharf
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Daniel Srikureja
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Sharon S Lum
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - Esther Wu
- Department of Surgery, Loma Linda University Health, Loma Linda, California.
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Assessing long term quality of life in geriatric patients after elective laparoscopic cholecystectomy. Am J Surg 2019; 219:1039-1044. [PMID: 31526511 DOI: 10.1016/j.amjsurg.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION While cholecystectomy is shown to be safe in older patients, few existent studies investigate associated quality of life. This study examines quality of life in symptomatic geriatric patients after elective laparoscopic cholecystectomy. METHODS Patients ≥65 years of age who underwent elective laparoscopic cholecystectomy at a tertiary care center were administered the 12-Item Short Form Survey (SF-12) and a gastrointestinal survey pre-operatively and post-operatively (within 6 and 18 months of surgery). Quality of life characteristics were compared amongst visit type in univariate and multivariate settings, with a mixed-model regression. RESULTS Our sample included 30 patients. Pain frequency (p = 0.004) and pain severity (p = 0.013) scores improved with each subsequent visit type. SF-12 mental health aggregate score improved overall from pre-operative to long term follow-up (p = 0.0403). DISCUSSION Our findings suggest that health-related quality of life in geriatric patients improves after elective laparoscopic cholecystectomy in the short and long term. SUMMARY Quality of life was assessed in symptomatic geriatric patients undergoing elective laparoscopic cholecystectomy. Pain frequency, pain severity, and the SF-12 mental health aggregate scores improved overall from pre-operative to post-operative visit types.
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Abdelrahman AM, Bingener J, Yu D, Lowndes BR, Mohamed A, McConico AL, Hallbeck MS. Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial. Surg Endosc 2015; 30:1205-11. [PMID: 26194249 PMCID: PMC4721929 DOI: 10.1007/s00464-015-4332-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 06/09/2015] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Single-incision laparoscopic cholecystectomy (SILC) may lead to higher patient satisfaction; however, SILC may expose the surgeon to increased workload. The goal of this study was to compare surgeon stress and workload between SILC and conventional laparoscopic cholecystectomy (CLC). METHODS During a double-blind randomized controlled trial comparing patient outcomes for SILC versus CLC (NCT0148943), surgeon workload was assessed by four measures: surgery task load index questionnaire (Surg-TLX), maximum heart rate, salivary cortisol level, and instruments usability survey. The maximum heart rate and salivary cortisol levels were sampled from the surgeon before the random assignment of the surgical procedure, intraoperatively after the cystic duct was clipped, and at skin closure. After each procedure, the surgeon completed the Surg-TLX and an instrument usability survey. Student's t tests, Wilcoxon rank sum test, and Kruskal-Wallis nonparametric ANOVAs on the dependent variables by the technique (SILC vs. CLC) were performed with α = 0.05. RESULTS Twenty-three SILC and 25 CLC procedures were included in the intent-to-treat analysis. No significant differences were observed between SILC and CLC for patient demographics and procedure duration. SILC had significantly higher post-surgery surgeon maximum heart rates than CLC (p < 0.05). SILC also had significantly higher mean change in the maximum heart rate between during and post-procedure (p < 0.05) than CLC. Salivary cortisol level was significantly higher during SILC than CLC (p < 0.01). Awkward manipulation of the instruments and limited fine motions were reported significantly more frequently with SILC than CLC (p < 0.01). In the surgeon-reported Surg-TLX, subscale of physical demand was significantly more demanding for SILC than CLC (p < 0.05). CONCLUSIONS Surgeon heart rate, salivary cortisol level, instrument usability, and Surg-TLX ratings indicate that SILC is significantly more stressful and physically demanding than the CLC. Surgeon stress and workload may impact patients' outcomes; thus, ergonomic improvement on SILC is necessary.
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Affiliation(s)
- Amro M Abdelrahman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | | | - Denny Yu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bethany R Lowndes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Amani Mohamed
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
- Department of Surgery, Mayo Clinic, Rochester, MN, USA.
