Feasibility and safety of single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy in an ambulatory setting
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摘要
Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy(SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC( n = 49) or LC( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time(46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC; P < 0.001). As compared with LC, SILC was associated with lower total costs(8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB; P < 0.001) and better cosmetic satisfaction(4.94 ±0.24 vs. 4.74 ± 0.54; P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy(SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC( n = 49) or LC( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time(46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC; P < 0.001). As compared with LC, SILC was associated with lower total costs(8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB; P < 0.001) and better cosmetic satisfaction(4.94 ±0.24 vs. 4.74 ± 0.54; P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
Background: Single-incision laparoscopic surgery has emerged as an alternative to conventional laparoscopic cholecystectomy(LC) in the clinical setting. Limited information is available on the possibility of performing single-incision laparoscopic surgery as an ambulatory procedure. This study aimed to determine the feasibility and safety of single-incision laparoscopic cholecystectomy(SILC) versus conventional LC in an ambulatory setting. Methods: Ninety-one patients were randomized to SILC( n = 49) or LC( n = 42). The success rate, operative duration, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, total cost, complications, pain score, vomiting, and cosmetic satisfaction of the two groups were then compared. Results: There were significant differences in the operative time(46.89 ± 10.03 min in SILC vs. 37.24 ± 10.23 min in LC; P < 0.001). As compared with LC, SILC was associated with lower total costs(8012.28 ± 752.67 RMB vs. 10258.91 ± 1087.63 RMB; P < 0.001) and better cosmetic satisfaction(4.94 ±0.24 vs. 4.74 ± 0.54; P = 0.031). There were no significant differences between-group in terms of general data, success rate, blood loss, hospital stay, gallbladder perforation, drainage, delayed discharge, readmission, complications, pain score, and vomiting( P > 0.05). Conclusions: Ambulatory SILC is safe and feasible for selected patients. The advantages of SILC as compared with LC are improved cosmetic satisfaction and lower total costs.
引文
[1] Mouret P. From the first Laparoscopie cholecystectomy to the frontiers of laparoscopic surgery-the future prospectives. Dig Surg 1991;8:124-125.
[2] Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.
[3] Chuang SH, Yang WJ, Chang CM, Lin CS, Yeh MC. Is routine single-incision laparoscopic cholecystectomy feasible? A retrospective observational study. Am J Surg 2015;210:315-321.
[4] Partelli S, Barugola G, Sartori A, Crippa S, Falconi M, Ruffo G. Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon:findings of a randomized trial. Surg Today2016;46:313-318.
[5] Wu XS, Shi LB, Gu J, Dong P, Lu JH, Li ML, et al. Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy:a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A2013;23:183-191.
[6] Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg2011;202:254-258.
[7] Arregui ME, Davis CJ, Arkush A, Nagan RF. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1991;1:240-245.
[8] Planells Roig M, Garcia Espinosa R, Cervera Delgado M, Navarro Vicente F, Carrau Giner M, Sanahuja Santafe A, et al. Ambulatory laparoscopic cholecystectomy. A cohort study of 1600 consecutive cases. Cir Esp 2013;91:156-162.
[9] Prasad A, Foley RJ. Day case laparoscopic cholecystectomy:a safe and cost effective procedure. Eur J Surg 1996;162:43-46.
[10] Beninato T, Kleiman DA, Soni A, Nissan DA, Filicori F, Servais EL, et al. Expanding the indications for single-incision laparoscopic cholecystectomy to all patients with biliary disease:is it safe? Surg Laparosc Endosc Percutan Tech2015;25:10-14.
[11] Sato N, Kohi S, Tamura T, Minagawa N, Shibao K, Higure A. Single-incision laparoscopic cholecystectomy for acute cholecystitis:a retrospective cohort study of 52 consecutive patients. Int J Surg 2015;17:48-53.
[12] Rawlings A, Hodgett SE, Matthews BD, Strasberg SM, Quasebarth M, Brunt LM.Single-incision laparoscopic cholecystectomy:initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg 2010;211:1-7.
[13] Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, et al. Single-site robotic cholecystectomy(SSRC)versus single-incision laparoscopic cholecystectomy(SILC):comparison of learning curves. First European experience. Surg Endosc 2012;26:1648-1655.
