Original Article

J Minim Invasive Surg 2015; 18(1): 7-13

Published online March 15, 2015

https://doi.org/10.7602/jmis.2015.18.1.7

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

The Feasibility of Fundal Retraction of the Gallbladder in the Single Port Laparoscopic Cholecystectomy: Comparison between a 4-instrument Fundal Retraction Group and a 3-instrument Group

Jung Sik Kim, M.D.1, Hyung Joon Han, M.D.1, Tae-Jin Song, M.D.1, Sae Byeol Choi, M.D.2, Wan-Bae Kim, M.D.2, Sang-Yong Choi, M.D.2, Sung-Ock Suh, M.D.3

Division of Hepatobiliopancreas and Transplantation Surgery, Department of Surgery, 1Korea University Ansan Hospital, Ansan, 2Korea University Guro Hospital, 3Korea University Anam Hospital, Seoul, Korea

Received: September 5, 2014; Revised: October 28, 2014; Accepted: October 28, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Owing to the accumulation of surgical experience, the indications of single port laparoscopic cholecystectomy (SLC) have increased. To overcome the difficulties and limitations of SLC, we included an additional instrument for use in retracting the gallbladder fundus. The aim of this study was to investigate the feasibility of 4-instrument fundal retraction SLC. Methods: We retrospectively analyzed 134 patients who had undergone SLC for benign gallbladder disease. We compared the clinical outcome between patients who had undergone SLC without fundal retraction (3-instrument SLC, n=102) and those who had undergone SLC with fundal retraction (4-instrument fundal retraction SLC, n=32). Results: Of 134 patients, 47 were male and 87 were female. A significantly higher proportion of patients in the 4-instrument fundal retraction group had gallbladder distention and wall thickening than patients in the 3-instrument SLC group. No statistically significant difference in the incidence of pericholecystic inflammation, adhesion, and gallbladder perforation; duration of operation, the incidence of complications, and duration of postoperative hospital stay was observed between the two groups. In univariate analysis to perform 4-instrument fundal retraction SLC, higher BMI, the presence of gallbladder distension, and wall thickening were significant factors. In multivariate analysis, gallbladder distention and the presence of concurrent operation during SLC were independently significant factors for performing 4-instrument fundal retraction SLC. Conclusion: Four-instrument fundal retraction SLC is a feasible and safe surgical procedure, particularly in patients with a high BMI, gallbladder distention, wall thickening, inflammation, or adhesions. If difficulties are encountered during 3-instrument SLC, simple fundal retraction using an additional instrument may be the preferred option prior to converting the operation to conventional laparoscopic cholecystectomy.

Keywords Gallbladder/surgery; Cholecystectomy, Laparoscopic/methods; Cholecystitis, Acute/surgery; Inflammation/surgery

