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Fisher AT, Bessoff KE, Khan RI, Touponse GC, Yu MM, Patil AA, Choi J, Stave CD, Forrester JD. Evidence-based surgery for laparoscopic cholecystectomy. Surg Open Sci 2022; 10:116-134. [PMID: 36132940 PMCID: PMC9483801 DOI: 10.1016/j.sopen.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Laparoscopic cholecystectomy is frequently performed for acute cholecystitis and symptomatic cholelithiasis. Considerable variation in the execution of key steps of the operation remains. We conducted a systematic review of evidence regarding best practices for critical intraoperative steps for laparoscopic cholecystectomy. Methods We identified 5 main intraoperative decision points in laparoscopic cholecystectomy: (1) number and position of laparoscopic ports; (2) identification of cystic artery and duct; (3) division of cystic artery and duct; (4) indications for subtotal cholecystectomy; and (5) retrieval of the gallbladder. PubMed, EMBASE, and Web of Science were queried for relevant studies. Randomized controlled trials and systematic reviews were included for analysis, and evidence quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Results Fifty-two articles were included. Although all port configurations were comparable from a safety standpoint, fewer ports sometimes resulted in improved cosmesis or decreased pain but longer operative times. The critical view of safety should be obtained for identification of the cystic duct and artery but may be obtained through fundus-first dissection and augmented with cholangiography or ultrasound. Insufficient evidence exists to compare harmonic-shear, clipless ligation against clip ligation of the cystic duct and artery. Stump closure during subtotal cholecystectomy may reduce rates of bile leak and reoperation. Use of retrieval bag for gallbladder extraction results in minimal benefit. Most studies were underpowered to detect differences in incidence of rare complications. Conclusion Key operative steps of laparoscopic cholecystectomy should be informed by both compiled data and surgeon preference/patient considerations.
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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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Wu Y, Yang W, Cai Z, Zhang Z. The effect of ultrasound-guided low serratus anterior plane block on laparoscopic cholecystectomy postoperative analgesia: A randomized clinical trial. Medicine (Baltimore) 2021; 100:e27708. [PMID: 34871261 PMCID: PMC8568462 DOI: 10.1097/md.0000000000027708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/19/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Anterior serratus plane block for analgesia in many procedures, but there have been no reports of analgesia undergoing laparoscopic cholecystectomy (LC). We investigated the effects of ultrasonic-guided low serratory anterior block on patients undergoing LC. METHODS One hundred patients who undergo LC were selected and randomly divided into 2 groups: Patients in group C with routine general anesthesia and patients in group S treat low anterior serratus block combined with general anesthesia. The serratus anterior block was performed at the T8 to T9 point after anesthesia induction, before cutting leather (T0), stamp card placement (T1), 2 groups of patients' heart rate (HR), blood pressure were recorded, at the same time dosage of analgesic drugs and postoperative 0.5, 6, 12, 24 hours when resting visual analogue scale (VAS) scores were recorded in 2 groups of patients. RESULTS The T0 point, patients' HR, blood pressure had significant difference (P > .05), the T1 point, patients' HR, mean arterial pressure in group S lower than group C (P < .05), the amount of intra-operative propofol and remifentanil, patients in group S were less than in group C (P < .05), and resting VAS pain score at the 0.5, 6, 12 hours after operation patients in group S were lower than group C also (P < .05), resting VAS pain had no significant difference at postoperative 24 hours between 2 groups (P > .05). CONCLUSION Low serratus anterior plane block in LC can provide safe and effective analgesia for patients.
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Affiliation(s)
- Yu Wu
- Department of Anesthesiology, No. 980th Hospital (Bethune International Peace Hospital) of Joint Logistic Support Force, Shijiazhuang, China
| | - Weicai Yang
- Department of Anesthesiology, First People's Hospital of Xiangtan City, Xiangtan, China
| | - Zenghua Cai
- Department of Anesthesiology, No. 980th Hospital (Bethune International Peace Hospital) of Joint Logistic Support Force, Shijiazhuang, China
| | - Zaiwang Zhang
- Department of Anesthesiology, No. 980th Hospital (Bethune International Peace Hospital) of Joint Logistic Support Force, Shijiazhuang, China
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Hasegawa N, Takeyama H, Suzuki Y, Noura S, Odagiri K, Yanagimoto Y, Yamashita M, Shimizu J, Kawase T, Imamura H, Iwazawa T, Tomita N, Dono K. Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report. Surg Case Rep 2021; 7:213. [PMID: 34546429 PMCID: PMC8455758 DOI: 10.1186/s40792-021-01292-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 09/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Paraduodenal hernia is a rare internal hernia which accounts for only 1% of all intestinal hernias. There have been limited reported cases of paraduodenal hernia treated by laparoscopic surgery. We report a case of left paraduodenal hernia that was successfully treated by single-incision laparoscopic surgery (SILS). Case presentation A 17-year-old woman presented with left upper abdominal pain. An abdominal enhanced multi-detector computed tomography demonstrated encapsulated cluster of small bowel loops in the left upper quadrant which passed through the dorsal side of the inferior mesenteric vein, and showed that blood flow of the prolapsed small bowel was preserved. We preoperatively diagnosed left paraduodenal hernia without ischemia or necrosis. We performed elective SILS because she was a young actress training school student and cosmetic benefit was thought to be important. We pulled out the protruded small bowel and closed a defect with a running suture by SILS. The patient was discharged 3 days after the surgery with no complications. Conclusions We reported the case of left paraduodenal hernia successfully diagnosed and treated by SILS.
