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Aiyoshi T, Jimbo T, Gotoh C, Masumoto K. Transumbilical Reduced-port Laparoscopic Urachal Resection for Pediatric and Adolescent Patients. Surg Laparosc Endosc Percutan Tech 2023; 33:95-97. [PMID: 36730547 DOI: 10.1097/sle.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/21/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND Port placement in laparoscopic urachal resection has not yet been standardized. We herein report an approach for transumbilical reduced-port laparoscopic urachal resection for pediatric and adolescent patients. METHODS We retrospectively reviewed the outcomes of pediatric and adolescent patients for urachal remnant treated with reduced-port laparoscopic urachal resection from 2016 to 2020 in our department. Regarding our surgical procedure, a skin incision was made around the umbilicus, and the urachus was dissected partially under direct vision. Two transumbilical 5 mm ports and a 3.5 mm port in the right lateral abdomen were placed. In the laparoscopic view, the urachus was dissected from the abdominal wall and resected at the bladder dome. The defect of the peritoneum was closed by suturing. RESULTS Sixteen patients underwent the procedure. The median patient age was 12.5 years old. Surgery was performed by trainee surgeons in all patients without intraoperative complications or conversion to open surgery. The median postoperative hospital stay was 2 days. CONCLUSIONS Our transumbilical reduced-port laparoscopic urachal resection technique has advantages in terms of safety, operability, and cosmetic appearance.
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Affiliation(s)
- Tsubasa Aiyoshi
- Department of Pediatric Surgery, Faculty of Medicine, University of Tsukuba,Tsukuba, Ibaraki, Japan
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Hoshi A, Chihara I, Shiga M, Nitta S, Nagumo Y, Sakka S, Kojo K, Ikeda A, Yoshino T, Kimura T, Kawahara T, Kandori S, Negoro H, Nishiyama H. Laparoendoscopic single-site surgery for urachal remnant with extraperitoneal approach through a suprapubic port. Asian J Endosc Surg 2022; 15:569-576. [PMID: 35307970 PMCID: PMC9313573 DOI: 10.1111/ases.13056] [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: 01/23/2022] [Revised: 02/24/2022] [Accepted: 03/05/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION No standard procedure has been established for laparoendoscopic single-site surgery for urachal remnants (LESS-U). This study aimed to report the novel surgical techniques and initial outcomes of laparoendoscopic single-site surgery with an extraperitoneal approach through a suprapubic port for urachal remnants (spLESS). METHODS Fifty-five patients (median age, 27 years; range, 15-69 years) who underwent LESS-U were analyzed. To overcome the limitations inherent in the conventional procedure (LESS-U through an umbilical port: uLESS), we modified the port placement and approached via the extraperitoneal space. spLESS is a novel procedure which reduces intestinal damage caused by the extraperitoneal approach and overcomes incomplete resection of the urachal remnant, especially in the bladder dome. Three trocars are inserted into the extraperitoneal space through a suprapubic port in spLESS, and complete resection of the urachal remnant from the umbilicus to the bladder is performed with an appropriate incision line. Patient characteristics and perioperative results were retrospectively collected. Cosmetic outcomes were prospectively evaluated using self-administered questionnaires (body image and photo-series questionnaire). RESULTS spLESS and uLESS were performed in 43 and 12 patients, respectively. No differences were observed between the perioperative results. The cosmetic outcomes were compared between the groups using body image and photo-series questionnaires. No patient developed major complications; there was no recurrence in either group. CONCLUSIONS spLESS is a novel procedure which can completely resect the urachal remnant and reduce the risk of intestinal damage. spLESS is a safe, effective, and feasible procedure with high postoperative cosmesis.
