Transumbilical Single Site Colecystectomy Versus Standard Laparoscopic Cholecystectomy: Results of a Pilot Trial

M. Umit Ugurlu, MD, M. Tahir Oruc, MD, Zehra Boyacioglu, MD, H. Taner Turgut, MD, Mehmet Ozyilmaz, MD, S. Yigit Yildiz, MD. KOCAELI DERINCE TEACHING AND RESEARCH HOSPITAL GENERAL SURGERY CLINIC, KOCAELI, TURKEY


Introduction: The potential benefits of single incision laparoscopic cholecystectomy (SILC) may include scarless surgery, reduced postoperative pain, reduced postoperative length of stay, and improved postoperative quality of life. Usage of commercially available SILC access devices and hand instruments has some disadvantages. This study aimed to compare the outcomes of trans-umbilical single site cholecystectomy (TUMP-LC) using standard laparoscopic instruments versus conventional 4-port laparoscopic cholecystectomy (4PLC).
Methods: Patients with symptomatic gallstones were randomized to TUMP-LC (n:25) or 4PLC (n:25). The surgical outcomes such as length of stay, complications perioperative morbidity, operative time and conversion were analyzed. For evaluation of surgical stress preoperative and postoperative CRP values at 6 h and 24 h were measured. Postoperative pain was evaluated using a standard 10-point visual analogue scale (VAS).
Results: Mean age was 47.7 vs. 51.2, mean BMI of the patients was 28.6 vs. 27.9 kg/m2 , mean surgical time (44.56 vs 46.5 min) and mean hospital stay (1.5 vs 1.8 d) were similar for both the TUMP-LC and 4PLC group. There were no open conversions and no major complications. The mean total wound length of the TUMP-LC group was significantly shorter (2 vs. 3.75 cm). Mean pain scores post-operatively at 4 h, 12 h were significantly higher in 4PLC group than the TUMP-LC group (6 ± 2.23 vs. 4 ± 1.19 and 5.47 ± 1.14 vs. 3.64 ± 1.03; p<0.05). Plasma CRP values were significantly higher at 6 h and 24 h of surgery in 4PLC group than the TUMP-LC group (17.2 vs. 25.3 and 33.2 vs. 4.7; p<0.05). None of the cases were converted to open and no major complications occurred.
Discussion: TUMP-LC using standard laparoscopic instrumentation without an access device is an effective alternative to standard four-incision laparoscopic cholecystectomy. Lower pain scores and surgical stress values shows that TUMP-LC is feasible and safe for properly selected patients in experienced hands.

Session Number: Poster – Poster Presentations
Program Number: P370
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