Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy

Newman, Richard M.; Umer, Affan; Bozzuto, Bethany J.; Dilungo, Jennifer L.; Ellner, Scott J.

doi:10.1016/j.jamcollsurg.2015.12.016

Cited by 22 publications

(13 citation statements)

References 16 publications

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“…Bucher et al found the cost of SLC to be higher in a Swiss trial, and Pan et al from China report equivalent operative costs compared to MLC [8,20]. In retrospective studies, the results differ from lower to substantially higher cost for SLC [46][47][48][49]. One of the main cost factors in SLC is the use of a disposable commercial port system which can be significantly reduced by the usage of a reusable port as reported by Shussmann et al [49].…”

Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Klein

Barutcu

Kröll

et al. 2020

Langenbecks Arch Surg

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Background Within the last years, single-incision laparoscopic cholecystectomy (SLC) emerged as an alternative to multiport laparoscopic cholecystectomy (MLC). SLC has advantages in cosmetic results, and postoperative pain seems lower. Overall complications are comparable between SLC and MLC. However, long-term results of randomized trials are lacking, notably to answer questions about incisional hernia rates, long-term cosmetic impact and chronic pain. Methods A randomized trial of SLC versus MLC with a total of 193 patients between December 2009 and June 2011 was performed. The primary endpoint was postoperative pain on the first day after surgery. Secondary endpoints were conversion rate, operative time, intraoperative and postoperative morbidity, technical feasibility and hospital stay. A long-term follow-up after surgery was added. Results Ninety-eight patients (50.8%) underwent SLC, and 95 patients (49.2%) had MLC. Pain on the first postoperative day showed no difference between the operative procedures (SLC vs. MLC, 3.4 ± 1.8 vs. 3.7 ± 1.9, respectively; p = 0.317). No significant differences were observed in operating time or the overall rate of postoperative complications (4.1% vs. 3.2%; p = 0.731). SLC exhibited better cosmetic results in the short term. In the long term, after a mean of 70.4 months, there were no differences in incisional hernia rate, cosmetic results or pain at the incision between the two groups. Conclusions Taking into account a follow-up rate of 68%, the early postoperative advantages of SLC in relation to cosmetic appearance and pain did not persist in the long term. In the present trial, there was no difference in incisional hernia rates between SLC and MLC, but the sample size is too small for a final conclusion regarding hernia rates. Trial registration German Registry of Clinical Trials DRKS00012447

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Section: Discussionmentioning

confidence: 99%

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Klein

Barutcu

Kröll

et al. 2020

Langenbecks Arch Surg

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“…[13] As a matter of fact, surgeons who started LC after their residency had a higher rate of biliary complications than did colleagues who learned LC during their residency. [2] Newman et al, [18] in the year 2016, done a study on laparoscopic surgery in which the compare cost analysis of traditional 4-port versus single-incision and robotically assisted cholecystectomy in 50 laparoscopic and nonlaparoscopic surgeries and concluded that non-traditional, minimally invasive gallbladder removal (SILS and ROBOSILS) offers significantly less surgical value for elective, outpatient gallbladder removal.…”

Section: Discussionmentioning

confidence: 99%

Role of Ultrasonography in Prediction of Technical Difficulties in Laparosopic Cholecystectomy - Clinical Research

Husain¹,

Firdaus²,

Pathak³

2016

Int. Jour. of Dent. and Med. Spec.

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Background: Laparoscopic surgery widely, known as single incision laparoscopic cholecystectomy (LC), has been proved as the gold standard surgical technique and is now considered the treatment of choice as well as preferred surgical technique in cholecystectomy. The use of laparoscopic technique in cholecystectomy is widely used for cholelithiasis patients. An abdominal ultrasonography (USG) often precedes this surgery and can verify the diagnosis, as well as help in showing possible complications during the perioperative period. Aim: A prospective study was conducted to evaluate the pre-operative with and without (based on clinical fi ndings) USG fi ndings and predictive diffi culties in cholelithiasis patients comparing with surgical fi ndings in LC. The post-operative evaluating criteria were as follows: (1) Duration of surgery, (2) Bleeding, (3) Dissection of Calot's triangle, (4) Dissection of gallbladder wall, (5) Spillage of bile and stone, (6) Diffi culty of gall bladder stone. Methods: We studied and evaluated surgical diffi culties in 150 patients of cholelithiasis who underwent abdominal USG test for surgical LC. Variables such as identifi cation and amount of gallstones involved were evaluated, both in preoperative USG and during surgery to evaluate sensitivity, specifi city, concordance and positive and negative predictive values. All patients had routine blood tests (including liver function tests), electrocardiography, chest X-ray, and abdominal ultrasound scan performed preoperatively. All patients received general anesthesia, and the standard Reddick and Olsen technique was performed. The harmonic scalpel was used in all cases. Results: On evaluation of surgical diffi culties in cholelithiasis patients, we found 135 females and 15 males for surgical LC. Out of which 36 (24.0%) cases to be predicted as diffi cult, 26 (17.33%) were laparoscopic converted for open surgery, 36 (24.0%) were technically diffi cult. 54 (36.0%) cases were predicted easy to perform on USG. On evaluation, our fi ndings were found to be signifi cant, and hence, we concluded that pre-operative ultrasound examination if of importance for predicting diffi culties in LC, but still required further studies.

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“…Analyses of the outpatient costs of robotic-assisted cholecystectomy show higher total charges and costs when compared to laparoscopic surgery. However, proponents cite the numerous benefits of robotic surgery including enhanced surgeon ergonomics and the potential for building skills to perform more complex operations robotically [48,52]. In pediatric patients hospitalization cost for robotic compared to non-robotic averaged $11,000 vs. $7000 [26].…”

Section: Costmentioning

confidence: 99%

Robotic Approach to Cholecystectomy

Barrera¹,

Sugiyama²

2017

Updates in Gallbladder Diseases

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Cholecystectomy is one of the most commonly performed abdominal procedures with more than 600,000 performed annually in the United States. Laparoscopic cholecystectomy, first introduced in the 1980s, offered faster recovery time and a more cosmetic result making it the more favorable approach. In developed countries, up to 90% of cholecystectomies are done via laparoscopy. After the first robotic surgery platform was approved by the FDA in 2000, it provided surgeons with enhanced ergonomic capabilities and visualization and also offered possibility of telemedicine. The first series of robotic cholecystectomies soon followed in the last 15 years, and robotic cholecystectomy has become increasingly popular and has been established as a safe approach. The aims of this chapter are to address the history of robotic-assisted cholecystectomy, the technical aspects of multiport and single-port approaches, use of cholangiography, demonstration of safety and use in both community and academic settings.

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Surgical Value of Elective Minimally Invasive Gallbladder Removal: A Cost Analysis of Traditional 4-Port vs Single-Incision and Robotically Assisted Cholecystectomy

Cited by 22 publications

References 16 publications

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Randomized controlled trial of single incision versus conventional multiport laparoscopic cholecystectomy with long-term follow-up

Role of Ultrasonography in Prediction of Technical Difficulties in Laparosopic Cholecystectomy - Clinical Research

Robotic Approach to Cholecystectomy

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