Page 30 - Laparoscopic Journal - WJOLS

WJOLS

Njem Josiah Miner, RK Mishra 10.5005/jp-journals-10033-1249
retrOSpective Study

A Comparative Study of Single Incision vs Conventional

Four Incision Laparoscopic Cholecystectomy:
A Single Center Experience

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1 Njem Josiah Miner, RK Mishra

ABSTRACT as a surgical technique is, however, feasible and promising for
treatment of symptomatic cholelithiasis.
Laparoscopic cholecystectomy has traditionally been per-
formed using multiple small incisions. Single incision laparo- Keywords: Analgesic, Four incision laparoscopic cholecystec-
scopic cholecystectomy (SILC) has emerged as an alternative tomy, Hospital stay, Single incision laparoscopic cholecys-
technique to improve cosmesis and minimize complications tectomy.
associated with multiple incisions. This study compared SILC How to cite this article: miner NJ, mishra RK. A Comparative
with conventional four incision laparoscopic cholecystectomy. Study of Single Incision vs Conventional Four Incision Laparo-
Materials and methods: One hundred and twenty-one patients s copic Cholecystectomy: A Single Center Experience. World J
had laparoscopic cholecystectomy at the institute of minimal Lap Surg 2015;8(2):62-67.
access, metabolic and bariatric surgery, Sir Ganga Ram Source of support: Nil
Hospital, New Delhi, between January 2013 and October 2014.
A total of 61 (50.4%) had conventional four port laparoscopic Conflict of interest: None
cholecystectomy (4PLC), while 60 (49.6%) had SILC. Indica-
tions for the operation were similar for the two groups. Excluded INTRoduCTIoN
were patients who were operated for malignant gallbladder
disease, patients with mirizzi syndrome, patients with gall- Laparoscopic cholecystectomy (LC) has become one of the
bla dder perforation and patients who were in American Society most effective procedures for the treatment of gallbladder
of Anesthesiologists (ASA) 1V and V.
1
pathology. This technique has induced tremendous
Primary end points: Analgesic requirements, Complications revolution in the surgery of biliary sytem, mainly due
and hospital visits, Length of hospital stay.
to improved results compared to the open technique
Results: The average length of hospital stay including in-patient and its cosmetic advantages has further endeared in the
and out-patient surgeries was 23.93 ± 9.8, range 4 to 48 hours 1,2
for those who had SILC and 30.07 ± 16, range 8 to 72 hours heart of surgeons. Since, the first LC by Muhe et al in
for patients who underwent 4PLC. Patients in both groups had 1985, conventional laparoscopic cholecystectomy (CLC)
either paracetamol or a nonsteroidal anti-inflammatory drug has become the gold standard for treating gallbladder
(NSAID) as postoperative analgesic. Only one (1.7%) patient disease. 1,3,4,9,12,13 Conventional laparos copic cholecystec­
who had SILC required an NSAID for postoperative analgesia, tomy is a safe established procedure and traditionally it
while 59 (98.3%) had postoperative pain relieve using only
paracetamol. Four (6.6%) of patients who had 4PLC required is performed through three to four small incisions. 4,5,9,11
an NSAID for postoperative analgesia, while 57 (93.4%) had It is the commonest operation performed laparoscopi­
only paracetamol for postoperative analgesia. cally worldwide.
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Conclusion: Single incision laparoscopic cholecystec- A trend toward even more minimally invasive app­
tomy appears to offer prospects for shorter hospital stay roaches has, however, led to techniques of single incision
and early return to work compared to conventional 4PCL. and natural orifices transluminal endoscopic surgery
Patients undergoing either SILC or 4PLC appear to have
similar analgesic requirement. Extrapolating this to pain (NOTES). 1,2,4,4,9 The first published report of single inci­
difference between the two surgical techniques, however, sion laparoscopic cholecystectomy (SILC) was by Navarra

requires caution. Single incision laparoscopic cholecystectomy in 1997 and since that time the idea of ‘scarless’ surgery
has gained increasing popularity among patients as well
as surgeons. 1,4,6 Single incision laparoscopic cholecys­
1 Senior Registrar, Director, Professor and Senior Consultant tectomy is indeed a rapidly evolving technique that is
2
4
1 Department of Surgery, Cardiothoracic Surgery Unit, JOS complimenting CLC in selected fields and patients. It is
University Teaching Hospital, JOS, Nigeria now considered by many as a bridge between traditional
2 Department of minimal Access Surgery, World Laparoscopy cholecystectomy and NOTES. 2,4,5 Single incision laparo­
Hospital, Gurgaon, Haryana, India scopic cholecystectomy utilizes three ports through a
Corresponding Author: Njem Josiah miner, Senior Registrar single skin incision at the umbilicus and is being consi­
Department of Surgery, Cardiothoracic Unit, JOS University dered as a ‘no scar’ surgery because the incision is placed
Teaching, PmB 2076, JOS, Nigeria, e-mail: njemjoe@gmail.com
4,7
within the umbilical scar. It has gained increasing
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