  1. Brown KM, Moore BT, Sorensen GB, et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc 2013;27:3108-3115.
    Pubmed CrossRef
  2. Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 2011;166:e109-112.
    Pubmed CrossRef
  3. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing singleport laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
    Pubmed CrossRef
  4. Marks J, Tacchino R, Roberts K, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 2011;201:369-372; discussion 372-363.
  5. Lirici MM, Califano AD, Angelini P, Corcione F. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 2011;202:45-52.
    Pubmed CrossRef
  6. Jacob DA, Raakow R. Single-port transumbilical endoscopic cholecystectomy: a new standard? Dtsch Med Wochenschr 2010;135:1363-1367.
    Pubmed CrossRef
  7. Ostlie DJ, Juang OO, Iqbal CW, et al. Single incision versus standard 4-port laparoscopic cholecystectomy: a prospective randomized trial. J Pediatr Surg 2013;48:209-214.
    Pubmed CrossRef
  8. Han HJ, Choi SB, Kim WB, Choi SY. Single-incision multiport laparoscopic cholecystectomy: things to overcome. Arch Surg 2011;146:68-73.
    Pubmed CrossRef
  9. Podolsky ER, Curcillo PG, 2nd. Reduced-port surgery: preservation of the critical view in single-port-access cholecystectomy. Surg Endosc 2010;24:3038-3043.
    Pubmed CrossRef
  10. Han HJ, Choi SB, Kim CY, Kim WB, Song TJ, Choi SY. Singleincision multiport laparoscopic cholecystectomy for a patient with situs inversus totalis: report of a case. Surg Today 2011;41:877880.
    Pubmed CrossRef
  11. Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 2011;25:367-377.
    Pubmed CrossRef
  12. Han HJ, Choi SB, Park MS, 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.
    Pubmed CrossRef
  13. Wu XS, Shi LB, Gu J, et al. Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy:a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A 2013;23:183-191.
    Pubmed CrossRef
  14. Hall TC, Dennison AR, Bilku DK, Metcalfe MS, Garcea G. Singleincision laparoscopic cholecystectomy: a systematic review. Arch Surg 2012;147:657-666.
    Pubmed CrossRef
  15. Reibetanz J, Wierlemann A, Germer CT, Krajinovic K. A novel technique for fundal retraction of the gallbladder in single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 2011;21:427429.
    Pubmed CrossRef
  16. Rupp CC, Farrell TM, Meyer AA. Single incision laparoscopic cholecystectomy using a "two-port" technique is safe and feasible:experience in 101 consecutive patients. Am Surg 2011;77:916-921.
    Pubmed
  17. Choi SH, Hwang HK, Kang CM, Lee WJ. Single-fulcrum laparoscopic cholecystectomy: a single-incision and multi-port technique. ANZ J Surg 2012;82:529-534.
    Pubmed CrossRef
  18. Sumiyoshi K, Sato N, Akagawa S, et al. Single-incision laparoscopic cholecystectomy with needle graspers. Hepatogastroenterology 2012;59:325-328.
    Pubmed
  19. Davila F, Tsin D, Gonzalez G, Davila MR, Lemus J, Davila U. Use of percutaneous needles in the feasability of single-port laparoscopic cholecystectomy. Cir Esp 2014;92:261-268.
    Pubmed
  20. Rivas H, Varela E, Scott D. Single-incision laparoscopic cholecystectomy:initial evaluation of a large series of patients. Surg Endosc 2010;24:1403-1412.
    Pubmed KoreaMed CrossRef
  21. Roberts KE, Solomon D, Duffy AJ, Bell RL. Single-incision laparoscopic cholecystectomy: a surgeon's initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 2010;14:506-510.
    Pubmed CrossRef
  22. Kamoun S, Alves A, Bretagnol F, Lefevre JH, Valleur P, Panis Y. Outcomes of laparoscopic colorectal surgery in obese and nonobese patients: a case-matched study of 180 patients. Am J Surg 2009;198:450-455.
    Pubmed CrossRef
  23. Jacob D, Raakow R. Single-port versus multi-port cholecystectomy for patients with acute cholecystitis: a retrospective comparative analysis. Hepatobiliary Pancreat Dis Int 2011;10:521-525.
    CrossRef
  24. Sasaki K, Watanabe G, Matsuda M, Hashimoto M. Original singleincision laparoscopic cholecystectomy for acute inflammation of the gallbladder. World J Gastroenterol 2012;18:944-951.
    Pubmed KoreaMed CrossRef
  25. Kumar M, Agrawal CS, Gupta RK. Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS 2007;11:358-362.
    Pubmed KoreaMed

Article

Original Article

J Minim Invasive Surg 2015; 18(1): 7-13

Published online March 15, 2015 https://doi.org/10.7602/jmis.2015.18.1.7

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

The Feasibility of Fundal Retraction of the Gallbladder in the Single Port Laparoscopic Cholecystectomy: Comparison between a 4-instrument Fundal Retraction Group and a 3-instrument Group

