Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach?

Glauser, Philippe M.; Käser, Samuel; Berov, Simeon; Walensi, Mikolaj; Kuhnt, Evelyn; Maurer, Christoph A.

doi:10.3109/13645706.2014.980430

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…A "Swiss cheese" effect may theoretically weaken the fascia and result in an incisional hernia [31] , though this is inconsistent with our findings [20] . While umbilical incision enlargement at the skin and fascia levels for specimen retraction is frequently necessary in standard LC operations [32] , the comparable fasciotomy size (2 cm) measured during late stages of our single-incision multiple-port longitudinal-array (SIMPLY) technique may explain the zero incisional hernia rate found in our study [20] . However, several close fasciotomies may join together and cause significant air leakage during instrument manipulation.…”

Section: Fascial Incisionsupporting

confidence: 54%

Single-incision laparoscopic surgery for biliary tract disease

Chuang

Lin

2016

WJG

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Single-incision laparoscopic surgery (SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy (SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials (RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration (CBDE) methods have been used for more than one hundred years, laparoscopic CBDE (LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and single-incision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.

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Section: Fascial Incisionsupporting

confidence: 54%

Single-incision laparoscopic surgery for biliary tract disease

Chuang

Lin

2016

WJG

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“…2,3 Perception of pain after laparoscopic procedures is a complex combination of intraoperative and postoperative factors, related to intraoperative manipulations and the patient itself. [3][4][5][6]23 Among these, port-site manipulation to extract the gallbladder and the choice of the extraction site contribute to postoperative pain. Moreover, the extraction site should be chosen according to postoperative pain, as well as other factors like feasibility of extraction, risk of surgical site infection, and port-site hernia.…”

Section: Discussionmentioning

confidence: 99%

“…2,4 Beyond these, the port-site manipulation and stretching of the port site to extract the specimen are further factors contributing to postoperative pain. 5,6 Depending on the surgeon's preference, different locations can be used to extract the gallbladder through a trocar incision. 7,8 To reduce the postoperative pain, many techniques are described in patients undergoing laparoscopic procedures, such as the use of intraperitoneal or trocar-site anesthesia, low-pressure pneumoperitoneum, or the choice of trocar site and port sizes.…”

Section: Introductionmentioning

confidence: 99%

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

et al. 2019

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Purpose. To date, no evidence supports the retrieval of the gallbladder through a specific trocar site, and this choice is left to surgeons’ preference. The aim of this meta-analysis was to investigate the influence of the trocar site used to extract the gallbladder on postoperative outcomes. Methods. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search of PubMed, Google Scholar, Cochrane Library, and EMBASE databases was performed. Terms used were: (“gallbladder” OR “cholecystectomy”) AND “umbilical” AND (“epigastric” OR “subxiphoid”). Randomized trials comparing the gallbladder retrieval from different trocar sites were considered for further analysis. Results. Literature search revealed 145 articles, of which 7 matched inclusion criteria and reported adequate data about postoperative pain, operative time, port-site infections, and hernias. A total of 876 patients were included, and the gallbladder was extracted through epigastric or umbilical trocar site in 441 and in 435 patients, respectively. A statistically significant difference among groups was noted in terms of postoperative pain at 1, 6, 12, and 24 hours in favor of the umbilical trocar site ( P < .001). No significant differences were noted in postoperative hernia and infection rate, nor in terms of operative time. Conclusions. This meta-analysis shows a statistically significant reduction in terms of postoperative pain at 1, 6, 12, and 24 hours after surgery when the gallbladder is extracted through the umbilical port. Retrieval time, infections, and hernias rate implicate no contraindication for the choice of a specific trocar site to extract specimens. Despite limitations of this study, the umbilical trocar should be favored as the first choice to retrieve the gallbladder.

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“…4 Aside from these, port-site manipulation and stretching to extract the specimen are factors that contribute to postoperative pain. 5,6 The gold standard operation for cholecystitis was open cholecystectomy, and cholelithiasis is no longer a routine practice. As a gold standard treatment for gallstones, laparoscopic cholecystectomy has surpassed it.Various modifications have evolved over time, but traditional laparoscopic cholecystectomy procedures have remained unchanged.Traditionally, four ports procedures were followed.…”

Section: Introductionmentioning

confidence: 99%

Effect of Gall Bladder Retrieval via Epigestric Vs Umbilical Port in Laparoscopic Cholectystectomy

Khan¹,

Khan²,

Ali³

et al. 2021

PJMHS

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Background and Aim: The retrieval of the gallbladder is a key event in laparoscopic cholecystectomy and significantly contributes to postoperative infections and pain. The GB is extracted through an umbilical or epigastric port. The goal of this single-center study was to compare GB retrieval via epigastric versus umbilical port in terms of postoperative site pain and infections. Materials and Methods:In this single-center study, 60 Cholelithiasis patients under went laparoscopic cholectystectomy (LC) for symptomatic gallbladder disease during the period from November 2020 to April 2021 at surgery department of Gambat Institute of Medical Sciences, Gambat Sindh Pakistan. The patients were selected out of the operating room for GB retrieval via umbilical port (Group-I with n = 30) versus epigastric port (Group-II with n = 30) randomly.All 60 patients had routine blood tests such as CBC, SGOT, SGPT, PT, and urine examinations. Until their bowels recovered, all of the patients were kept nil by mouth and on parenteral fluids. They were closely monitored in the post-operative period, with special attention paid to recording the pulse rate, temperature, and level of pain on a 24-hour basis. Results:Chronic Cholecystitis patients chosen randomly from the cholecystectomy list to have their gallbladder delivered through an umbilical or epigastric port.Group I had median pain (IQR) of 5 (1.5), 4 (1), and 2 (1) when compared to group II's median pain (IQR) of 4 (1), 2 (1), and 1 (0.5) one day after the procedure (p-value=0.001), at the time of hospital discharge (p-value0.001), and one month post-surgery (p-value0.001).In group B, there was a clear regression in postoperative pain from the day of surgery until a month later (p-value0.001). Conclusion:According to our findings, umbilical ports are preferable to epigastric ports in terms of post-operative pain, but there is an increased port site infection and hernia risk. Keywords:Cholecystectomy, Umbilical port, Epigastric port, Gall bladder retrieval, Laparoscopic.

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Enlargement of umbilical incision in standard laparoscopic cholecystectomy is frequently necessary: An argument for the single incision approach?

Cited by 4 publications

References 27 publications

Single-incision laparoscopic surgery for biliary tract disease

Single-incision laparoscopic surgery for biliary tract disease

Gallbladder Retrieval From Epigastric Versus Umbilical Port in Laparoscopic Cholecystectomy: A PRISMA-Compliant Meta-Analysis

Effect of Gall Bladder Retrieval via Epigestric Vs Umbilical Port in Laparoscopic Cholectystectomy

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