Double incision laparoscopic cholecystectomy (DILC) with routinary intra-operative cholangiography (IOC) : less trauma, same safety. Report on 30 consecutive non-selected cases

Laparoscopic cholecystectomy with two incisions: an improved, feasible and safe technique with superior cosmetic outcomes

OBJECTIVE

Conventional laparoscopic cholecystectomy (CLC) is usually performed with four incisions. Minimally invasive surgery for gallbladder disease with less pain and smaller scars has become increasingly popular. This study reported a new, two-incision laparoscopic cholecystectomy (TILC) using conventional instruments.

METHODS

In this prospective study, 43 patients were recruited to undergo TILC and were compared with 43 historical cases undergoing CLC. We evaluated operative time, postoperative pain, cosmesis and complications.

RESULTS

There was no significant difference in gender, age, body mass index, bile duct damage, blood loss and postoperative hospital stay between the two groups. The mean operation time was longer with TILC than with CLC, but the difference was not statistically different. Postoperative pain scores were significantly lower with TILC than with CLC. The mean cosmetic satisfaction score was significantly higher with TILC than that with CLC. There was no significant difference in the incidence of complications between the two groups.

CONCLUSION

Our work demonstrates that TILC generates less postoperative pain and significantly improved cosmesis for patients. TILC is a safe and feasible alternative to CLC.

Fewer Ports Cut Opioid Use and Length of Stay in Elective Laparoscopic Cholecystectomy

Background:

Postoperative pain is one of the most common reasons for prolonged hospital stay with opioid analgesia the mainstay of treatment.

Objectives:

The purpose of this study was to determine whether the degree of abdominal trauma, reflected by the number and sizes of ports used in elective laparoscopic cholecystectomy, correlated against opioid analgesia requirements and length of stay.

Methods:

A retrospective clinical audit was undertaken of 144 patients who underwent elective laparoscopic cholecystectomies with 3-port (12/5/5) and 4-port approaches (12/5/5/5 and 12/10/5/5). In the reduced port cases, liver retraction was achieved using a suction retractor, removing the requirement for a fourth port. The number of ports and total cross-sectional area of all ports were compared against the procedure time, length of stay, and opioid analgesia required.

Results:

The smaller total cross-sectional area associated with the 3-port approach (12/5/5, 277.25 mm²) resulted in significantly lower total oral morphine equivalent daily dose required compared to 12/10/5/5 (453.96 mm²) and 12/5/5/5 (327.52 mm²) approaches, being 30.7 mg and 21.0 mg less, respectively (p < 0.001). The 3-port approach had a mean length of stay 0.8 days which was significantly shorter compared to both 4-port approaches (p = 0.001, length of stay of 1.1 and 1.2 days for 12/5/5/5 and 12/10/5/5, respectively). Laparoscopic cholecystectomy patients in the study hospitals routinely stayed overnight.

Conclusions:

The absolute number of ports used in elective laparoscopic cholecystectomies appears to play an important role in postoperative recovery. In particular, 3-port configurations may result in less postoperative pain without the burden of an increase in length of stay, morbidity, or mortality rates.

Laparoscopic cholecystectomy with two mini cosmetic incisions

Minimally invasive surgery gained popularity between general surgeons especially laparoscopic four-port cholecystectomy. By introducing different methods such as NOTES and SILS, the costs elevated with its cosmetics. We aim to study a new technique of laparoscopic cholecystectomy by two incisions with best cosmetics, and same quality and lower cost as conventional four-port laparoscopic cholecystectomy and make a comparison between them. In a double-blind clinical trial from December 2012 to September 2014, patients with cholelithiasis who presented to general surgery clinic and candidate for laparoscopic cholecystectomy were studied. Half of patients underwent double-incision laparoscopic cholecystectomy and other half underwent conventional four-port laparoscopic cholecystectomy. The mean age and BMI were higher in double-incision and four-port group, respectively, but not statistically different. Also male to female ratio was 6:1 in double-incision group and 9:1 in four-port group, and they were not statistically different. The mean operation time was about 2 min more in double-incision group, but it is trivial to consider a significant difference at level of 5%. The mean pain score (0-10) was significantly lower in double incision group in comparison with four-port group (p < 0.0001). Patients in double incision group reported higher satisfaction and were sooner in return to work than in four-port group (p < 0.0001). It seems that DILS for uncomplicated cholelithiasis is safe. By reducing port number, we succeed in reducing the pain and need for analgesics, reducing hospital staying and sooner return to work. By taking into account using conventional CLS instrument and lowering the hospital charges, it could be a good alternative to SILS.

Two-Incision Laparoscopic Cholecystectomy: Reducing Scars in a Simple Way

BACKGROUND

About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health.

OBJECTIVE

To describe a two-incision laparoscopic cholecystectomy (TILC) technique using only conventional material, without increasing complications or operative time.

MATERIALS AND METHODS

A consecutive and prospective case series compared to another historical operated by conventional laparoscopic cholecystectomy (LC). The TILC was performed with three trocars in two incisions, two trocars in umbilical incision, and one in epigastrium.

RESULTS

A total of 72 patients were operated on by the same surgeon (36 in each group). There were no significant differences between groups for gender, mean age, body mass index, or length of hospital stay. The procedures were classified by the surgeon according to surgical difficulty and 58.3% (n = 42) were considered low grade, 9.7% (n = 7) difficult, and the other were intermediaries, with no difference between the series (P < .05). There were minor complications in 6.94% (n = 5) procedures. There were no differences between mean operative time (P = .989), which was 49 (95% confidence interval [CI] 42-56) minutes in LC and 40 (95% CI 35-44) min in TILC. There was no need for additional trocars in any case or for conversion to open surgery.

CONCLUSIONS

TILC is feasible, safe, and with good aesthetic result, using the same instruments of LC, without increasing operative time.

Safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic cholecystectomy in patients with acute cholecystitis: comparison with three-port laparoscopic cholecystectomy

INTRODUCTION

Single-incision laparoscopic cholecystectomy (SILC) has been increasing in use steadily, and many researchers have reported the safety and feasibility of SILC. However, most studies were confined to selected patients and excluded patients with acute inflammation. In this study, we evaluated the safety and feasibility of SILC with our technique in patients with acute cholecystitis.

PATIENTS AND METHODS

Ninety-six patients with acute cholecystitis undergoing laparoscopic cholecystectomy at Uijeonbu St. Mary's Hospital (Uijeongbu, Korea) between October 2011 and December 2012 were retrospectively reviewed. SILC was performed in 49 patients, and conventional three-port laparoscopic cholecystectomy was performed in 47 patients. Patient demographics and operative outcomes were compared between groups to evaluate the safety and feasibility of SILC using our technique.

RESULTS

There were no differences between groups in demographics except for the sex ratio. SILC was more often performed in female patients (69% versus 34%, P=.001). There were no statistically significant differences between groups in terms of operation time, critical view of safety identification time, iatrogenic gallbladder perforation, port-site seroma, and postoperative hospital stay, respectively. One patient in each group required conversion to open cholecystectomy because of massive bleeding.

CONCLUSIONS

This study showed that needlescopic grasper-assisted SILC with our technique is acceptable not only in selected patients but also in patients with acute cholecystitis. Lateral and cephalad retraction using a needlescopic grasper and a snake retractor can make SILC safe and easy in acute cholecystitis through better visualization of the triangle of Calot.