Jung Sik Kim, M.D.1, Hyung Joon Han, M.D.1, Tae-Jin Song, M.D.1, Sae Byeol Choi, M.D.2, Wan-Bae Kim, M.D.2, Sang-Yong Choi, M.D.2, Sung-Ock Suh, M.D.3

Division of Hepatobiliopancreas and Transplantation Surgery, Department of Surgery, 1Korea University Ansan Hospital, Ansan, 2Korea University Guro Hospital, 3Korea University Anam Hospital, Seoul, Korea

Received: September 5, 2014; Revised: October 28, 2014; Accepted: October 28, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Owing to the accumulation of surgical experience, the indications of single port laparoscopic cholecystectomy (SLC) have increased. To overcome the difficulties and limitations of SLC, we included an additional instrument for use in retracting the gallbladder fundus. The aim of this study was to investigate the feasibility of 4-instrument fundal retraction SLC. Methods: We retrospectively analyzed 134 patients who had undergone SLC for benign gallbladder disease. We compared the clinical outcome between patients who had undergone SLC without fundal retraction (3-instrument SLC, n=102) and those who had undergone SLC with fundal retraction (4-instrument fundal retraction SLC, n=32). Results: Of 134 patients, 47 were male and 87 were female. A significantly higher proportion of patients in the 4-instrument fundal retraction group had gallbladder distention and wall thickening than patients in the 3-instrument SLC group. No statistically significant difference in the incidence of pericholecystic inflammation, adhesion, and gallbladder perforation; duration of operation, the incidence of complications, and duration of postoperative hospital stay was observed between the two groups. In univariate analysis to perform 4-instrument fundal retraction SLC, higher BMI, the presence of gallbladder distension, and wall thickening were significant factors. In multivariate analysis, gallbladder distention and the presence of concurrent operation during SLC were independently significant factors for performing 4-instrument fundal retraction SLC. Conclusion: Four-instrument fundal retraction SLC is a feasible and safe surgical procedure, particularly in patients with a high BMI, gallbladder distention, wall thickening, inflammation, or adhesions. If difficulties are encountered during 3-instrument SLC, simple fundal retraction using an additional instrument may be the preferred option prior to converting the operation to conventional laparoscopic cholecystectomy.

Keywords: Gallbladder/surgery, Cholecystectomy, Laparoscopic/methods, Cholecystitis, Acute/surgery, Inflammation/surgery