[14] Pan MX, Liang ZW, Cheng Y, Jiang ZS, Xu XP, Wang KH, et al. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy.World J Gastroenterol 2013;19:4786-4790.
[15] Tay CW, Shen L, Hartman M, Iyer SG, Madhavan K, Chang SK. SILC for SILC:single institution learning curve for single-incision laparoscopic cholecystectomy.Minim Invasive Surg 2013;2013:381628.
[16] Hernandez J, Ross S, Morton C, McFarlin K, Dahal S, Golkar F, et al. The learning curve of laparoendoscopic single-site(LESS)cholecystectomy:definable, short,and safe. J Am Coll Surg 2010;211:652-657.
[17] Han HJ, Choi SB, Park MS, Lee JS, Kim WB, Song TJ, et al. Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model:an analysis of 150 consecutive patients. J Hepatobiliary Pancreat Sci 2011;18:510-515.
[18] Feinberg EJ, Agaba E, Feinberg ML, Camacho D, Vemulapalli P. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surg Laparosc Endosc Percutan Tech 2012;22:114-117.
[19] Joseph M, Phillips MR, Farrell TM, Rupp CC. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate:a review and a word of caution. Ann Sure 2012;256:1-6.
[20] Guzman-Valdivia G. Routine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary. Surg Laparosc Endosc Percutan Tech 2008;18:547-550.
[21] Arezzo A, Pas sera R, Forcignano E, Rapetti L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events:results of a meta-analysis of randomized controlled trials. Surg Endosc2018;32:3739-37,53.
[22] Sarli L, Pietra N, Costi R, Grattarola M. Gallbladder perforation during laparoscopic cholecystectomy. World J Surg 1999;23:1186-1190.
[23] Barrat C, Champault A, Matthyssens L, Champault G. Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy does not influence the prognosis. Prospective study. Ann Chir 2004;129:25-29.
[24] Uygar Kalayci M, Veli Akin B, Alis H, Kapan S, Nuray Turhan A, Aygun E. Short--term effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain. Surg Endosc 2008;22:1317-1320.
[25] Altuntas YE, Oncel M, Haksal M, Kement M, Gundogdu E, Aksakal N, et al. Gallbladder perforation during elective laparoscopic cholecystectomy:incidence,risk factors, and outcomes. North Clin Istanb 2018;5:47-53.
[26] Bas G, Eryilmaz R, Akcakaya A, Daldal E, Alimoglu O, Okan I, et al. The effect of the degree of histologic inflammation on gallbladder perforation during laparoscopic choleystectomy. J Laparoendosc Adv Surg Tech A 2005;15:130-134.
[27] Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D. Incisional hernia after single-incision laparoscopic cholecystectomy:incidence and predictive factors. Surg Endosc 2016;30:4539-4543.
[28] Christoffersen MW, Brandt E, Oehlenschlager J, Rosenberg J, Helgstrand F,J rgensen LN, et al. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy:a nationwide prospective, matched cohort study.Surg Endosc 2015;29:3239-3245.
[29] Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N,Mavridou P, et al. Different pain scores in single transumbilical incision laparo-scopic cholecystectomy versus classic laparoscopic cholecystectomy:a randomized controlled trial. Surg Endosc 2010;24:1842-1848.
[30] Brown KM, Moore BT, Sorensen GB, Boettger CH, Tang F, Jones PG,et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy:a randomized prospective trial. Surg Endosc2013;27:3108-3115.
[31] Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
[32] Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy:report of preliminary data. Am J Surg 2011;201:369-373.
[33] Garg P, Thakur JD, Garg M, Menon GR. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy:a meta-analysis of randomized controlled trials. J Gastrointest Surg 2012;16:1618-1628.
[34] Sabuncuoglu MZ, Benzin MF, Cakir T, Sozen I, Sabuncuoglu A. Triple, double-and single-incision laparoscopic cholecystectomy:a prospective study. Int J Clin Exp Med 2014;7:3385-3391.
[35] Sajid MS, Ladwa N, Kalra L, Hutson, KK, Singh KK, Sayegh M. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy:meta-analysis and systematic review of randomized controlled trials. World J Surg 2012;36:2644-2653.
