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Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy

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Abstract

Background

Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0–4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC).

Methods

A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up.

Results

A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS (n = 28) or LC (n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1–5.8) in LESS and 2.7 cm (1.5–5.1) in LC (p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0–5.5) in LESS and 2.3 cm (1.2–3.5) in LC (p < .0001). The mean operative time was 60.3 min (32–128) for LESS and 51.3 min (25–120) for LC (p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases (p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0–7) for the LESS group and 4.0 (0–10) for the LC group (p = 0.07), and at postoperative hour 24 it was 0.3 points (0–6) for LESS and 2.3 (0–10) for LC (p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group.

Conclusions

The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.

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References

  1. Ma J, Cassera MA, Spaun GO, Hammill CW, Hansen PD, Aliabadi-Wahle S (2011) Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 1:22–27

    Article  Google Scholar 

  2. Allemann P, Schafer M, Demartines N (2010) Critical appraisal of single port access cholecystectomy. Br J Surg 97:1476–1480

    Article  PubMed  CAS  Google Scholar 

  3. Gill IS, Advincula AP, Aron M et al (2010) Consensus statement of the consortium for laparoendoscopic single-site surgery. Surg Endosc 24:762–768

    Article  PubMed  Google Scholar 

  4. Canes D, Desai MM, Aron M et al (2008) Transumbilical single-port surgery: evolution and current status. Eur Urol 54(5):1020–1029

    Article  PubMed  Google Scholar 

  5. Chuang SC, Lee KT, Chang WT et al (2004) Risk factors for wound infection after cholecystectomy. J Formos Med Assoc 103(8):607–612

    PubMed  Google Scholar 

  6. Gill IS, Canes D, Aron M, Haber GP, Goldfarb DA, Flechner S, Desai MR, Kaouk JH, Desai MM (2008) Single port transumbilical (E-NOTES) donor nephrectomy. J Urol 180(2):637–641 discussion 641

    Article  PubMed  Google Scholar 

  7. Msezane LP, Mushtaq I, Gundeti MS (2009) An update on experience with the single-instrument port laparoscopic nephrectomy. BJU Int 103(10):1406–1408 discussion 1408–1409

    Article  PubMed  Google Scholar 

  8. Aron M, Canes D, Desai MM, Haber GP, Kaouk JH, Gill IS (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103(4):516–521

    Article  PubMed  Google Scholar 

  9. Bresadola F, Pasqualucci A, Donini A et al (1999) Elective transumbilical compared with standard laparoscopic cholecystectomy. Eur J Surg 165(1):29–34

    Article  PubMed  CAS  Google Scholar 

  10. Tacchino R, Greco F, Matera D (2009) Single-incision laparoscopic cholecystectomy: surgery without a visible scar. Surg Endosc 23(4):896–899

    Article  PubMed  CAS  Google Scholar 

  11. Cuesta MA, Berends F, Veenhof AA (2008) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22(5):1211–1213

    Article  PubMed  Google Scholar 

  12. Rao PP, Bhagwat SM, Rane A (2008) The feasibility of single port laparoscopic cholecystectomy: a pilot study of 20 cases. HPB (Oxford) 10(5):336–340

    Article  Google Scholar 

  13. Merchant AM, Cook MW, White BC et al (2009) Transumbilical Gelport access technique for performing single incision laparoscopic surgery (SILS). J Gastrointest Surg 13(1):159–162

    Article  PubMed  Google Scholar 

  14. Romanelli JR, Roshek TB 3rd, Lynn DC, Earle DB (2009) Single-port laparoscopic cholecystectomy: initial experience. Surg Endosc 24(6):1374–1379

    Article  PubMed  Google Scholar 

  15. Gumbs AA, Milone L, Sinha P, Bessler M (2009) Totally transumbilical laparoscopic cholecystectomy. J Gastrointest Surg 13(3):533–534

    Article  PubMed  Google Scholar 

  16. Palanivelu C, Jani K, Maheshkumar GS (2007) Single-center experience of laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A 17(5):608–614