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Affiliation(s)
- Akio Hoshi
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Ichiro Chihara
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Masanobu Shiga
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Satoshi Nitta
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Yoshiyuki Nagumo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Shotaro Sakka
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Kosuke Kojo
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Atsushi Ikeda
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Takayuki Yoshino
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Tomokazu Kimura
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Takashi Kawahara
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Shuya Kandori
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hiromitsu Negoro
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hiroyuki Nishiyama
- Department of Urology, Faculty of MedicineUniversity of TsukubaTsukubaJapan
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Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopic surgery for patients with symptomatic urachal remnants: an experience with 57 patients. Int Urol Nephrol 2021; 53:855-861. [PMID: 33389460 DOI: 10.1007/s11255-020-02746-x] [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: 09/25/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the surgical feasibility and postoperative cosmesis of a novel transumbilical laparoendoscopic single-site (LESS) surgical approach involving Y-shaped incisions and three-flap umbilicoplasty in urachal remnant patients. METHODS Patients with symptomatic urachal remnants who underwent either conventional laparoscopic surgery (CL group, n = 21) or LESS surgery with Y-shaped incisions and three-flap umbilicoplasty (LESS group, n = 36) between May 2010 and September 2019 were retrospectively assessed. Perioperative factors and postoperative esthetic outcomes were compared between the groups using univariate and multivariate analyses. Esthetic outcomes were assessed using the body image questionnaire consisting of the body image scale (BIS) and the cosmetic scale (CS); a higher score indicated a better outcome. RESULTS The median operative time was greater and the insufflation time was shorter in the LESS group than in the CL group. The estimated blood loss and postoperative hospital stay and surgical site infection rate did not differ significantly between the groups. While the BIS score also did not differ significantly between the groups, the CS score was greater in the LESS group than in the CL group. Multivariate analysis revealed that the surgery type (LESS surgery) was an independent predictor of greater postoperative esthetic satisfaction. CONCLUSION Transumbilical LESS surgery with Y-shaped incisions and subsequent three-flap umbilicoplasty is feasible in patients with symptomatic urachal remnants. Regarding postoperative cosmesis, the higher CS score suggests that this technique is superior to CL surgery. Furthermore, the selection of this procedure was an independent predictor of good postoperative esthetic outcomes.
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Narita M, Kageyama S, Okegawa T, Kinoshita H, Sato F, Nakagawa K, Habuchi T, Hoshi A, Matsubara A, Yoshimura K, Terachi T, Mimata H, Kawauchi A. Urological laparoendoscopic single-site and reduced port surgery: A nationwide survey in Japan. Int J Urol 2017; 25:263-268. [DOI: 10.1111/iju.13504] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 10/30/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Mitsuhiro Narita
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | - Susumu Kageyama
- Department of Urology; Shiga University of Medical Science; Shiga Japan
| | | | - Hidefumi Kinoshita
- Department of Urology and Andrology; Kansai Medical University; Osaka Japan
| | | | - Ken Nakagawa
- Department of Urology; Tokyo Dental College Ichikawa General Hospital; Chiba Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Akio Hoshi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | - Akio Matsubara
- Department of Urology; Hiroshima University; Hiroshima Japan
| | - Koji Yoshimura
- Department of Urology; Shizuoka General Hospital; Shizuoka Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | | | - Akihiro Kawauchi
- Department of Urology; Shiga University of Medical Science; Shiga Japan
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Three-flap umbilicoplasty: a novel and preliminary method of laparoendoscopic single-site transumbilical surgical approach for urachal remnants. Int Urol Nephrol 2017; 49:1965-1971. [PMID: 28828600 DOI: 10.1007/s11255-017-1678-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Symptomatic urachal remnants are rare benign anomalies affecting young adults. For these patients, both curative treatment and acceptable postoperative aesthetic outcomes are important. Here, we describe a novel transumbilical approach, using Y-shaped incisions and three-flap umbilicoplasty techniques, to improve repair and aesthetic outcomes. MATERIALS AND METHODS The clinical and perioperative data of 16 patients (11 men; median age, 25 years; range 16-46 years) who underwent LESS surgery and three-flap umbilicoplasty (LESS group) between December 2013 and March 2017 were analyzed. For comparison, the perioperative data of those who underwent conventional laparoscopic surgery (CL group) between May 2010 and November 2013 at the same institutions were investigated. RESULTS The median operative time of the LESS group was longer than that of the CL group (146.5 vs 107 min; p = 0.009). The estimated blood loss and postoperative hospital stay were not significantly different between the two groups. The two perioperative complications were injury to the transverse colon serosa and minor surgical site infection. Both complications were resolved with appropriate management. CONCLUSIONS This novel umbilical approach is useful for patients with symptomatic urachal remnants, with the reduction in port-site scarring resulting in good postoperative cosmesis.
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Garisto JD, Henriquez K, Pimentel M EE. Single-Incision Laparoscopy Surgery Excision of an Infected Urachal Cyst: Description of the Technique. J Endourol Case Rep 2017; 3:7-9. [PMID: 28164161 PMCID: PMC5278813 DOI: 10.1089/cren.2016.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Urachal cysts (UCs) are secondary to incomplete obliteration of the embryonic urachal duct and may become symptomatic when infected. Treatment is primarily surgical to excise the infected cyst. Surgical approaches include a lower midline laparotomy or minimally invasive (MI) techniques. Case: We present a case of a young male with an infected UC that was treated with a single-incision laparoscopy surgery. The operative technique is described. Conclusion: This approach is a safe and feasible option for the MI management of UCs.
