Prospective randomized comparison of single-incision laparoscopic cholecystectomy with new facilitating maneuver vs. conventional four-port laparoscopic cholecystectomy

Abstract

Objective: We aimed to investigate the technical feasibility of single-incision laparoscopic cholecystectomy (SILC) with our new facilitative maneuver and to compare it with the gold standard four-port laparoscopic cholecystectomy (LC). Material and Methods:Operation time, cosmetic score and incisional hernia rates between LC (n=20) and SILC-1 (first 20 consecutive operations with the new technique) and 2 (subsequent 20 operations with the new technique) were compared. Results:The median operation time for LC, SILC-1 and SILC-2 were; 35 min (12-75), 47.5 min (30-70), and 30 min (12-80), respectively (p=0.005). The operation duration was similar in LC and SILC-2 (p=0.277) groups. Wound seroma rate was higher in SILC-1 (45%) and SILC-2 (30%) groups than LC (5%) group (p=0.010). Cosmetic score was similar between all the groups. Hernia rates were 15.8% and 5.3% in the SILC-1 and SILC-2 groups, respectively, while there was no hernia in the LC group.Conclusion: SILC with new facilitating maneuver is comparable with classical four-port laparoscopic cholecystectomy in terms of ease, operation time, reproducibility and safety. Besides these advantages, the single-incision access technique must be optimized to provide comparable wound complication and postoperative hernia rates before being recommended to patients.

Laparoscopic cholecystectomy in children with sickle cell disease: A simple modified technique

“…15 Laparoscopic cholecystectomy has been the gold standard for gallbladder removal since 1989. [1][2][3][4][5][6][7][8][9] Laparoscopic cholecystectomy has several significant advantages over open cholecystectomy, including less pain, a faster recovery, and fewer postoperative complications. [1][2][3][4][5] Nevertheless, surgeons continue to try to improve the original technique by reducing the number of ports and the size of the incision, using a natural orifice approach, or employing different instruments.…”

“…[1][2][3][4][5][6][7][8][9] Laparoscopic cholecystectomy has several significant advantages over open cholecystectomy, including less pain, a faster recovery, and fewer postoperative complications. [1][2][3][4][5] Nevertheless, surgeons continue to try to improve the original technique by reducing the number of ports and the size of the incision, using a natural orifice approach, or employing different instruments. [1][2][3][4][5][6][7][8][9] In our case, a pediatric surgeon at our institution made this simple modification by using two natural skin creases: the inferior umbilical fold and the right groin skin crease.…”

“…[1][2][3][4][5] Nevertheless, surgeons continue to try to improve the original technique by reducing the number of ports and the size of the incision, using a natural orifice approach, or employing different instruments. [1][2][3][4][5][6][7][8][9] In our case, a pediatric surgeon at our institution made this simple modification by using two natural skin creases: the inferior umbilical fold and the right groin skin crease. Dissection and division of the cystic artery were performed with diathermy in this modified procedure.…”

“…Laparoscopic cholecystectomy has been the gold standard for gallbladder removal since 1989 . Laparoscopic cholecystectomy has several significant advantages over open cholecystectomy, including less pain, a faster recovery, and fewer postoperative complications .…”

“…The original laparoscopic cholecystectomy technique was established around 20 years ago, and since then, the technique has been continually modified to optimize the procedure. [1][2][3][4][5] Generally, the aim of these modifications is to reduce scarring from multiple incisions, pain, the length of hospital stay, and recovery time. [1][2][3][4][5][6][7][8][9] Patients with hemoglobinopathies are prone to developing cholelithiasis due to recurrent hemolysis.…”