    Article  PubMed  Google Scholar 

  17. Aitken RC (1969) Measurement of feelings using visual analogue scales. Proc R Soc Med 62:989–993

    PubMed  CAS  Google Scholar 

  18. Martins MVDC, Skinovsky J, Coelho DE (2009) Laparoscopic cholecystectomy by single trocar access (SITRACC®) - A new option. Rev Col Bras Cir 36(2):177–179

    Article  PubMed  Google Scholar 

  19. Martins MVDC, Skinovsky J, Coelho DE, Torres MF (2008) SITRACC - single trocar access: a new device for a new surgical approach. Bras J Video-Sur 1(2):061–063

    Google Scholar 

  20. Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192

    Article  PubMed  Google Scholar 

  21. Erbella J Jr, Bunch GM (2010) Single-incision laparoscopic cholecystectomy: the first 100 outpatients. Surg Endosc 24:1958–1961

    Article  PubMed  Google Scholar 

  22. Curcillo PG II, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A et al (2010) Single-port-access (SPA) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860

    Article  PubMed  Google Scholar 

  23. Roberts KE, Solomon D, Duffy AJ, Bell RL (2001) Single-incision laparoscopic cholecystectomy: a surgeon’s initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 14:506–510

    Article  Google Scholar 

  24. Kuon Lee S, You YK, Park JH, Kim HJ, Lee KK, Kim DG (2009) Single-port transumbilical laparoscopic cholecystectomy: a preliminary study in 37 patients with gallbladder disease. J Laparoendosc Adv Surg Tech A 19:495–499

    Article  PubMed  Google Scholar 

  25. Rivas H, Varela E, Scott D (2009) Single-incision laparoscopic cholecystectomy: initial evaluation of a large series of patients. Surg Endosc 24:1403–1412

    Article  PubMed  Google Scholar 

  26. Hu H, Zhu J, Wang W, Huang A (2010) Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures. Surg Endosc 24:1080–1084

    Article  PubMed  Google Scholar 

  27. Hodgett SE, Hernandez JM, Morton CA, Ross SB, Albrink M, Rosemurgy AS (2009) Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 13:188–192

    Article  PubMed  Google Scholar 

  28. Vidal O, Valentini M, Espert JJ, Ginesta C, Jimeno J, Martinez A et al (2009) Laparoendoscopic single-site cholecystectomy: a safe and reproducible alternative. J Laparoendosc Adv Surg Tech A 19:599–602

    Article  PubMed  Google Scholar 

  29. Chow A, Purkayastha S, Paraskeva P (2009) Appendicectomy and cholecystectomy using single-incision laparoscopic surgery (SILS): the first UK experience. Surg Innov 16:211–217

    Article  PubMed  Google Scholar 

  30. Rothenberg SS, Shipman K, Yoder S (2009) Experience with modified single-port laparoscopic procedures in children. J Laparoendosc Adv Surg Tech A 19:695–698

    Article  PubMed  Google Scholar 

  31. Philipp SR, Miedema BW, Thaler K (2009) Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard. J Am Coll Surg 209:632–637

    Article  PubMed  Google Scholar 

  32. Hong TH, You YK, Lee KH (2009) Transumbilical single-port laparoscopic cholecystectomy: scarless cholecystectomy. Surg Endosc 23:1393–1397

    Article  PubMed  Google Scholar 

  33. Bucher P, Pugin F, Morel P (2010) From single-port access to laparoendoscopic single-site cholecystectomy. Surg Endosc 24:234–235

    Article  PubMed  Google Scholar 

  34. Asakuma M, Hayashi M et al (2011) Impact of single-port cholecystectomy on postoperative pain. Br J Surg 98(7):991–995

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Dr. Fernando Athayde Veloso Madureira, Dr. José Eduardo Ferreira Manso, Dr. Delta Madureira Filho, and Dr. Antonio Carlos Garrido Iglesias have no conflicts of interest or any financial ties to disclose.

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Correspondence to Fernando Athayde Veloso Madureira.

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Madureira, F.A.V., Manso, J.E.F., Madureira Fo, D. et al. Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy. Surg Endosc 27, 1009–1015 (2013). https://doi.org/10.1007/s00464-012-2556-1

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  • DOI: https://doi.org/10.1007/s00464-012-2556-1

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