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Affiliation(s)
- Noboru Hasegawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Takeyama
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan.
| | - Yozo Suzuki
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Shingo Noura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Kazuki Odagiri
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Yoshitomo Yanagimoto
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Masafumi Yamashita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Tomono Kawase
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Iwazawa
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Naohiro Tomita
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
| | - Keizo Dono
- Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara-cho, Toyonaka, Osaka, 560-8565, Japan
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Zhao JJ, Syn NL, Chong C, Tan HL, Ng JYX, Yap A, Kabir T, Goh BKP. Comparative outcomes of needlescopic, single-incision laparoscopic, standard laparoscopic, mini-laparotomy, and open cholecystectomy: A systematic review and network meta-analysis of 96 randomized controlled trials with 11,083 patients. Surgery 2021; 170:994-1003. [PMID: 34023139 DOI: 10.1016/j.surg.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/17/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most randomized trials on minimally invasive cholecystectomy have been conducted with standard (3/4-port) laparoscopic or open cholecystectomy serving as the control group. However, there exists a dearth of head-to-head trials that directly compare different minimally invasive techniques for cholecystectomy (eg, single-incision laparoscopic cholecystectomy versus needlescopic cholecystectomy). Hence, it remains largely unknown how the different minimally invasive cholecystectomy techniques fare up against one another. METHODS To minimize selection and confounding biases, only randomized controlled trials were considered for inclusion. Perioperative outcomes were compared using frequentist network meta-analyses. The interpretation of the results was driven by treatment effects and surface under the cumulative ranking curve values. A sensitivity analysis was also undertaken focusing on a subgroup of randomized controlled trials, which recruited patients with only uncomplicated cholecystitis. RESULTS Ninety-six eligible randomized controlled trials comprising 11,083 patients were identified. Risk of intra-abdominal infection or abscess, bile duct injury, bile leak, and open conversion did not differ significantly between minimally invasive techniques. Needlescopic cholecystectomy was associated with the lowest rates of wound infection (surface under the cumulative ranking curve value = 0.977) with an odds ratio of 0.095 (95% confidence interval: 0.023-0.39), 0.32 (95% confidence interval: 0.11-0.98), 0.33 (95% confidence interval: 0.11-0.99), 0.36 (95% confidence interval: 0.14-0.98) compared to open cholecystectomy, single-incision laparoscopic cholecystectomy, mini-laparotomy, and standard laparoscopic cholecystectomy, respectively. Mini-laparotomy was associated with the shortest operative time (surface under the cumulative ranking curve value = 0.981) by a mean difference of 22.20 (95% confidence interval: 13.79-30.62), 12.17 (95% confidence interval: 1.80-22.54), 9.07 (95% confidence interval: 1.59-16.54), and 8.36 (95% confidence interval: -1.79 to 18.52) minutes when compared to single-incision laparoscopic cholecystectomy, needlescopic cholecystectomy, standard laparoscopic cholecystectomy, and open cholecystectomy, respectively. Needlescopic cholecystectomy appeared to be associated with the shortest hospitalization (surface under the cumulative ranking curve value = 0.717) and lowest postoperative pain (surface under the cumulative ranking curve value = 0.928). CONCLUSION Perioperative outcomes differed across minimally invasive techniques and, in some instances, afforded superior outcomes compared to standard laparoscopic cholecystectomy. These findings suggest that there may be equipoise for exploring further the utility of novel minimally invasive techniques and potentially incorporating them into the general surgery training curriculum.
