Background. Classical laparoscopic cholecystectomy involves four ports while most novel 'single port' technique only requires one incision on the abdominal wall. This technique is thought to decrease surgical trauma and improve cosmesis although there are reports pointing out that classical laparoscopic cholecystectomy is also feasible in terms of cosmesis. Objectives. In this study we tried to determine if there are certain advantages in quality of life after single port surgery which would justify its utilization instead of classical laparoscopic cholecystectomy. Material and Methods. This is a prospective randomized study which enrolled 30 patients randomized either into classical laparoscopic cholecystectomy or single port surgery. The primary endpoint was patient satisfaction after surgery. This was assessed with short form 36 and gastrointestinal quality of life index (first preoperatively and then 3 months postoperatively) and a visual analogue scale on the first and seventh days. Results. There was not a statistically significant difference between groups in the emotional role, social functions, mental health, vitality and general health subscales of short form 36. At the end of 12 weeks, both groups demonstrated increases in the gastrointestinal and social subscales of the gastrointestinal quality of life index. There was not a statistically significant difference between groups when the visual analogue scale scores on first and seventh days were compared. Conclusions. The equal length of hospitalization, patient quality of life and pain perception and the longer operative times, high likelihood of incisional hernia and surgical site infection call into question the utilization of single port surgery, as it does not seem to confer an advantage over classical laparoscopic cholecystectomy (Adv Clin Exp Med 2015, 24, 3, 469-473).
INTRODUCTIONSingle-incision laparoscopic surgery (SILS) was first used two decades ago. This method was then used in gynecology, urology, and also general surgery, with an emphasis on cholecystectomy (1, 2). According to the short-term results, this new method was less painful, led to fewer hernias, provided better cosmesis, and was more economical (2).However, some disadvantages of this method were reported in recent studies (3). Baik et al. (4) reported that the complex instruments and ports used in this method caused significant difficulties and restrictions during surgery. Ma et al. (5) had to use additional ports for the vast majority of patients (67%) during single-incision laparoscopic cholecystectomy (SILC) due to technical difficulties during surgery. Additional ports were also used in rectal surgery due to technical difficulties (6).Despite their use in numerous clinical studies, we did not come across data on the use of additional ports in the articles we could access.We found that the surgery became easy and that suspension was not needed when a 5-mm port at the subxiphoid region was added to the SILC technique. We compared the preliminary results of this technique as planned and implemented by us for the first time with the results of patients for whom we used the SILC method. MATERIAL AND METHODS Study DesignThe first 10 patients in whom we used SILC were evaluated in our pilot study. We found the mean duration of the surgery to be 65.5±13.4 min. We aimed to reduce this duration by 10% in patients in whom we used an additional port. The number of patients needed was calculated. Considering a power of 80% and reliability of 0.05, we found that 22 patients should be present in each group. Two groups (Group 1; SILC, Group 2; MCAP) were randomized by automatic numbering from April 2012. The study was started with 54 patients for the possible loss of patients and data during the study. Some patients were excluded from the study due to the reasons presented in the flow-chart (Figure 1). The study was completed with 23 patients in each group. Study Patients and Evaluated DataThis study was conducted in the Department of General Surgery, Kafkas University School of Medicine, between April 2012 and September 2013. All study patients were given information about the Material and Methods: Fifty-four patients who were diagnosed with chronic cholelithiasis were prospectively randomized and divided into two groups. An additional 5-mm port (MCAP: with an additional port using a multichannel device through the umbilicus) was placed in the subxiphoid area instead of a transabdominal suspension suture in one group of patients. The other group was operated on with the SILC technique. The demographic and surgical data of the patients were compared. Results:The MCAP technique shortened the surgery duration by more than half (MCAP: 35.0±12.3, SILC: 79.1±27.7 min) (p<0.05). No difference was found between the two methods in terms of estimated blood loss, length of hospitalization, postoperative day 1 and 7 visual analo...
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