Page 29 - Peer Reviewed Laparoscopic Jornal

WJOLS

A Review of Randomized Controlled Trials comparing Single Port Laparoscopic Cholecystectomy

conventional cholecystectomy in databases such as Google trials as well as the learning curve within each trial group.
Scholar, Highwire press, and PubMed, and SCOPUS A decline in operating time of about 21 minutes was
between 1st January 2009 and 20th February 2013 was made observed between the first five single port laparoscopy
using search terms, such as single incision laparoscopic procedures and the last five procedures, more so, two
cholecystectomy, single port cholecystectomy, and surgeons with more than 15 years experience in advanced
minimally invasive cholecystectomy. Other synonyms were laparoscopic surgery and transanal endoscopic microsurgery
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included in the search, such as transumbilical laparoscopic performed all the procedures. Other studies showed mean
cholecystectomy, nearly scarless cholecystectomy and operating times for conventional laparoscopic chole-
laparoendoscopic single site cholecystectomy, NOTUS cystectomy that were marginally statistically significant
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cholecystectomy. These studies must compare conventional (p = 0.03), p = 0.05. Phillips et al demonstrated a highly
laparoscopic cholecystectomy, or its synonyms, such as statistically significant difference in the mean operating time
traditional laparoscopic cholecystectomy and Four-port in a multicenter study involving 10 centers which enrolled
laparoscopic cholecystectomy. a large number of participating patients.

Inclusion Criteria Postoperative Pain
• Articles published in English. The reduction in postoperative pain is a one of the benefits
• Publications between 1st January 2009 and 20th of single incision laparoscopic cholecystectomy.
February 2013. Conventional laparoscopic cholecystectomy involves about
• Randomized controlled trials. three to four multiple incision, rather than one umbilical
• The patients are adults aged 18 years up to 90 years old. incision used in single port laparoscopic cholecystectomy.
• The articles must evaluate any of the following criteria, Other factors that may cause postoperative pain include
operating time, postoperative pain and cosmesis, and irritation of the peritoneum under the diaphragm by the
bile duct injury and postoperative wound infection and carbon dioxide used in creating the pneumoperitoneum, and
conversion.

Exclusion Criteria

Randomization with bias or Quasi randomization. Eleven
randomized controlled trials were found, but one study was
excluded because the randomization was biased, hence,
10 studies were considered.

DISCUSSION

Operating Time
Operating time is an important consideration because it
offers some idea about the difficulty of a surgical procedure. Fig. 1: Laparoendoscopic single-site cholecystectomy 23
Single incision cholecystectomy is associated with crossing
of instrument intracorporeally as well as the ends of trocars
and handles of the hand instruments impeding the
extracorporeal instrumentation. It depicts the time from the
first incision on the patient to the closure of the last incision
on the patient. There were no differences in the mean
operation time in two studies (Figs 1 and 2), 23,24 similarity
in the operating time noted in these results may be as a
result of the similarity in the instruments used which are
the chip on tip flexible telescope and the articulated
instruments. While the mean operating time for conventional
laparoscopic cholecystectomy was shorter and statistically
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significant (p = 0.003, p = 0.001 and p = 0.00001). 26
These variations may be partly explained by the differences
in the level of skill of different surgeons’ involved in the Fig. 2: Conventional laparoscopic cholecystectomy 23
World Journal of Laparoscopic Surgery, May-August 2013;6(2):93-97 95