Two-port versus four-port laparoscopic cholecystectomy.
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.
- SourceAvailable from: M. Mahir Ozmen[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.Eur J Endosc Laparosc Surg. 01/2014; 1(1):24-29.
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ABSTRACT: This study evaluated the feasibility and safety of 3-port robotically assisted laparoscopic hysterectomy (RALH), using a consecutive series of women who underwent 3-port RALH in a university hospital. From November 2010 until June 2013 we operated on 53 women, whose mean age was 48.4 ± 7.7 years (range 35–68 years), and mean body mass index was 27.1 ± 5.1 kg/m2 (range 19.5–42.9 kg/ m2). The indications for hysterectomy were myoma in 31 (58.5 %), adenomyosis in 10 (18.9 %), cervical dysplasia in 4 (7.5 %), neoplasia in 4 (7.5 %), and recurrent polyps or postmenopausal bleeding in the remaining 4 women (7.5 %). We performed total RALH in 50 cases (94.3 %) and subtotal in the others. The median duration of total intervention was 169 min (interquartile range 147.5–206.5 min). The mean weight of the uterus was 209.8 ± 166.6 g (range 36–790 g) and mean estimated blood loss was 72.3 ± 75.9 ml (range 0–300 ml). There were no perioperative complications, in particular no blood transfusions nor conversions to laparotomy. The median hospital stay was 4 days (interquartile range 3–4 days). One patient was reoperated 1 month later for vaginal vault hematoma and another was readmitted 3 weeks post-operatively due to vaginal vault dehiscence after premature intercourse, but did not require reoperation. Three-port RALH is feasible and safe for simple hysterectomy. We believe this experience using minimum ports to be useful to prepare for robotically assisted single-port hysterectomy.Journal of Robotic Surgery 09/2014; 8(3):221-226.
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ABSTRACT: 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.Journal of Minimal Access Surgery 10/2014; 10(4):190-6.