Systemic Immune Response and Clinical Results After Single Port Versus Conventional Laparoscopic Cholecystectomy: Prospective Nonrandomized Study

Hyung-Joon Han, MD, Sae-Byeol Choi, MD, Wan-Bae Kim, MD, Tae-Jin Song, MD, Sung-Ock Suh, MD, Sang-Yong Choi, MD, Chung-Yun Kim, MD, Jong-Han Kim, MD, Seong Heum Park, MD, Dong-Sik Kim, MD, Jin-Suk Lee, MD, Young-Chul Kim, MD. Department of Surgery, Korea University College of Medicine

Introduction

The benefits of laparoscopic surgery and technical advances could open the new chapter in the minimally invasive surgery. The tendency of minimizing surgical trauma encourages the use of new approaches in laparoscopic surgery. Patients benefit from diminished surgical trauma and maintained immune function after laparoscopic surgery.The objective of this study was to compare the systemic acute cytokine response, specifically interleukin (IL)-6, C-reactive protein, leukocytes subpopulations to conventional laparoscopic and single port laparoscopic cholecystectomy and clinical outcomes, including pain, in order to determine if there is an advantage of any of these approaches.

Method

From September 1, 2009 to December 31, 2009, 149 patients had been diagnosed with gallstones or gallbladder polyps at Korea University Hospital and 77 patients were enrolled after giving written informed consent. The 61 patients included in the study were selected from enrolled 77 patients among 149 consecutive patients with diagnosed gallstones or gallbladder polyp.

Results

Of the 61 patients, 26 were males and 35 were females. Then mean age of the patients was 45.9 ± 14.3 years. The median serum level of IL-6 in the single port group on the postoperative day 1 (13.89, 7.55-31.17 versus 10.74, 6.31-30.03 pg/ml) was slightly higher and slightly lower on preoperative day (2.94, 1.25-3.79 versus 3.45, 1.84-6.29 pg/ml) and postoperative day 2 (6.70, 4.90-17.85 versus 7.04, 4.99-19.09 pg/ml) than that of the conventional group, however, there was no significant difference between both groups (p=0.345). On postoperative day 2, the level of the single port group had increased to 28.33 mg/L (20.97-63.97), being still higher than that of the conventional group (19.47, 11.09-54.96 mg/L). There were significant differences in the consecutive serum level of CRP in each group (p<0.001).

Conclusion

In this study, we evaluated the clinical outcomes, pain scores, serum IL-6, CRP, and leukocyte subpopulations in 31 patients who underwent single port laparoscopic cholecystectomy, comparing with 30 patients who underwent conventional laparoscopic cholecystectomy. We demonstrated no differences in those variables between the single port and conventional laparoscopic groups, although the mean age in the conventional group, the mean operation time in the single port group, and postoperative 4 hour pain score in the single port group were higher than that of the other group. Considering that the higher age was related to less surgery-induced pain and the longer operation time was associated with higher level of IL-6, we suggest that surgical stress in the single port group might be inferior to the conventional group.


Session: SS18
Program Number: S106

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