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Affiliation(s)
- Juan D Garisto
- Department of Urology, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid , Panama City, Panama
| | - Katherine Henriquez
- Department of Urology, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid , Panama City, Panama
| | - Edwin E Pimentel M
- Department of Urology, Complejo Hospitalario Metropolitano Dr. Arnulfo Arias Madrid , Panama City, Panama
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Yanishi M, Kinoshita H, Mishima T, Taniguchi H, Yoshida K, Komai Y, Yasuda K, Watanabe M, Sugi M, Matsuda T. Influence of scars on body image consciousness with respect to gender following laparoendoscopic single-site versus conventional laparoscopic surgery. Scand J Urol 2016; 51:57-61. [PMID: 27834569 DOI: 10.1080/21681805.2016.1250811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate and compare the cosmetic outcomes of laparoscopic single-site surgery (LESS) and conventional laparoscopy (CL) in the treatment of ureteropelvic junction obstruction (UPJO) and urachal remnant removal. LESS is thought to produce better cosmetic results than CL; however, patients' perception of their scars has not been assessed. This study compared the subjective body image and cosmesis ratings of patients who had undergone LESS or CL for UPJO and urachal remnant removal. MATERIALS AND METHODS Fifty patients who underwent LESS or CL for UPJO or urachal remnant removal between June 2008 and June 2015 were included. Cosmetic outcomes were evaluated using the Body Image Questionnaire (BIQ) and Photo-Series Questionnaire (PSQ). RESULTS The body image and cosmetic scores were significantly higher for patients who underwent LESS than for those who underwent CL, for both pyeloplasty and urachal remnant removal (p < .05 each). When performed for either a pyeloplasty or urachal remnant removal, significantly greater BIQ and PSQ scores were observed in females after LESS compared to CL, but not in males. CONCLUSION LESS for UPJO and urachal remnant removal has better self-reported body image and cosmesis ratings than CL. This trend is particularly strong in female patients.
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Affiliation(s)
- Masaaki Yanishi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Hidefumi Kinoshita
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Takao Mishima
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Hisanori Taniguchi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Kenji Yoshida
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Yoshihiro Komai
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Kaneki Yasuda
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Masato Watanabe
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Motohiko Sugi
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
| | - Tadashi Matsuda
- a Department of Urology and Andrology , Kansai Medical University , Hirakata , Osaka , Japan
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Kobayashi K, Sasaki K, Iijima T, Yoshimi F, Nagai H. Excision of the urachal remnant using the abdominal wall-lift laparoscopy: A case report. Int J Surg Case Rep 2016; 22:90-3. [PMID: 27064744 PMCID: PMC4832082 DOI: 10.1016/j.ijscr.2016.03.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 03/23/2016] [Accepted: 03/23/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Here, we report the surgical excision of the urachal remnant using the abdominal wall-lift laparoscopy with a camera port in the umbilicus, combined with a small Pfannenstiel incision to optimally treat the bladder apex. PRESENTATION OF CASE A 21-year-old woman presented with periumbilical discharge and pain on urination. Contrast enhanced CT and MRI showed an abscess in the umbilical region that was connected to the bladder via a long tube-like structure. It was diagnosed as an infected urachal sinus. Partial excision of the umbilical fossa followed by dissection of the urachal remnant was easily performed using the abdominal wall-lift laparoscopy from the umbilicus down to the bladder without pneumoperitoneum or additional trocar placement. A Pfannenstiel incision was made above the pubis to get access to the junction between the urachal remnant and the bladder. Under direct vision, we succeeded in accurately dividing the remnant tract, and we adequately closed the bladder opening with absorbable sutures. This method has the advantage of easily closing peritoneal defects after excision of the urachal remnant with direct sutures under a laparoscopic view from the umbilicus. Cosmetic satisfaction was obtained postoperatively. DISCUSSION AND CONCLUSION Urachal sinus excision using the abdominal wall-lift laparoscopy seems to surpass the previously reported methods in term of safety, cosmetics, and adequacy of surgical procedures.
