Gasless Laparoendoscopic Single-Site Cholecystectomy with Abdominal Wall Lift:a Randomized Trial Compared with Conventional Laparoscopic Cholecystectomy

Sanyuan Hu. Department of General Surgery,Qilu Hospital of Shandong University,P.R.China

Background On the request to make laparoscopic surgery even more minimally invasive,laparoscopic single-site surgeries have been described. We present a novel technique of gasless laparoendoscopic single-site surgery (GLESS) with abdominal wall lift (AWL) for cholecystectomy.This study aimed to compare the outcome and morbidity parameters of gasless laparoendoscopic single-site cholecystectomy (GLESC) and standard laparoscopic cholecystectomy (LC).

Methods Data from 25 patients who underwent GLESC and 19 patients who underwent LC in Qilu Hospital of Shandong University,Shandong,China between June 2009 and July 2010 were collected.The BMI,associated disease,operating time,estimated blood loss(EBL),rate for conversion to open procedure ,the CRP level,pain scores at 6h and 24h, shoulder and back pain rate, time taken for resumption of oral intake and normal activities,postoperative hospital stay, wound complications were noted and a retrospective analysis was conducted.

Results Out of 44 patients,23 underwent GLESC and 19 underwent LC. The follow-up period was 48 to 174 days (median,120days). The mean operating time was longer in the GLESC group (78.91±24.59 min) than in the LC group (46.84 ± 9.60 min; p < 0.05). The mean pain scores at 6h were similar in the two groups (4.96 ± 0.98 for the GLESC group vs. 5.42 ± 1.17 for the LC group;nonsignificant difference). However the pain scores at 24h were significantly lower in the GLESC group (3.39 ± 1.12) than in the LC group(4.84 ± 1.42; p=0.001). The shoulder and back pain rate of GLESC group was significantly lower than that of LC group(P = 0.023).The time to resumption of normal activities(8.37 ± 1.84 vs. 9.68 ± 2.03 hours; p = 0.033) was significantly shorter in the GLESC group than in the LC group.The EBL(11.74 ± 4.42 vs. 8.68 ± 3.27 ml; p=0.17), the CRP level (35.75 ± 22.00 vs. 20.22 ± 11.08 mg/L; p=0.054) and the hospital stay(1.17 ± 0.39 vs. 1.26 ± 0.45 days; p=0.495) were similar in the two groups,respectively.There were two cases in the GLESC group were converted to laparoendoscopic single-site cholecystectomy (LESC) using AWL combined with low-pressure pneumoperitoneum (6mmHg) and no wound complications such as wound infection or hernia.

Conclusion The GLESC with AWL is safe , feasible and possible in most cases of gallbladder diseases.It appears to be cosmetically superior compared to standard laparoscopic cholecystectomy and other advantages include less postoperative pain and faster postoperative recovery.The techniques provide satisfactory exposure of operative field and a easier access method for patients having certain BMI and height.The use of a flexible laparoscope,bent or articulating instruments greatly reduces the “learning curve” of this procedure.It can offer an acceptable alternative to NOTES.It may prove to be a better approach for LESS technique and can be potentially recommended as a standard and reproducible procedure.

Keywords: LESS,gasless,abdominal wall lift,cholecystectomy,pain score