全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...

Prospective Observational Study of Single-Site Multiport Per-umbilical Laparoscopic Endosurgery versus Conventional Multiport Laparoscopic Cholecystectomy: Critical Appraisal of a Unique Umbilical Approach

DOI: 10.1155/2014/909321

Full-Text   Cite this paper   Add to My Lib

Abstract:

Purpose. This prospective observational study compares an innovative approach of Single-Site Multi-Port Per-umbilical Laparoscopic Endo-surgery (SSMPPLE) cholecystectomy with the gold standard—Conventional Multi-port Laparoscopic Cholecystectomy (CMLC)—to assess the feasibility and efficacy of the former. Methods. In all, 646 patients were studied. SSMPPLE cholecystectomy utilized three ports inserted through three independent mini-incisions at the umbilicus. Only the day-to-day rigid laparoscopic instruments were used in all cases. The SSMPPLE cholecystectomy group had 320 patients and the CMLC group had 326 patients. The outcomes were statistically compared. Results. SSMPPLE cholecystectomy had average operative time of 43.8?min and blood loss of 9.4?mL. Their duration of hospitalization was 1.3 days (range, 1–5). Six patients (1.9%) of this group were converted to CMLC. Eleven patients had controlled gallbladder perforations at dissection. The Visual Analogue Scores for pain on postoperative days 0 and 7, the operative time, and the scar grades were significantly better for SSMPPLE than CMLC. However, umbilical sepsis and seroma outcomes were similar. We had no bile-duct injuries or port-site hernias in this study. Conclusion. SSMPPLE cholecystectomy approach complies with the principles of laparoscopic triangulation; it seems feasible and safe method of minimally invasive cholecystectomy. Overall, it has a potential to emerge as an economically viable alternative to single-port surgery. 1. Introduction Conventional Multi-port Laparoscopic Cholecystectomy (CMLC) is the gold-standard for tackling benign gallbladder diseases; it generally requires 4 (sometimes even 5 or more) ports spread across different quadrants of abdomen. Recently, the surgeons’ quest for reducing the access-trauma by reducing the number of ports has led to several technical modifications regarding minimally invasive cholecystectomy [1, 2]. And the natural-orifice transluminal endoscopic surgery (NOTES) with its potential to achieve completely scarless abdomen, though the most sought for, seems to have fallen out of favor owing to the technical complexity, the prolonged learning curve, and the questionable safety due to the issues regarding closure of mucosal breach. Logically, the per-umbilical approach, with its potential to produce almost the similar results, has been warmly welcomed by the surgeons and the industry. However, this “third generation” surgery is far from being accepted as the standardized approach due to the lack of ease and uniformity in

