Comparison of outcomes of single incision robotic cholecystectomy and single incision laparoscopic cholecystectomy

Sun Min Lee,Jin Hong Lim 한국간담췌외과학회 2021 Annals of hepato-biliary-pancreatic surgery Vol.25 No.1

Backgrounds/Aims: Multiport laparoscopic cholecystectomy is the standard surgical procedure for symptomatic gallbladder diseases. However, as a result of the ongoing trend toward minimally invasive laparoscopy, single-incision laparoscopic cholecystectomy (SILC) has evolved. Single-incision robotic cholecystectomy (SIRC) can overcome several limitations of manual SILC. The purpose of this study is to evaluate and compare the safety and feasibility of SIRC and SILC. Methods: This study retrospectively reviewed data for all patients who underwent SIRC or SILC from March 2018 to July 2019 in a single institution. The following variables were analyzed: age, sex, body mass index, pain scale, length of stay, and complications. The data were analyzed using the Independent two sample t-test or the Fisher’s exact test. Results: A total of 343 patients underwent SIRC or SILC during the study period. After excluding patients with acute cholecystitis, 197 SIRC and 103 SILC patients were analyzed in this study. The surgery time and postoperative hospital stay did not differ between SIRC and SILC. However, the SIRC patients experienced less bile spillage during the surgery than did the SILC patients (SIRC vs. SILC: 24 (23.3%) vs. 11 (5.6%) cases, respectively; p<0.001). Although there was no difference in the incidence of postoperative complications between procedures, additional pain control was administered more frequently in SILC patients (SILC 1.08±0.893, SIRC 0.58±0.795; p<0.001). Conclusions: While both SILC and SIRC are effective for single-incision cholecystectomy, SIRC was superior to SILC in terms of technical stability. Moreover, it has the advantage of postoperative pain control.

Laparoendoscopic Single-Site Nephrectomy Using a Modified Umbilical Incision and a Home-Made Transumbilical Port

Ho Song Yu,함원식,나군호,한상원,최영득,한웅규,장원식 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.2

Purpose: To assess the clinical utility of laparoendoscopic single-site surgery (LESS) nephrectomy using a modified umbilical incision and home-made transumbilical port in cases requiring extirpative surgery. Materials and Methods: Initial consecutive 18 patients underwent LESS nephrectomies that were performed by a single surgeon. A home-made port was placed through a modified umbilical incision,the length of which had preoperatively been determined. The laparoscopic transperitoneal nephrectomy procedures were performed with various combinations of standard and articulating laparoscopic instruments. Patient characteristics and perioperative outcomes, including pathologic results, were recorded prospectively. Results: All 18 extirpative surgeries, including simple nephrectomy (eight cases), radical nephrectomy (nine cases), and nephroureterectomy (one case), were completed successfully. The median operation time was 167 min (range 82-220), and the median blood loss was 250 mL (range 0-1050). All specimens were extracted intact through a modified umbilical incision (median length 2.5 cm, range 1.5-6.0). Final pathological analysis revealed a nonfunctioning kidney in five cases, a dysplastic kidney in three cases, a mixed epithelial and stromal tumor in one case, renal cell carcinoma in eight cases (T1: five cases, T3: three cases), and Ta ureter transitional cell carcinoma in one case. Conclusion: LESS nephrectomy using a home-made port and modified umbilical incision is feasible with both minimal incision and cost-effective. Our technique may be more useful for extirpative procedures in which a specimen needs to be removed intact, because incision length can be freely adjusted. Prospective comparisons are warranted to more clearly elucidate the utility of this surgical technique.

Laparoendoscopic Single-Site Nephrectomy Using a Modified Umbilical Incision and a Home-Made Transumbilical Port

Yu, Ho Song,Ham, Won Sik,Rha, Koon Ho,Han, Sang Won,Choi, Young Deuk,Han, Woong Kyu,Chang, Won Sik Yonsei University College of Medicine 2011 Yonsei medical journal Vol.52 No.2