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Affiliation(s)
- Kosuke Kobayashi
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan.
| | - Kazuhito Sasaki
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Tatsuo Iijima
- Department of Diagnostic Pathology, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Fuyo Yoshimi
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
| | - Hideo Nagai
- Department of Surgery, Ibaraki Prefectural Central Hospital & Cancer Center 6528 Koibuchi, Kasama, Ibaraki 309-1793, Japan
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Nogueras-Ocaña M, Rodríguez-Belmonte R, Uberos-Fernández J, Jiménez-Pacheco A, Merino-Salas S, Zuluaga-Gómez A. Urachal anomalies in children: surgical or conservative treatment? J Pediatr Urol 2014; 10:522-6. [PMID: 24321777 DOI: 10.1016/j.jpurol.2013.11.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 11/06/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To shed light on the current controversy regarding the best treatment option for managing urachal anomalies in children. PATIENTS AND METHODS A retrospective follow-up of a case series comprising 13 children who were diagnosed with urachal anomalies was performed. All cases were diagnosed between 2000 and 2011 and followed up at the Pediatric Urology Unit of San Cecilio University Hospital in Granada (Spain). Information about the baseline and follow-up variables was collected from clinical records. RESULTS Nine of the 13 patients were symptomatic (6 patients with urachal cysts and 3 patients with urachal persistency). Conservative management was originally used in all but one case. During follow-up, reinfection appeared in two cases, and these patients were treated surgically. Spontaneous resolution was achieved in eight cases (61.5%). Two children with persistent urachal cysts are still being followed (4 and 6 years after the diagnosis), although ultrasound monitoring reveals a gradual reduction in the size of the cysts. The median time between diagnosis and resolution was 16.5 months. CONCLUSION With the exception of cases in which there is a clear indication for surgery (i.e. reinfection), a conservative approach based on regular monitoring may be useful.
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Affiliation(s)
- Mercedes Nogueras-Ocaña
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain.
| | | | | | - Antonio Jiménez-Pacheco
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Sergio Merino-Salas
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
| | - Armando Zuluaga-Gómez
- Unit of Pediatric Urology, Department of Urology, San Cecilio University Hospital, Granada, Spain
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[Study of laparoendoscopic single-site surgery (LESS) for urachal remnants in our department]. Nihon Hinyokika Gakkai Zasshi 2014; 104:697-701. [PMID: 24564076 DOI: 10.5980/jpnjurol.104.697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined laparoendoscopic single-site surgery (LESS) for urachal remnants and evaluated its usefulness and efficacy. PATIENTS AND METHODS From August 2011 to July 2012, we underwent this surgery for 5 patients (3 males, 2 females). The mean age was 30.8 (25-36) years old. A 2 cm incision was made around the umbilicus and Access Platform was placed. The entire urachal tissues were excised, and this 2 cm incison was reshaped as the umbilicus. RESULTS The median operative time was 220 (156-460) minutes, and the median operative blood loss was 10 (10-70) ml. They had no operative complications, and were discharged 6 (5-14) days after surgery. CONCLUSIONS Our surgical procedures have very excellent cosmesis and advantages in particular for young because we reshape as the umbilicus the surgical wound. We think that this surgery can be performed safe and effectively for surgeons trained in the conventional laparoscopic procedures.
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Khorgami Z, Shoar S, Anbara T, Soroush A, Nasiri S, Movafegh A, Aminian A. A randomized clinical trial comparing 4-port, 3-port, and single-incision laparoscopic cholecystectomy. J INVEST SURG 2013; 27:147-54. [PMID: 24215388 DOI: 10.3109/08941939.2013.856497] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUNDS Despite increasing trend in single incision laparoscopic cholecystectomy (SILC), there is still controversy regarding its global acceptance as a routine practice. Our study aimed to compare surgical events, early in-hospital and later outcomes of SILC with conventional multiport laparoscopic cholecystectomy (LC). METHODS Through a randomized controlled trial (RCT) between June and December 2011, 90 consecutive patients with documented biliary diseases waiting for LC were equally allocated to 3-port, 4-port, and single incision LC group. Operative time, surgical adverse events, postoperative pain according to visual analogue scale (VAS), total morphine administration, length of hospital stay, and cosmetic outcomes were compared between these three groups. RESULTS A total of 27 males (30%) and 63 females (70%) were enrolled in this study. The average patients' age and BMI were 42.6 ± 12.1 years and 26.2 ± 2.7 kg/m(2), respectively. Operative time in SILC group was significantly longer than other groups. Total intraoperative adverse events and postoperative complications did not differ significantly between the three groups. Mean ± SD VAS score at rest was significantly lower (p < 0.05) in SILC group. The average VAS at coughing was significantly lower in SILC group in all time intervals except the first 6 hr (p < 0.05). In addition, total morphine dose showed significantly lower amount in SILC group (p = 0.02). 12-month follow-up did not reveal significant difference between the study groups (p > 0.05). CONCLUSION SILC is associated with less postoperative pain in later hours, reduces in-hospital analgesic dosages, has longer procedure time, but does not increase intraoperative and postoperative adverse events It seems that SILC has no obvious advantages in terms of later outcomes.
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Affiliation(s)
- Zhamak Khorgami
- 1 Department of surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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