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Affiliation(s)
- Joseph J Zhao
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Nicholas L Syn
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore. http://twitter.com/ARWMD
| | - Cheryl Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Hwee Leong Tan
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore
| | - Julia Yu Xin Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ashton Yap
- Townsville Hospital, Queensland, Australia
| | - Tousif Kabir
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Hepatopancreatobiliary Service, Department of General Surgery, Sengkang General Hospital, Singapore
| | - Brian K P Goh
- Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore; Duke-NUS Medical School, Singapore.
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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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Fujiwara H, Suto T, Umemura A, Tanahashi Y, Amano S, Ikeda K, Harada K, Sasaki A. Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report. Surg Case Rep 2020; 6:246. [PMID: 33000428 PMCID: PMC7527381 DOI: 10.1186/s40792-020-01005-6] [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: 06/12/2020] [Accepted: 09/19/2020] [Indexed: 12/27/2022] Open
Abstract
Background The European and American guidelines recommend that symptomatic umbilical hernias (UHs) are repaired using an open approach with a preperitoneal flat mesh. However, the standard treatment procedure for large UH in patients with extreme obesity is yet to be established. Here, we present the first case of a patient with morbid obesity undergoing laparoscopic UH repair using needlescopic instruments and an intraperitoneal onlay mesh plus repair (IPOM plus). Case presentation A 29-year-old man, who was classified as morbidly obese (body mass index, 36.7 kg/m2) noticed a reducible nontender mass in the umbilical region and was subsequently diagnosed with an UH, with a diameter of 4 cm. Laparoscopic IPOM plus repair was planned using a needlescopic method for a large UH in the patient with morbid obesity. A 3-mm rigid laparoscope was mainly used in the procedure. After a 12-mm trocar and two 3-mm trocars were inserted, fascial defect closure was performed using intracorporeal suturing with 0 monofilament polypropylene threads. Then, IPOM was performed laparoscopically using an 11.4-cm round mesh coated with collagen to prevent adhesions. The operative time and blood loss were 57 min and 1 g, respectively. The postoperative course was uneventful. Conclusions Reduced-port laparoscopic surgery using needlescopic instruments and an IPOM plus technique is a minimally invasive and convenient combination option for large UH in a patient with morbid obesity.
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Affiliation(s)
- Hisataka Fujiwara
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Takayuki Suto
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3695, Japan
| | - Yota Tanahashi
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Satoshi Amano
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | | | - Kazuho Harada
- Anesthesia Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Sasaki
- Department of Surgery, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3695, Japan
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Hoshino M, Omura N, Yano F, Tsuboi K, Yamamoto SR, Akimoto S, Masuda T, Kashiwagi H, Yanaga K. Needlescopic versus conventional laparoscopic Heller–Dor procedure for achalasia: a propensity score-matched analysis. Surg Today 2020; 50:721-725. [DOI: 10.1007/s00595-019-01945-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/03/2019] [Indexed: 12/28/2022]
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9
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Umemura A, Suto T, Fujiwara H, Nakamura S, Endo F, Sasaki A. Retrospective case-matched study between reduced port laparoscopic rectopexy and conventional laparoscopic rectopexy for rectal prolapse. J Minim Access Surg 2018; 15:316-319. [PMID: 30178763 PMCID: PMC6839351 DOI: 10.4103/jmas.jmas_100_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Reduced port laparoscopic Well's procedure (RPLWP) is a novel technique used to overcome the limitations of single-incision laparoscopic surgery. The aim of this study was to compare outcomes between RPLWP and conventional laparoscopic Well's procedure (CLWP) and to investigate the learning curve of RPLWP. Patients and Methods: From January 2006 to March 2017, a retrospective review of a prospectively maintained laparoscopic surgery database was performed to identify patients had undergone CLWP and RPLWP. From these patients, each of 10 cases were manually matched for age, sex, body mass index. From January 2006 to March 2015, CLWP was used for all procedures whereas, from April 2015, RPLWP was routinely performed as a standard procedure for rectal prolapse. Results: No significant differences were observed between the two groups in terms of operating time, blood loss, intraoperative complications, and conversion to CLWP or open rectopexy. Based on the postoperative outcomes, the hospital stay was significantly shorter in the RPLWP group. The estimated learning curve for RPLWP was fitted and defined as y = 278.47e-0.064x with R2= 0.838; therefore, a significant decrease in operative time was observed by using the more advanced surgical procedure. Conclusions: RPLWP is an effective, safe, minimally invasive procedural alternative to CLWP with no disadvantage for patients when a skilled surgeon performs it.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, Morioka, Japan
| | - Takayuki Suto
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | | | - Seika Nakamura
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Fumitaka Endo
- Department of Surgery, Morioka Municipal Hospital, Morioka, Japan
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, Morioka, Japan
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