<P><B>Purpose</B></P><P>To assess the clinical utility of laparoendoscopic single-site surgery (LESS) nephrectomy using a modified umbilical incision and home-made transumbilical port in cases requiring extirpative surgery.</P><P><B>Materials and Methods</B></P><P>Initial consecutive 18 patients underwent LESS nephrectomies that were performed by a single surgeon. A home-made port was placed through a modified umbilical incision, the length of which had preoperatively been determined. The laparoscopic transperitoneal nephrectomy procedures were performed with various combinations of standard and articulating laparoscopic instruments. Patient characteristics and perioperative outcomes, including pathologic results, were recorded prospectively.</P><P><B>Results</B></P><P>All 18 extirpative surgeries, including simple nephrectomy (eight cases), radical nephrectomy (nine cases), and nephroureterectomy (one case), were completed successfully. The median operation time was 167 min (range 82-220), and the median blood loss was 250 mL (range 0-1050). All specimens were extracted intact through a modified umbilical incision (median length 2.5 cm, range 1.5-6.0). Final pathological analysis revealed a nonfunctioning kidney in five cases, a dysplastic kidney in three cases, a mixed epithelial and stromal tumor in one case, renal cell carcinoma in eight cases (T1: five cases, T3: three cases), and Ta ureter transitional cell carcinoma in one case.</P><P><B>Conclusion</B></P><P>LESS nephrectomy using a home-made port and modified umbilical incision is feasible with both minimal incision and cost-effective. Our technique may be more useful for extirpative procedures in which a specimen needs to be removed intact, because incision length can be freely adjusted. Prospective comparisons are warranted to more clearly elucidate the utility of this surgical technique.</P>

First Single-Port Laparoscopic Pancreatectomy in Regional Clinical Hospital Shymkent

( Nurgissa Shaldarbekov ),( Bekken Zhanaidar ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

Aims: Pancreatic surgery is an extremely challenging field, and the management of pancreatic diseases continues to evolve. In the past decade, minimal access surgery is moving towards minimizing the surgical trauma by reducing numbers and size of the port. In the last few years, a novel technique with a single-incision laparoscopic approach has been described for several laparoscopic procedures. We present a single-port laparoscopic spleen-preserving distal pancreatectomy. To our knowledge, this is the first single-port pancreatic resection in Regional Clinical Hospital Shymkent. Methods: A 35-year-old woman with neuroendocrine tumor underwent spleen-preserving distal pancreatectomy via single- port approach. A single-incision advanced access platform with gelatin cap, self-retaining sleeve and wound protector was used. Results: Operative time was 182 minutes. Blood loss was minimal, and the patient did not receive a transfusion. The recovery was uneventful, and the patient was discharged on postoperative day 4. Conclusions: Single-port laparoscopic spleen-preserving distal pancreatectomy is feasible and can be safely performed in specialized centers by skilled laparoscopic surgeons.

Repeat Single Incision Laparoscopic Surgery after Primary Single Incision Laparoscopic Surgery for Colorectal Disease

Sun Hye Kim,Seong Hyeon Yun,Yoon Ah Park,Yong Beom Cho,Hee Cheol Kim,Woo Yong Lee 대한내시경복강경외과학회 2018 Journal of Minimally Invasive Surgery Vol.21 No.1

Purpose: Single-incision laparoscopic surgery (SILS) for colorectal surgery is widely performed for many disease entities. However, there are few reports about the role of repeat single-incision laparoscopic surgery (R-SILS). The aim of this study is to analyze R-SILS data to evaluate the feasibility and safety of the occurrence and review its outcomes.Methods: This is a retrospective review of the prospectively collected SILS database in Samsung Medical Center, Seoul, Korea, between April 2009 and December 2015. A retrospective review of 38 patients who underwent R-SILS from 2,207 patients who underwent primary SILS for colorectal surgery was performed. Results: The indications of R-SILS were 23 primary SILS-related complications, 10 cancer-related, and 5 other surgical indications. Of the 38 repeat surgeries, 24 were emergent operations, and 14 were elective operations. Fecal diversion for anastomotic leakage after rectal surgery was the most common reason for reoperation. There were 2 cases of conversions: one case was converted to conventional multi-port, and the other case was converted to open surgery. Mean operative time was 137.9±64.1 min, estimated blood loss (EBL) was 105±98 ml, and length of hospital stay was 10.1±8.1 days. Post-operative complication was noted in 5 (13.2%) of 38 R-SILS cases, and there was no 30-day postoperative mortality.Conclusion: Repeat single-incision laparoscopy surgery is feasible and safe in select patients when performed by an experienced surgeon.

