Original Article

J Minim Invasive Surg 2015; 18(4): 106-112

Published online December 15, 2015

https://doi.org/10.7602/jmis.2015.18.4.106

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

보조기구를 이용한 단일공 복강경하 담낭절제술

온진석, 정해일, 배상호, 백무준, 이문수, 김창호

순천향대학교 의과대학 천안병원 외과학교실

Received: June 24, 2015; Revised: September 7, 2015; Accepted: October 5, 2015

Modified Single Port Laparoscopic Cholecystectomy

Jin Seok Ohn, M.D., Hae Il Jung, M.D., Sang Ho Bae, M.D., Ph.D., Moo-Jun Baek, M.D., Ph.D., Moon Soo Lee, M.D., Ph.D.,
Chang Ho Kim, M.D., Ph.D.

Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

Received: June 24, 2015; Revised: September 7, 2015; Accepted: October 5, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Currently, single port laparoscopic cholecystectomy (SLC) is gradually being expanded.
However, its operative time and complications are reportedly variable according to the surgeon’s
expertise and experience. In order to overcome these problems, we introduced surgical methods using
a 2 mm sized auxiliary device (NELIS, Korea) in cholecystectomy.
Methods: Between March 2010 and October 2010, laparoscopic cholecystectomy was performed in 53
patients for non-inflammatory gallbladder stones or gallbladder polyps based on the computed
tomography findings. Fourteen of 53 consecutive patients underwent SLC and others underwent CLC.
The patient`s clinical characteristics and operative results were evaluated retrospectively.
Results: Comparison of clinical characteristics between SLC and CLC groups indicated that the SLC
group included younger patients (p=0.008), however other characteristics (sex, mean body index, and
previous abdominal operation history) were not significantly different. Operative outcomesparameters
including the intensity of postoperative pain, rate of wound complication, and
postoperative hospital stay did not differ significantly between the 2 groups. Operative time of the
SLC group was longer than that of the CLC group (p=0.002). However, the operative time was
decreased according to the increasing SLC cases. By 3 months, patients in the SLC group reported
significantly better cosmesis (p=0.036).
Conclusion: SLC with an auxiliary device (2 mm, Hold port, NELIS) is technically feasible and might
be an alternative method for obtaining a critical view of safety and cosmetic results.

Keywords Gallbladder, Cholecystectomy, Laparoscopic

  1. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparo- scopic cholecystectomy. The new 'gold standard'? Arch Surg 1992; 127:917-921; discussion 921-913.
  2. Mori T, Ikeda Y, Okamoto K, et al. A new technique for two- trocar laparoscopic cholecystectomy. Surg Endosc 2002;16:589- 591.
    CrossRef
  3. Slim K, Pezet D, Stencl J Jr, et al. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg 1995;19:394-397.
    CrossRef
  4. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One- wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.
    CrossRef
  5. Sharma A, Soni V, Baijal M, Khullar R, Najma K, Chowbey PK. Single port versus multiple port laparoscopic cholecystectomy-a comparative study. Indian J Surg 2013;75:115-122.
    CrossRef
  6. Saad S, Strassel V, Sauerland S. Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 2013;100:339-349.
    CrossRef
  7. Reibetanz J, Ickrath P, Hain J, Germer CT, Krajinovic K. Single- port laparoscopic cholecystectomy versus standard multiport laparoscopic cholecystectomy: a case-control study comparing the long-term quality of life and body image. Surg Today 2013;43: 1025-1030.
    CrossRef
  8. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single- port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
    CrossRef
  9. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007;142:823-826; discussion 826-827.
    CrossRef
  10. Qiu J, Yuan H, Chen S, He Z, Han P, Wu H. Single-port versus conventional multiport laparoscopic cholecystectomy: a meta- analysis of randomized controlled trials and nonrandomized studies. J Laparoendosc Adv Surg Tech A 2013;23:815-831.
    CrossRef
  11. Zehetner J, Pelipad D, Darehzereshki A, Mason RJ, Lipham JC, Katkhouda N. Single-access laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 2013;23:235-243.
    CrossRef
  12. Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M. Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 2012;22:731-737.
    CrossRef
  13. Berci G, Morgenstern L. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:638-639.
  14. You KC, Yoo T, Park SG, et al. How to do single-port laparoscopic cholecystectomy using LEAN BACK technique. ANZ J Surg 2015;85:284-285.
    CrossRef
  15. Sulu B, Diken T, Altun H, et al. A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture. Ulus Cerrahi Derg 2014;30:192-196.
    CrossRef
  16. Kim MJ, Kim TS, Kim KH, An CH, Kim JS. Safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic cholecystectomy in patients with acute cholecystitis: comparison with three-port laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2014;24:523-527.
    CrossRef
  17. Uras C, Boler DE. Endoloop retraction technique in single- port laparoscopic cholecystectomy: experience in 27 patients. J Laparoendosc Adv Surg Tech A 2013;23:545-548.
    CrossRef
  18. Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 2009;23:1660-1666.
    CrossRef
  19. MacDonald ER, Alkari B, Ahmed I. "Single-port" laparoscopic cholecystectomy--the Aberdeen technique. Surg Laparosc Endosc Percutan Tech 2010;20:e7-9.
    CrossRef
  20. Ponsky TA. Single port laparoscopic cholecystectomy in adults and children: tools and techniques. J Am Coll Surg 2009;209:e1-6.
    CrossRef
  21. Jang JY, Choi SH, Hwang HK, Kang CM, Lee WJ. Single-fulcrum Laparoscopic Cholecystectomy: A Variant Type of Single Incision and Multiport Technique. J Korean Soc Endosc Laparosc Surg 2011;14:51-55.
  22. Koo EJ, Youn SH, Baek YH, et al. Review of 100 cases of single port laparoscopic cholecystectomy. J Korean Surg Soc 2012;82: 179-184.
    CrossRef
  23. 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.
    CrossRef
  24. Christoffersen MW, Brandt E, Oehlenschlager J, et al. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study. Surg Endosc 2015. (in press).
    CrossRef
  25. Jung GO, Park DE, Chae KM. Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution. J Korean Surg Soc 2012;83:374-380.
    CrossRef