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Single-incision laparoscopic surgery through the umbilicus is associated with a higher incidence of trocar-site hernia than conventional laparoscopy: a meta-analysis of randomized controlled trials. Hernia 2015; 20:1-10. [DOI: 10.1007/s10029-015-1371-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/28/2015] [Indexed: 12/14/2022]
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Bingener J, Skaran P, McConico A, Novotny P, Wettstein P, Sletten DM, Park M, Low P, Sloan J. A Double-Blinded Randomized Trial to Compare the Effectiveness of Minimally Invasive Procedures Using Patient-Reported Outcomes. J Am Coll Surg 2015; 221:111-21. [PMID: 26095558 DOI: 10.1016/j.jamcollsurg.2015.02.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Institute of Medicine has included the comparison of minimally invasive surgical techniques in its research agenda. This study seeks to evaluate a model for the comparison of minimally invasive procedures using patient-reported outcomes. STUDY DESIGN A double-blinded randomized controlled trial (NCT01489436) was conducted. Baseline data were obtained, standardized anesthesia was induced, and patients were randomized to single-port (SP) or 4-port (FP) laparoscopic cholecystectomy. Perioperative care was standardized. The outcomes were pain (Visual Analog Scale) on postoperative day 1 (primary) and quality of life (Patient-Reported Outcomes Measures Information System and Linear Analog Self-Assessment), serum cytokines, and heart rate variability (secondary). Analysis was intention to treat. Using identical occlusive dressings, patients and the outcomes assessor remained blinded until postoperative day 2. RESULTS Fifty-five patients were randomized to each arm. There was no difference in demographics. Visual Analog Scale pain score on postoperative day 1 was significantly different from baseline in each group (SP: 1.6 ± 1.9 to 4.2 ± 2.4 vs FP: 1.8 ± 2.3 to 4.2 ± 2.2), but not different from each other (p = 0.83). Patients in the FP arm reported significantly less fatigue on postoperative day 7 than patients in the SP group (3.1 ± 2.1 vs 4.2 ± 2.2; p = 0.009). Fewer patients in the FP group required postoperative oral narcotics before discharge (40% vs 60%; p = 0.056). Cytokines levels and heart rate variability were similar between arms. In patients followed for >1 year, no difference in umbilical hernia rates was noted. CONCLUSIONS Early postoperative quality of life data captured differences in fatigue, indicating improved recovery after FP within a controlled trial. Physiologic measures were similar, suggesting that the differences between SP and FP are minimal.
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Affiliation(s)
| | - Pam Skaran
- Department of Surgery, Mayo Clinic, Rochester, MN
| | | | - Paul Novotny
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Peter Wettstein
- Department of Surgery and Immunology, Mayo Clinic, Rochester, MN
| | | | - Myung Park
- Department of Surgery, Mayo Clinic, Rochester, MN
| | - Philip Low
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Jeff Sloan
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Single incision versus standard multiport laparoscopic cholecystectomy: up-dated systematic review and meta-analysis of randomized trials. Surgeon 2014; 12:271-89. [PMID: 24529791 DOI: 10.1016/j.surge.2014.01.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/14/2014] [Accepted: 01/16/2014] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to compare single incision laparoscopic cholecystectomy (SILC) to the standard multiport technique (MLC) for clinically relevant outcomes in adults. METHODS Systematic review and random-effects meta-analysis of randomized trials. RESULTS We identified 30 trials (SILC N = 1209, MLC N = 1202) mostly of moderate to low quality. Operating time (30 trials): longer with SILC (WMD = 12.4 min, 95% CI 9.3, 15.5; p < 0.001), but difference reduced with experience - in 10 large trials (1321 patients) WMD = 5.9 (-1.3, 13.1; p = 0.105). Intra-operative blood loss (12 trials, 1201 patients): greater with SILC, but difference practically irrelevant (WMD = 1.29 mL, 0.24-2.35; p = 0.017). Procedure failure (27 trials, 2277 patients): more common with SILC (OR = 13.9, 4.34-44.7; p < 0.001), but overall infrequent (SILC pooled incidence 4.39%) and almost exclusively addition of a trocar. Post-operative pain (29 trials) and hospital stay (22 trials): no difference. Complications (30 trials): infrequent (SILC pooled incidence 5.35%) with no overall SILC vs. MLC difference. Incisional hernia (19 trials, 1676 patients): very rare (15 vs. 4 cases), but odds significantly higher with SILC (OR = 4.94, 1.26-19.4; p = 0.025). Cosmetic satisfaction (16 trials, 11 with data at 1-3 months): in 5 trials with non-blinded patients (N = 513) in favour of SILC (SMD = 1.83, 0.13, 3.52; p = 0.037), but in 6 trials with blinded patients (N = 719) difference small and insignificant (SMD = 0.42, -1.12, 1.96; p = 0.548). DISCUSSION SILC outcomes largely depend on surgeon's skill, but regardless of it, when compared to MLC, SILC requires somewhat longer operating time, risk of incisional hernia is higher (but overall very low) and early cosmetic benefit is modest. CONCLUSION From the (in)convenience and safety standpoint, SILC is an acceptable alternative to MLC with a modest cosmetic benefit.
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