Laparo-Endoscopic Single Site (LESS) Cholecystectomy With Epidural Anesthesia: Is This An Approach Worth Pursuing?

Sharona B Ross, MD, Ryan D Freeman, BS, Franka Co, BS, Carrie E Ryan, MS, Prashant Sukharamwala, MD, Benjamin Sadowitz, MD, Alexander Rosemurgy, MD. Florida Hospital Tampa

INTRODUCTION

Some patients are not well suited to undergo general anesthesia because of comorbidities. Furthermore, by avoiding inhalational anesthetics and neuromuscular blockade, epidural anesthesia offers substantial cost savings. This study was undertaken to detail our experience with Laparo-Endoscopic Single Site (LESS) cholecystectomy with epidural anesthesia.

METHODS

36 consecutive patients undergoing LESS cholecystectomy with epidural anesthesia were prospectively followed. Operative duration was from time into the operating room to time out of the operating room. Patients were asked to score their postoperative pain, scar satisfaction, and overall treatment outcome on a Likert scale from 1 (very severe / very dissatisfied / very bad) to 10 (no pain / very satisfied / very good). Median data are reported.

RESULTS

36 patients (10 men and 26 women) underwent LESS cholecystectomy with epidural anesthesia; they were of age 43 years and BMI 28 kg/m2. 70% had cholecystitis. One operation (3%) was converted to general anesthesia due to narcotic tachyphylaxis. Operations lasted 66 minutes. All patients had minimal blood loss (<<100 ml) and there were no intraoperative complications. Time in the recovery room (PACU) was 105 minutes and total length of stay was 8 hours. The only postoperative complication was a urinary tract infection. Patients scored their pain on postoperative day 1 at 5 (moderate) and reported 2 days to resume a usual diet. At one month, patients rated their scar satisfaction as 10 and their overall satisfaction with their treatment as 10.

CONCLUSION

LESS cholecystectomy can be safely, efficiently, and predictably undertaken with epidural anesthesia; epidural anesthesia is a safe and effective alternative to general anesthesia for LESS cholecystectomy. Epidural anesthesia does not prolong cholecystectomy and the approach leads to safe conduct without intraoperative complications. PACU and hospital length of stay are impressively short. Patient satisfaction with their scar after LESS cholecystectomy is extraordinary and inspiring, and overall satisfaction strongly supports cholecystectomy with epidural anesthesia. Ultimately, outcomes after LESS cholecystectomy with epidural anesthesia support further application and study, and the approach offers potential opportunities for tremendous cost savings.