Two-port versus four-port laparoscopic cholecystectomy.

Department of Surgery, North District Hospital, Sheung Shui, N. T., Hong Kong SAR, China.
Surgical Endoscopy (Impact Factor: 3.31). 11/2003; 17(10):1624-7. DOI: 10.1007/s00464-002-8718-9
Source: PubMed

ABSTRACT Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy.
One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to receive either the two-port or the four-port technique. All patients were blinded to the type of operation they underwent. Four surgical tapes were applied to standard four-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length and difficulty of the operation, postoperative stay, and patient satisfaction score on surgery and scars.
Demographic data were comparable for both groups. Patients in the two-port group had shorter mean operative time (54.6 +/- 24.7 min vs 66.9 +/- 33.1 min for the four-post group; p = 0.03) and less pain at individual subcostal port sites [mean score using 10-cm unscaled VAS: 1.5 vs 2.8 ( p = 0.01) at the midsubcostal port site and 1.3 vs 2.3 ( p = 0.02) at the lateral subcostal port site]. Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar between the two groups.
Two-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Transumbilical single-port laparoscopic surgery (SPLS) is a newly emerged and rapidly evolving, minimally invasive treatment method. Transumbilical SPLS produces minimal parietal injury and can achieve cosmetic advantages by reducing additional trocar placement. The in-line or chopstick arrangement of laparoscopic instruments can make the operative procedures somewhat strange and inconvenient at first, but experienced laparoscopic surgeons can achieve the same coverage as conventional laparoscopic surgery with time. Here, we report the first case of transumbilical SPLS anterior resection (SPLS-AR) with transanal retrieval of aspecimen and intracorporeal single stapling anastomosis. The operating time was 270 min. There were no intraoperative or postoperative complications. Transumbilical SPLS resulted in a 1.5-cm wound with early recovery. Transumbilical SPLS-AR with transanal retrieval and intracorporeal anastomosis for sigmoid colon cancer is feasible by experienced laparoscopic colorectal surgeons based on careful evaluation and selection of patients. This operation fulfills both oncological principles and cosmetic demand.
    Journal of the Korean Surgical Society 02/2011; 80(2):77. DOI:10.4174/jkss.2011.80.2.77 · 0.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for cholelithiasis. There have been some changes in the LC technique, one of which was a reduction in the number of trocars. Our aim was to explore the feasibility of reducing the port number without compromising safety in cases of LC, and we evaluated the real benefi t associated with it in terms of pain, reco-very, and patient satisfaction. Materials and Methods: Sixty adults with symptomatic cholelithiasis were enrolled in this study, : and patients were divided into four equal groups of 15 each. During the operation, one-[single incision laparoscopic surgery (SILS)], two-, three-, or four-trocar LC was performed. For the assessment, the following parameters were compared: operative time, success rate, visual ana-logue pain score, requirement of analgesia (diclofenac), complications, patient satisfaction score with respect to operation and scars, and postoperative hospital stay. Results: There were 45 female (75%) and 15 male (25%) patients with a median (range) age of : 42.8 (20-62) years. The demographic data (age, sex, body mass index) were similar in all gro-ups. The three-and four-trocar groups had a signifi cantly shorter mean operative time than the others (SILS 50 ± 14 min, 2-trocar 36 ± 10 min, 3-trocar 27 ± 10 min and 4-trocar 24 ± 7min; p= 0.01). There were no bile duct injuries or intraabdominal collections in any group. One patient in the SILS group developed cholangitis and one patient in the three-trocar group developed wound infection postoperatively that improved with conservative treatment. There was no difference in terms of analgesia requirement, mean overall pain score, overall satisfaction scores, or hospital stay between the four groups. Scar satisfaction score was signifi cantly higher in the SILS and the two-trocar groups compared to the others. Conclusion: It appears that the SILS and two-port techniques are as reliable as the three-port and four-port method, with no obvious increase in bile duct injuries; although they did not reduce the need for analgesia, they did increase patient satisfaction.
  • [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Two-port mini laparoscopic cholecystectomy (LC) has been proposed as a safe and feasible technique. However, there are limited studies to evaluate the effectiveness of the procedure. This study is a prospective randomised trial to compare the standard four-port LC with two-port mini LC. MATERIALS AND METHODS: A total of 116 consecutive patients undergoing LC were randomised to four-port/two-port mini LC. In two-port mini LC, a 10-mm umbilical and a 5-mm epigastric port were used. Outcomes measured were duration and difficulty of operation, post-operative pain, analgesia requirements, post-operative stay, complications and cosmetic score at 30 days. RESULTS: Out of 116 patients, the ratio of M:F was 11:92, with mean age 40.79 ± 12.6 years. Twelve patients (nine in four-port group and three in two-port group) were lost to follow-up. The mean operative time were similar (P = 0.727). Post-operative pain was significantly low in the two-port group at up to 24 hrs (P = 0.023). The overall analgesia requirements (P = 0.003) and return to daily activity (P = 0.00) were significantly lower in two-port group. The cosmesis score of the two-port group was better than four-port group (P = 0.00). However, the length of hospital stay (P = 0.760) and complications (P = 0.247) were similar between the two groups. CONCLUSION: Two-port mini LC resulted in reduced pain, need for analgesia, and improved cosmesis without increasing the operative time and complication rates compared to that in four-port LC. Thus, it can be recommended in selected patients.
    Journal of Minimal Access Surgery 10/2014; 10(4):190-6. DOI:10.4103/0972-9941.141517 · 1.37 Impact Factor