Article

Original Article

J Minim Invasive Surg 2015; 18(4): 106-112

Published online December 15, 2015 https://doi.org/10.7602/jmis.2015.18.4.106

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

보조기구를 이용한 단일공 복강경하 담낭절제술

온진석, 정해일, 배상호, 백무준, 이문수, 김창호

순천향대학교 의과대학 천안병원 외과학교실

Received: June 24, 2015; Revised: September 7, 2015; Accepted: October 5, 2015

Modified Single Port Laparoscopic Cholecystectomy

Jin Seok Ohn, M.D., Hae Il Jung, M.D., Sang Ho Bae, M.D., Ph.D., Moo-Jun Baek, M.D., Ph.D., Moon Soo Lee, M.D., Ph.D.,
Chang Ho Kim, M.D., Ph.D.

Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

Received: June 24, 2015; Revised: September 7, 2015; Accepted: October 5, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Currently, single port laparoscopic cholecystectomy (SLC) is gradually being expanded.
However, its operative time and complications are reportedly variable according to the surgeon’s
expertise and experience. In order to overcome these problems, we introduced surgical methods using
a 2 mm sized auxiliary device (NELIS, Korea) in cholecystectomy.
Methods: Between March 2010 and October 2010, laparoscopic cholecystectomy was performed in 53
patients for non-inflammatory gallbladder stones or gallbladder polyps based on the computed
tomography findings. Fourteen of 53 consecutive patients underwent SLC and others underwent CLC.
The patient`s clinical characteristics and operative results were evaluated retrospectively.
Results: Comparison of clinical characteristics between SLC and CLC groups indicated that the SLC
group included younger patients (p=0.008), however other characteristics (sex, mean body index, and
previous abdominal operation history) were not significantly different. Operative outcomesparameters
including the intensity of postoperative pain, rate of wound complication, and
postoperative hospital stay did not differ significantly between the 2 groups. Operative time of the
SLC group was longer than that of the CLC group (p=0.002). However, the operative time was
decreased according to the increasing SLC cases. By 3 months, patients in the SLC group reported
significantly better cosmesis (p=0.036).
Conclusion: SLC with an auxiliary device (2 mm, Hold port, NELIS) is technically feasible and might
be an alternative method for obtaining a critical view of safety and cosmetic results.

