Pain, well-being, body image and cosmesis: A comparison of single-port and four-port laparoscopic cholecystectomy

Sodergren, Mikael H.; Aslanyan, Alec; McGregor, Colleen; Purkayastha, Sanjay; Malhotra, Surbhi; Darzi, Ara; Paraskeva, Paraskevas

doi:10.3109/13645706.2014.886594

Cited by 20 publications

(8 citation statements)

References 30 publications

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“…A recent study also reports significantly lower pain one week postoperatively, even though no significant difference was found in analgesic requirement (27). However, opponents of this technique argue that the umbilical incision is obviously smaller in 4-PLC because only one trocar for the camera has to be inserted instead of all instruments.…”

Section: Discussionmentioning

confidence: 96%

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

Glauser

Käser

Berov

et al. 2014

Minimally Invasive Therapy & Allied Technologies

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Section: Discussionmentioning

confidence: 96%

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

Glauser

Käser

Berov

et al. 2014

Minimally Invasive Therapy & Allied Technologies

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“…When performing RPC for ulcerative colitis (UC) the main argument for a purely laparoscopic approach is to diminish the fall in fecundity experienced by female patients of child‐bearing age who have had open surgery . Most patients who require surgery for UC are young and prefer a laparoscopic approach as the cosmetic results are superior to those of open surgery .…”

Section: Introductionmentioning

confidence: 99%

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

et al. 2016

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Aim Laparoscopic surgery is well established for colon cancer, with defined benefits. Use of laparoscopy for the performance of restorative proctocolectomy (RPC) with ileoanal anastomosis is more controversial. Technical aspects include difficult dissection of the distal rectum and a potentially increased risk of anastomotic leakage through multiple firings of the stapler. In an attempt to overcome these difficulties we have used the technique of transanal rectal excision to perform the proctectomy. This paper describes the technique, which is combined with an abdominal approach using a single-incision platform (SIP).Method Data were collected prospectively for consecutive operations between May 2013 and October 2015, including all cases of restorative proctocolectomy with ileoanal pouch anastomosis performed laparoscopically. Only patients having a transanal total mesorectal excision (TaTME) assisted by SIP were included. The indication for RPC was ulcerative colitis (UC) refractory to medical treatment. ResultsThe procedure was performed on 16 patients with a median age of 46 (26-70) years. The male:female ratio was 5:3 and the median hospital stay was 6 (3-20) days. The median operation time was 247 (185-470) min and the overall conversion rate to open surgery was 18.7%. The 30-day surgical complication rate was 37.5% (Clavien-Dindo 1 in four patients, 2 in one patient and 3 in one patient). One patient developed anastomotic leakage 2 weeks postoperatively.Conclusion This initial study has demonstrated the feasibility and safety of TaTME combined with SIP when performing RPC with ileal pouch-anal anastomosis for UC.Keywords Ulcerative colitis, RPC, laparoscopy, single incision laparoscopic surgery, IBD, IPAA What does this paper add to the literature? The paper reports the novel approach of combining single-incision surgery and transanal rectal excision for restorative proctocolectomy. The technique has the ability to minimize surgical trauma and allow safe distal rectal dissection, especially in men with a narrow pelvis.

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“…Some studies reported that SIRC or SILC was associated with less postoperative pain than 3PLC or four-port laparoscopic cholecystectomy (4PLC). [18][19][20] Contrary to these results, however, other studies reported that 3PLC and 4PLC each produced better postoperative pain outcomes than SIRC or SILC because of the larger umbilical fascial incision and movements within that space and the greater pressure. 21,22 The exact mechanism has not yet been established, and the pain is subjective to the individual, making it difficult to compare among patients.…”

Section: Discussionmentioning

confidence: 79%

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

Kim

Han

Kang

et al. 2018

J Minim Invasive Surg

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Robotic-associated minimally invasive surgery is a novel method for overcoming some limitations of laparoscopic surgery. This study aimed to evaluate the outcomes (postoperative pain, cosmesis, surgeon's workload) of single-incision robotic cholecystectomy (SIRC) vs. single-incision laparoscopic cholecystectomy (SILC) vs. conventional three-port laparoscopic cholecystectomy (3PLC). Methods: 134 patients who underwent laparoscopic or robotic cholecystectomy at a single center during 2016~2017 were enrolled. Prospectively collected data included demographics, operative outcomes, questionnaire regarding pain and cosmesis, and NASA-Task Load Index (NASA-TLX) scores for surgeon's workload. Results: 55 patients underwent SIRC, 29 SILC, and 50 3PLC during the same period. 3PLC patient group was older than the others (SIRC vs. SILC vs. 3PLC: 48.1 vs. 42.2 vs. 54.1 years, p<0.001). Operative time was shortest with 3PLC (44.1 vs. 38.8 vs. 25.4 min, p<0.001). Estimated blood loss, postoperative complications, and postoperative stay were similar among the groups. Pain control was lowest in the 3PLC group (98.2% vs. 100% vs. 84.0%, p=0.004), however, at 2 weeks postoperatively there were no differences among the groups (p=0.374). Cosmesis scores were also worst after 3PLC (17.5 vs. 18.4 vs. 13.3, p<0.001). NASA-TLX score was highest in the SILC group (21.9 vs. 44.3 vs. 25.2, p<0.001). Conclusion: Although SIRC and SILC take longer than 3PLC, they produce superior cosmetic outcomes. Compared with SILC, SIRC is more ergonomic, lowering the surgeon's workload. Despite of higher cost, SIRC could be an alternative for treating gallbladder disease in selected patients.

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Pain, well-being, body image and cosmesis: A comparison of single-port and four-port laparoscopic cholecystectomy

Cited by 20 publications

References 30 publications

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

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

Initial experience of restorative proctocolectomy for ulcerative colitis by transanal total mesorectal rectal excision and single‐incision abdominal laparoscopic surgery

Comparison of Single-Incision Robotic Cholecystectomy, Single-Incision Laparoscopic Cholecystectomy and 3-Port Laparoscopic Cholecystectomy - Postoperative Pain, Cosmetic Outcome and Surgeon’s Workload

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