References

  1. Brown KM, Moore BT, Sorensen GB, et al. Patient-reported outcomes after single-incision versus traditional laparoscopic cholecystectomy: a randomized prospective trial. Surg Endosc 2013;27:3108-3115.
    Pubmed CrossRef
  2. Aprea G, Coppola Bottazzi E, Guida F, Masone S, Persico G. Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 2011;166:e109-112.
    Pubmed CrossRef
  3. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing singleport laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
    Pubmed CrossRef
  4. Marks J, Tacchino R, Roberts K, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 2011;201:369-372; discussion 372-363.
  5. Lirici MM, Califano AD, Angelini P, Corcione F. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 2011;202:45-52.
    Pubmed CrossRef
  6. Jacob DA, Raakow R. Single-port transumbilical endoscopic cholecystectomy: a new standard? Dtsch Med Wochenschr 2010;135:1363-1367.
    Pubmed CrossRef
  7. Ostlie DJ, Juang OO, Iqbal CW, et al. Single incision versus standard 4-port laparoscopic cholecystectomy: a prospective randomized trial. J Pediatr Surg 2013;48:209-214.
    Pubmed CrossRef
  8. Han HJ, Choi SB, Kim WB, Choi SY. Single-incision multiport laparoscopic cholecystectomy: things to overcome. Arch Surg 2011;146:68-73.
    Pubmed CrossRef
  9. Podolsky ER, Curcillo PG, 2nd. Reduced-port surgery: preservation of the critical view in single-port-access cholecystectomy. Surg Endosc 2010;24:3038-3043.
    Pubmed CrossRef
  10. Han HJ, Choi SB, Kim CY, Kim WB, Song TJ, Choi SY. Singleincision multiport laparoscopic cholecystectomy for a patient with situs inversus totalis: report of a case. Surg Today 2011;41:877880.
    Pubmed CrossRef
  11. Antoniou SA, Pointner R, Granderath FA. Single-incision laparoscopic cholecystectomy: a systematic review. Surg Endosc 2011;25:367-377.
    Pubmed CrossRef
  12. Han HJ, Choi SB, Park MS, 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.
    Pubmed CrossRef
  13. Wu XS, Shi LB, Gu J, et al. Single-incision laparoscopic cholecystectomy versus multi-incision laparoscopic cholecystectomy:a meta-analysis of randomized clinical trials. J Laparoendosc Adv Surg Tech A 2013;23:183-191.
    Pubmed CrossRef
  14. Hall TC, Dennison AR, Bilku DK, Metcalfe MS, Garcea G. Singleincision laparoscopic cholecystectomy: a systematic review. Arch Surg 2012;147:657-666.
    Pubmed CrossRef
  15. Reibetanz J, Wierlemann A, Germer CT, Krajinovic K. A novel technique for fundal retraction of the gallbladder in single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 2011;21:427429.
    Pubmed CrossRef
  16. Rupp CC, Farrell TM, Meyer AA. Single incision laparoscopic cholecystectomy using a "two-port" technique is safe and feasible:experience in 101 consecutive patients. Am Surg 2011;77:916-921.
    Pubmed
  17. Choi SH, Hwang HK, Kang CM, Lee WJ. Single-fulcrum laparoscopic cholecystectomy: a single-incision and multi-port technique. ANZ J Surg 2012;82:529-534.
    Pubmed CrossRef
  18. Sumiyoshi K, Sato N, Akagawa S, et al. Single-incision laparoscopic cholecystectomy with needle graspers. Hepatogastroenterology 2012;59:325-328.
    Pubmed
  19. Davila F, Tsin D, Gonzalez G, Davila MR, Lemus J, Davila U. Use of percutaneous needles in the feasability of single-port laparoscopic cholecystectomy. Cir Esp 2014;92:261-268.
    Pubmed
  20. Rivas H, Varela E, Scott D. Single-incision laparoscopic cholecystectomy:initial evaluation of a large series of patients. Surg Endosc 2010;24:1403-1412.
    Pubmed KoreaMed CrossRef
  21. Roberts KE, Solomon D, Duffy AJ, Bell RL. Single-incision laparoscopic cholecystectomy: a surgeon's initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 2010;14:506-510.
    Pubmed CrossRef
  22. Kamoun S, Alves A, Bretagnol F, Lefevre JH, Valleur P, Panis Y. Outcomes of laparoscopic colorectal surgery in obese and nonobese patients: a case-matched study of 180 patients. Am J Surg 2009;198:450-455.
    Pubmed CrossRef
  23. Jacob D, Raakow R. Single-port versus multi-port cholecystectomy for patients with acute cholecystitis: a retrospective comparative analysis. Hepatobiliary Pancreat Dis Int 2011;10:521-525.
    CrossRef
  24. Sasaki K, Watanabe G, Matsuda M, Hashimoto M. Original singleincision laparoscopic cholecystectomy for acute inflammation of the gallbladder. World J Gastroenterol 2012;18:944-951.
    Pubmed KoreaMed CrossRef
  25. Kumar M, Agrawal CS, Gupta RK. Three-port versus standard four-port laparoscopic cholecystectomy: a randomized controlled clinical trial in a community-based teaching hospital in eastern Nepal. JSLS 2007;11:358-362.
    Pubmed KoreaMed

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Journal of Minimally Invasive Surgery

pISSN 2234-778X
eISSN 2234-5248