Keywords: Gallbladder, Cholecystectomy, Laparoscopic

References

  1. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparo- scopic cholecystectomy. The new 'gold standard'? Arch Surg 1992; 127:917-921; discussion 921-913.
  2. Mori T, Ikeda Y, Okamoto K, et al. A new technique for two- trocar laparoscopic cholecystectomy. Surg Endosc 2002;16:589- 591.
    CrossRef
  3. Slim K, Pezet D, Stencl J Jr, et al. Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg 1995;19:394-397.
    CrossRef
  4. Navarra G, Pozza E, Occhionorelli S, Carcoforo P, Donini I. One- wound laparoscopic cholecystectomy. Br J Surg 1997;84:695.
    CrossRef
  5. Sharma A, Soni V, Baijal M, Khullar R, Najma K, Chowbey PK. Single port versus multiple port laparoscopic cholecystectomy-a comparative study. Indian J Surg 2013;75:115-122.
    CrossRef
  6. Saad S, Strassel V, Sauerland S. Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 2013;100:339-349.
    CrossRef
  7. Reibetanz J, Ickrath P, Hain J, Germer CT, Krajinovic K. Single- port laparoscopic cholecystectomy versus standard multiport laparoscopic cholecystectomy: a case-control study comparing the long-term quality of life and body image. Surg Today 2013;43: 1025-1030.
    CrossRef
  8. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S. Randomized controlled trial comparing single- port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011;254:22-27.
    CrossRef
  9. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007;142:823-826; discussion 826-827.
    CrossRef
  10. Qiu J, Yuan H, Chen S, He Z, Han P, Wu H. Single-port versus conventional multiport laparoscopic cholecystectomy: a meta- analysis of randomized controlled trials and nonrandomized studies. J Laparoendosc Adv Surg Tech A 2013;23:815-831.
    CrossRef
  11. Zehetner J, Pelipad D, Darehzereshki A, Mason RJ, Lipham JC, Katkhouda N. Single-access laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a systematic review and meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 2013;23:235-243.
    CrossRef
  12. Alptekin H, Yilmaz H, Acar F, Kafali ME, Sahin M. Incisional hernia rate may increase after single-port cholecystectomy. J Laparoendosc Adv Surg Tech A 2012;22:731-737.
    CrossRef
  13. Berci G, Morgenstern L. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:638-639.
  14. You KC, Yoo T, Park SG, et al. How to do single-port laparoscopic cholecystectomy using LEAN BACK technique. ANZ J Surg 2015;85:284-285.
    CrossRef
  15. Sulu B, Diken T, Altun H, et al. A comparison of single-port laparoscopic cholecystectomy and an alternative technique without a suspension suture. Ulus Cerrahi Derg 2014;30:192-196.
    CrossRef
  16. Kim MJ, Kim TS, Kim KH, An CH, Kim JS. Safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic cholecystectomy in patients with acute cholecystitis: comparison with three-port laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 2014;24:523-527.
    CrossRef
  17. Uras C, Boler DE. Endoloop retraction technique in single- port laparoscopic cholecystectomy: experience in 27 patients. J Laparoendosc Adv Surg Tech A 2013;23:545-548.
    CrossRef
  18. Dominguez G, Durand L, De Rosa J, Danguise E, Arozamena C, Ferraina PA. Retraction and triangulation with neodymium magnetic forceps for single-port laparoscopic cholecystectomy. Surg Endosc 2009;23:1660-1666.
    CrossRef
  19. MacDonald ER, Alkari B, Ahmed I. "Single-port" laparoscopic cholecystectomy--the Aberdeen technique. Surg Laparosc Endosc Percutan Tech 2010;20:e7-9.
    CrossRef
  20. Ponsky TA. Single port laparoscopic cholecystectomy in adults and children: tools and techniques. J Am Coll Surg 2009;209:e1-6.
    CrossRef
  21. Jang JY, Choi SH, Hwang HK, Kang CM, Lee WJ. Single-fulcrum Laparoscopic Cholecystectomy: A Variant Type of Single Incision and Multiport Technique. J Korean Soc Endosc Laparosc Surg 2011;14:51-55.
  22. Koo EJ, Youn SH, Baek YH, et al. Review of 100 cases of single port laparoscopic cholecystectomy. J Korean Surg Soc 2012;82: 179-184.
    CrossRef
  23. 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.
    CrossRef
  24. Christoffersen MW, Brandt E, Oehlenschlager J, et al. No difference in incidence of port-site hernia and chronic pain after single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: a nationwide prospective, matched cohort study. Surg Endosc 2015. (in press).
    CrossRef
  25. Jung GO, Park DE, Chae KM. Clinical results between single incision laparoscopic cholecystectomy and conventional 3-port laparoscopic cholecystectomy: prospective case-matched analysis in single institution. J Korean Surg Soc 2012;83:374-380.
    CrossRef

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