Safety and Feasibility of Solo Single-Incision Laparoscopic Cholecystectomy Compared to Conventional Three-Incision Laparoscopic Cholecystectomy: A Multicenter Cohort Study

( Suk-won Suh ),( Youngrok Choi ),( Ho-seong Han ),( Yoo-seok Yoon ),( Jai Young Cho ),( Yoo Shin Choi ),( Seung Eun Lee ),( Jaehong Jeong ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Although increment application of single-incision laparoscopic cholecystectomy (SILC), it had technical difficulties of physical disturbance and unstable surgical view through the small incision, therefore, we introduced solo single-incision LC (S-SILC) using laparoscopic scope holder, a simple, fixed and easily handled by a surgeon. Methods: A comparison of S-SILC (group A, n=566) and conventional three-incision laparoscopic cholecystectomy (C-TILC, group B, n=874) from January, 2013 to December, 2016 at multicenter was performed. Baseline characteristics, perioperative outcomes including complications were compared. Results: Mean operative time was not significantly different between two groups (P = 0.176), however, S-SILC had more intraoperative GB perforation, especially in initial period (17.0% vs. 2.3%, P < 0.001) and increased usage of additional port (3.2% vs. 0.5%, P < 0.001) and shorter hospital stay (3.3 ± 1.7 vs. 1.9 ± 2.7, P<0.001) than C-TILC. There was no significant difference of major postoperative complications between two groups (P = 0.909) and its identified risk factors were not operation type (P = 0.971), but mean age (P = 0.004) and upper abdominal operation history (P = 0.048). Conclusions: S-SILC is feasible and safe, but careful selection of surgical candidates is necessary, in initial period of S-SILC experience.

Single Incision Laparoscopic Appendectomy for Management of Complicated Appendicitis: Comparison between Single-Incision and Conventional

Yoon Jung Oh,성낙송,Won Jun Choi,윤대성,최인석,이상억,문주익,권성욱,박시민,배인의 대한내시경복강경외과학회 2018 Journal of Minimally Invasive Surgery Vol.21 No.4

Purpose: Single incision laparoscopic appendectomy (SILA) is a widely used surgical procedure for treatment of appendicitis with better cosmesis. However, many surgeons generally tend to choose conventional multiport laparoscopic appendectomy regarding with complicated appendicitis. The aim of this study is to demonstrate the safety and feasibility of SILA for treatment of complicated appendicitis by comparison with 3-ports conventional laparoscopic appendectomy (CLA). Methods: Retrospective chart review of patients diagnosed appendicitis at single hospital during January 2015 to May 2017 collected 500 patients. Among 134 patients with complicated appendicitis, we compared outcomes for 29 patients who got SILA and 105 patients who got CLA. Results: 179 and 321 patients were treated by SILA and CLA, respectively. 134 (26.8%) patients were treated for complicated appendicitis, 29 patients by SILA and 105 patients by CLA, respectively. There was no case converted to open or added additional trocar in both groups. There were no differences in demographics with regard to age, sex, body mass index (BMI), and American society of anesthesiologists (ASA) scores. There was no difference in mean operating time (58.97±18.53 (SILA) vs. 57.57±21.48 (CLA), p=0.751). The drain insertion rate (6.9% vs 37.1%, p=0.001) and the length of hospital stay (2.76±1.41 vs. 3.97±2.97, p=0.035) were lower in SILA group with significance. There was no significant difference in the rate of surgical site infection (6.9% vs. 6.7%, p=1.000). Conclusion: This study demonstrates that SILA is a feasible and safe procedure for treatment of complicated appendicitis.