References

[1]  T. Kagaya, “Laparoscopic cholecystectomy via two ports, using the “Twin-Port” system,” Journal of Hepato-Biliary-Pancreatic Surgery, vol. 8, no. 1, pp. 76–80, 2001.
[2]  S. Trichak, “Three-port versus standard four-port laparoscopic cholecystectomy: a prospective randomized study,” Surgical Endoscopy and Other Interventional Techniques, vol. 17, no. 9, pp. 1434–1436, 2003.
[3]  M. Gagner and A. Garcia-Ruiz, “Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments,” Surgical Laparoscopy, Endoscopy and Percutaneous Techniques, vol. 8, no. 3, pp. 171–179, 1998.
[4]  S. Purkayastha, H. S. Tilney, P. Georgiou, T. Athanasiou, P. P. Tekkis, and A. W. Darzi, “Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a meta-analysis of randomised control trials,” Surgical Endoscopy and Other Interventional Techniques, vol. 21, no. 8, pp. 1294–1300, 2007.
[5]  A. N. Kalloo, V. K. Singh, S. B. Jagannath et al., “Flexible transgastric peritoneoscopy: a novel approach to diagnostic and therapeutic interventions in the peritoneal cavity,” Gastrointestinal Endoscopy, vol. 60, no. 1, pp. 114–117, 2004.
[6]  M. T. Gettman and M. L. Blute, “Transvesical peritoneoscopy: initial clinical evaluation of the bladder as a portal for natural orifice translumenal endoscopic surgery,” Mayo Clinic Proceedings, vol. 82, no. 7, pp. 843–845, 2007.
[7]  J. D. Raman, J. A. Cadeddu, P. Rao, and A. Rane, “Single-incision laparoscopic surgery: initial urological experience and comparison with natural-orifice transluminal endoscopic surgery,” BJU International, vol. 101, no. 12, pp. 1493–1496, 2008.
[8]  J. Erbella Jr. and G. M. Bunch, “Single-incision laparoscopic cholecystectomy: the first 100 outpatients,” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 8, pp. 1958–1961, 2010.
[9]  B. Bokobza, A. Valverde, E. Magne et al., “Single umbilical incision laparoscopic cholecystectomy: initial experience of the Coelio Club,” Journal of visceral surgery, vol. 147, no. 4, pp. e253–e257, 2010.
[10]  R. Sinha, “Transumbilical single-incision laparoscopic cholecystectomy with conventional instruments and ports: the way forward?” Journal of Laparoendoscopic and Advanced Surgical Techniques, vol. 21, no. 6, pp. 497–503, 2011.
[11]  T. Adachi, T. Okamoto, S. Ono, T. Kanematsu, and T. Kuroki, “Technical progress in single-incision laparoscopic cholecystectomy in our initial experience,” Minimally Invasive Surgery, vol. 2011, Article ID 972647, 4 pages, 2011.
[12]  P. A. Jategaonkar and S. P. Yadav, “Mirroring dynamic gallbladder retraction of conventional laparoscopic cholecystectomy at the transumbilical approach,” Annals of the Royal College of Surgeons of England, vol. 96, no. 2, pp. 167–168, 2014.
[13]  E. R. Podolsky and P. G. Curcillo II, “Reduced-port surgery: preservation of the critical view in single-port-access cholecystectomy,” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 12, pp. 3038–3043, 2010.
[14]  C. Palanivelu, P. A. Jategaonkar, M. Rangarajan, and B. Srikanth, “‘Pseudo’ cholelithiasis: sequelae of minimally invasive cholecystectomy with maximum surprise: an unusual case,” Endoscopy, vol. 41, supplement 2, pp. E186–E187, 2009.
[15]  P. G. Curcillo II, A. S. Wu, E. R. Podolsky et al., “Single-port-access (SPA?) cholecystectomy: a multi-institutional report of the first 297 cases,” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 8, pp. 1854–1860, 2010.
[16]  H. Massoumi, N. Kiyici, and H. Hertan, “Bile leak after laparoscopic cholecystectomy,” Journal of Clinical Gastroenterology, vol. 41, no. 3, pp. 301–305, 2007.
[17]  T. A. Azeez and K. M. Mahran, “Transumbilical laparoscopic cholecystectomy: towards a scarless abdominal surgery,” Hepato-Gastroenterology, vol. 58, no. 106, pp. 298–300, 2011.
[18]  T. Blinman, “Incisions do not simply sum,” Surgical Endoscopy and Other Interventional Techniques, vol. 24, no. 7, pp. 1746–1751, 2010.
[19]  S. Trastulli, R. Cirocchi, J. Desiderio, et al., “Systematic review and meta-analysis of randomized clinical trials comparing single-incision versus conventional laparoscopic cholecystectomy,” British Journal of Surgery, vol. 100, pp. 191–208, 2012.
[20]  J. Y. Ge, L. Wang, H. Zou, and X. W. Zhang, “Periumbilical laparoscopic surgery through triple channels using common instrumentation,” Experimental and Therapeutic Medicine, vol. 5, no. 4, pp. 1053–1056, 2013.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133