[36] Tranchart H, Ketoff S, Lanas P, Pourcher G, Di Giuro G, Tzanis D, et al. Single incision laparoscopic cholecystectomy:for what benefit? HPB(Oxford)2013;15:433-438.
[37] Chang SK, Tay CW, Bicol RA, Lee YY, Madhavan K. A case-control study of single-incision versus standard laparoscopic cholecystectomy. World J Surg2011;35:289-293.
[2] Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One-wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.
[3] Chuang SH, Yang WJ, Chang CM, Lin CS, Yeh MC. Is routine single-incision laparoscopic cholecystectomy feasible? A retrospective observational study. Am J Surg 2015;210:315-321.
[4] Partelli S, Barugola G, Sartori A, Crippa S, Falconi M, Ruffo G. Single-incision laparoscopic cholecystectomy versus traditional laparoscopic cholecystectomy performed by a single surgeon:findings of a randomized trial. Surg Today2016;46:313-318.
[5] Wu XS, Shi LB, Gu J, Dong P, Lu JH, Li ML, et al. Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy:a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A2013;23:183-191.
[6] Lai EC, Yang GP, Tang CN, Yih PC, Chan OC, Li MK. Prospective randomized comparative study of single incision laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Am J Surg2011;202:254-258.
[7] Arregui ME, Davis CJ, Arkush A, Nagan RF. In selected patients outpatient laparoscopic cholecystectomy is safe and significantly reduces hospitalization charges. Surg Laparosc Endosc 1991;1:240-245.
[8] Planells Roig M, Garcia Espinosa R, Cervera Delgado M, Navarro Vicente F, Carrau Giner M, Sanahuja Santafe A, et al. Ambulatory laparoscopic cholecystectomy. A cohort study of 1600 consecutive cases. Cir Esp 2013;91:156-162.
[9] Prasad A, Foley RJ. Day case laparoscopic cholecystectomy:a safe and cost effective procedure. Eur J Surg 1996;162:43-46.
[10] Beninato T, Kleiman DA, Soni A, Nissan DA, Filicori F, Servais EL, et al. Expanding the indications for single-incision laparoscopic cholecystectomy to all patients with biliary disease:is it safe? Surg Laparosc Endosc Percutan Tech2015;25:10-14.
[11] Sato N, Kohi S, Tamura T, Minagawa N, Shibao K, Higure A. Single-incision laparoscopic cholecystectomy for acute cholecystitis:a retrospective cohort study of 52 consecutive patients. Int J Surg 2015;17:48-53.
[12] Rawlings A, Hodgett SE, Matthews BD, Strasberg SM, Quasebarth M, Brunt LM.Single-incision laparoscopic cholecystectomy:initial experience with critical view of safety dissection and routine intraoperative cholangiography. J Am Coll Surg 2010;211:1-7.
[13] Spinoglio G, Lenti LM, Maglione V, Lucido FS, Priora F, Bianchi PP, et al. Single-site robotic cholecystectomy(SSRC)versus single-incision laparoscopic cholecystectomy(SILC):comparison of learning curves. First European experience. Surg Endosc 2012;26:1648-1655.
[14] Pan MX, Liang ZW, Cheng Y, Jiang ZS, Xu XP, Wang KH, et al. Learning curve of transumbilical suture-suspension single-incision laparoscopic cholecystectomy.World J Gastroenterol 2013;19:4786-4790.
[15] Tay CW, Shen L, Hartman M, Iyer SG, Madhavan K, Chang SK. SILC for SILC:single institution learning curve for single-incision laparoscopic cholecystectomy.Minim Invasive Surg 2013;2013:381628.
[16] Hernandez J, Ross S, Morton C, McFarlin K, Dahal S, Golkar F, et al. The learning curve of laparoendoscopic single-site(LESS)cholecystectomy:definable, short,and safe. J Am Coll Surg 2010;211:652-657.
[17] Han HJ, Choi SB, Park MS, Lee JS, Kim WB, Song TJ, et al. Learning curve of single port laparoscopic cholecystectomy determined using the non-linear ordinary least squares method based on a non-linear regression model:an analysis of 150 consecutive patients. J Hepatobiliary Pancreat Sci 2011;18:510-515.