단일창 다포트 복강경 충수 절제술

민인철,김동주,장이찬,최재운,선우영,정준수,최한림,류동희 대한내시경복강경외과학회 2009 Journal of Minimally Invasive Surgery Vol.12 No.2

Purpose: Laparoscopic appendectomy (LA) is becoming popular for the treatment of acute appendicitis. The laparoscopic appendectomy has the advantages of a more rapid recovery, better cosmetic outcome and reduced postoperative pain compared to the open appendectomy. Several laparoscopic procedures have been described that used two or more trocars. We present the results of a new LA technique that performed through three ports in a single incision. Methods: A single incision three-port LA was performed in 10 patients. Under general anesthesia, a 5 mm scope (0o), 2 mm working port and 5 mm working port were inserted through the umbilicus. The appendix was grasped and dissected from the surrounding tissues with a grasper or dissector. The base of the appendix was ligated with an endo-loop two times and cut by scissors. The appendix was then withdrawn through the umbilicus. Results: The average operating time in our series was 69.5±23.3 minutes and the median time to discharge 4.5±1.9 days. Wound infection developed in two patients. There was no conversion to traditional LA or laparotomy. Conclusion: A single incision three port LA was safe and effective for LA. The availability of laparoscopic procedures has expanded the range of options available from which to choose a suitable procedure for individual cases.

단일 지렛대 원리를 이용한 단일통로 복강경 담낭절제술: 변형된 단일절개, 다투관침 방법

장지영,최성훈,황호경,강창무,이우정 대한내시경복강경외과학회 2011 Journal of Minimally Invasive Surgery Vol.14 No.2

Purpose: Several techniques and devices have recently been introduced for single-incision laparoscopic cholecystectomy. We describe our technique using standard laparoscopic instruments and ports, and report the initial results. Methods: Between March 2009 and June 2010, 60 consecutive patients underwent single-fulcrum laparoscopic cholecystectomy for benign gallbladder disease. The general patient characteristics and perioperative results, including the operation time, conversion rate and complications, were assessed retrospectively. Results: Seventeen (28.3%) patients were male and 43 (71.7%) patients were female. The mean age was 47.4±12.4 years, and the mean total operation time was 57.5±13.9 min. The operation time became stable after 30 cases. There was no conversion to conventional laparoscopic cholecystectomy or open surgery. Additional trocars were required in three patients due to intraoperative complications, which were managed successfully with additional trocars. The intraoperative complications included loosening of the clips on the cystic duct, vertical laceration of the cystic duct, and burn injuries to the duodenal wall. There was no postoperative morbidity. Conclusion: Despite the limited sample size in this series, the results suggest that single-fulcrum laparoscopic cholecystectomy is safe and feasible for the treatment of benign gallbladder disease. Nevertheless, a further prospective randomized controlled trial comparing this technique with conventional techniques will be needed to confirm its true clinical value.

Single port laparoscopic appendectomy in children using glove port and conventional rigid instruments

Seung Eun Lee,Yoo Shin Choi,Beom Gyu Kim,Seong-Jae Cha,Joong-Min Park,In Taik Chang 대한외과학회 2014 Annals of Surgical Treatment and Research(ASRT) Vol.86 No.1

Purpose: To further improve the advantages of minimally invasive surgery, single port laparoscopic techniques continue to be developed. We report our initial experience with single port laparoscopic appendectomy (SPLA) in children and compare its outcomes to those of conventional laparoscopic appendectomy (CLA). Methods: Clinical data were prospectively collected for SPLA cases performed at Chung-Ang University Hospital by a single surgeon between March 2011 and December 2011, including operative time, perioperative complications, conversion rate, and length of hospital stay. Each case of SPLA was performed using conventional laparoscopic instruments through Glove port placed into the single umbilical incision. To compare outcomes, a retrospective review was performed for those patients who underwent CLA between March 2010 and December 2010. Results: Thirty-one patients underwent SPLA and 114 patients underwent CLA. Mean age (10.5 years vs. 11.1 years, P = 0.43), weight (48.2 kg vs. 42.9 kg, P = 0.27), and operation time (41.8 minutes vs. 37.9 minutes, P = 0.190) were comparable between both groups. Mean hospital stay was longer for CLA group (2.6 days vs. 3.7 days, P = 0.013). There was no conversion to conventional laparoscopic surgery in SPLA group. In CLA group, there were nine complications (7.9%) with 3 cases of postoperative ileuses and 6 cases wound problems. There was one complication (3.2%) of umbilical surgical site infection in SPLA group (P = 0.325). Conclusion: The results of this study demonstrated that SPLA using conventional laparoscopic instruments is technically feasible and safe in children. SPLA using conventional laparoscopic instruments might be popularized by eliminating the need for specially designed instruments.