[18] Feinberg EJ, Agaba E, Feinberg ML, Camacho D, Vemulapalli P. Single-incision laparoscopic cholecystectomy learning curve experience seen in a single institution. Surg Laparosc Endosc Percutan Tech 2012;22:114-117.
[19] Joseph M, Phillips MR, Farrell TM, Rupp CC. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate:a review and a word of caution. Ann Sure 2012;256:1-6.
[20] Guzman-Valdivia G. Routine administration of antibiotics to patients suffering accidental gallbladder perforation during laparoscopic cholecystectomy is not necessary. Surg Laparosc Endosc Percutan Tech 2008;18:547-550.
[21] Arezzo A, Pas sera R, Forcignano E, Rapetti L, Cirocchi R, Morino M. Single-incision laparoscopic cholecystectomy is responsible for increased adverse events:results of a meta-analysis of randomized controlled trials. Surg Endosc2018;32:3739-37,53.
[22] Sarli L, Pietra N, Costi R, Grattarola M. Gallbladder perforation during laparoscopic cholecystectomy. World J Surg 1999;23:1186-1190.
[23] Barrat C, Champault A, Matthyssens L, Champault G. Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy does not influence the prognosis. Prospective study. Ann Chir 2004;129:25-29.
[24] Uygar Kalayci M, Veli Akin B, Alis H, Kapan S, Nuray Turhan A, Aygun E. Short--term effects of gallbladder perforations during laparoscopic cholecystectomy on respiratory mechanics and depth of pain. Surg Endosc 2008;22:1317-1320.
[25] Altuntas YE, Oncel M, Haksal M, Kement M, Gundogdu E, Aksakal N, et al. Gallbladder perforation during elective laparoscopic cholecystectomy:incidence,risk factors, and outcomes. North Clin Istanb 2018;5:47-53.
[26] Bas G, Eryilmaz R, Akcakaya A, Daldal E, Alimoglu O, Okan I, et al. The effect of the degree of histologic inflammation on gallbladder perforation during laparoscopic choleystectomy. J Laparoendosc Adv Surg Tech A 2005;15:130-134.
[27] Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D. Incisional hernia after single-incision laparoscopic cholecystectomy:incidence and predictive factors. Surg Endosc 2016;30:4539-4543.
[28] Christoffersen MW, Brandt E, Oehlenschlager J, Rosenberg J, Helgstrand F,J rgensen LN, et al. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy:a nationwide prospective, matched cohort study.Surg Endosc 2015;29:3239-3245.
[29] Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N,Mavridou P, et al. Different pain scores in single transumbilical incision laparo-scopic cholecystectomy versus classic laparoscopic cholecystectomy:a randomized controlled trial. Surg Endosc 2010;24:1842-1848.
[30] Brown KM, Moore BT, Sorensen GB, Boettger CH, Tang F, Jones PG,et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy:a randomized prospective trial. Surg Endosc2013;27:3108-3115.
[31] Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
[32] Marks J, Tacchino R, Roberts K, Onders R, Denoto G, Paraskeva P, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy:report of preliminary data. Am J Surg 2011;201:369-373.
[33] Garg P, Thakur JD, Garg M, Menon GR. Single-incision laparoscopic cholecystectomy vs. conventional laparoscopic cholecystectomy:a meta-analysis of randomized controlled trials. J Gastrointest Surg 2012;16:1618-1628.
[34] Sabuncuoglu MZ, Benzin MF, Cakir T, Sozen I, Sabuncuoglu A. Triple, double-and single-incision laparoscopic cholecystectomy:a prospective study. Int J Clin Exp Med 2014;7:3385-3391.
[35] Sajid MS, Ladwa N, Kalra L, Hutson, KK, Singh KK, Sayegh M. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy:meta-analysis and systematic review of randomized controlled trials. World J Surg 2012;36:2644-2653.
[36] Tranchart H, Ketoff S, Lanas P, Pourcher G, Di Giuro G, Tzanis D, et al. Single incision laparoscopic cholecystectomy:for what benefit? HPB(Oxford)2013;15:433-438.
[37] Chang SK, Tay CW, Bicol RA, Lee YY, Madhavan K. A case-control study of single-incision versus standard laparoscopic cholecystectomy. World J Surg2011;35:289-293.