A Comparative Study of Needlescopic Grasper Assisted Single Incision versus Three Port versus Pure Single Incision Laparoscopic Cholecystectomy

This study compared the surgical outcomes of single-incision with needlescopic grasper (nSILC) versus three-port (TPLC) versus pure single-incision laparoscopic cholecystectomies (pSILC). The present study showed similar surgical outcomes between the pSILC and nSILC procedures. However, the operative time for the nSILC group was longer than that for the TPLC group but shorter than that for the pSILC group. Therefore, nSILC is a feasible surgical procedure for patients with benign gallbladder disease compared to TPLC and an effective approach to overcome the limitations of pSILC.

Colecistectomía acuscópica con dos puertos vs colecistectomía laparoscópica con tres puertos ¿Cuál es mejor? / Needlescopic cholecystectomy with two ports vs Laparoscopic cholecystectmy with three ports. Which is better?

Objetivo: Comparar la técnica de colecistectomía acuscópica contra la técnica de colecistectomía laparoscópica habitual con 3 puertos. Sede: Hospital General, ''Dr. Darío Fernández Fierro'', ISSSTE, México D.F., 2º nivel de atención. Diseño: Ensayo clínico controlado en paralelo, prospectivo, aleatorizado. Pacientes y métodos: Se incluyeron pacientes mayores de 20 años quienes ameritaban colecistectomía por patología de vesícula biliar corroborada por ultrasonido (USG), comprendido en el periodo de diciembre de 2006 a febrero 2008 y divididos en 2 grupos de forma aleatoria simple. Todos los pacientes firmaron el formato institucional de consentimiento informado. A un grupo de 50 pacientes se le realizó colecistectomía acuscópica mientras que al otro grupo de 52 pacientes se les practicó colecistectomía laparoscópica. Se documentó la edad, género, tiempo quirúrgico, complicaciones transoperatorias, diagnóstico prequirúrgico, tiempo de estancia hospitalaria postquirúrgica, intensidad y localización del dolor postquirúrgico, y la percepción estética postquirúrgica. Análisis estadístico: Se realizó un análisis grupal y posteriormente comparativo entre ambas técnicas, utilizando el programa de análisis estadístico SPSS versión 15, las variables cuantitativas fueron analizadas mediante la prueba t de Student, y las variables cualitativas con la Chi cuadrada. Resultados: Las variables de edad, género, diagnóstico preoperatorio, tipo de intervención de acuerdo a necesidad quirúrgica, tiempo de estancia postquirúrgica, intensidad del dolor postquirúrgico a las 6, 12, 18 y 24 horas no mostró ninguna diferencia significativa. Sólo cuatro variables tuvieron significancia estadística; éstas fueron: el tiempo quirúrgico promedio (P = 0.0013), el dolor percibido a las 6 horas de postoperatorio (P = 0.0038), la localización del dolor postquirúrgico (P = 0.0005), y la percepción estética postquirúrgica (P = 0.00004). Conclusiones: Dado los resultados del análisis estadístico consideramos que la colecistectomía acuscópica supera por muy poco a la colecistectomía laparoscópica, debido a que es un procedimiento de menor invasión, lo cual se traduce en menor dolor postquirúrgico y sobre todo un resultado estético más aceptado y preferido por los pacientes.

Objective: To compare needlescopic cholecystectomy with usual laparoscopic cholecystectomy with three ports. Setting: General Hospital, ''Dr. Darío Fernández Fierro'', ISSSTE, Mexico City. Second level health care hospital. Design: A prospective and randomized in parallel controled clinical assay. Patients and methods: Patients older than 20 years who needed cholecystectomy due to gallbladder pathology confirmed by ultrasound (US) were included in this study. The study was performed in the period from December 2006 to February 2008; patients were divided randomly in two groups. All patients signed the institutional informed consent form. One group of 50 patients was subjected to needlescopic cholecystectomy and the other to laparoscopic cholecystectomy. We recorded, age, gender, surgical time, transoperative complications, pre-surgical diagnosis, length of post-surgery in-hospital stay, intensity and site of post-surgical pain, and aesthetic perception after surgery. Statistical analysis: We performed a group analysis and then a comparison study between both techniques, using the SPSS version 15 software. Quantitative variables were analyzed using Student's t test and qualitative variables were assessed with Chi square. Results: Variables corresponding to age, gender, pre-operative diagnosis, type of intervention according to surgical need, post-surgical in hospital stay, intensity of post-surgical pain at 6, 12, 18, and 24 h revealed no statistically significant differences. Only four variables were statistically significant: average surgical time (P = 0.0013), pain perceived at 6 hours after surgery (P = 0.0038), localization of post-surgical pain (P = 0.0005), post-surgical aesthetic perception (P = 0.00004). Conclusions: Given the results of the statistical analysis, we consider that needlescopic cholecystectomy excels by very little the usual laparoscopic cholecystecomy, because the former is a less invasive procedure, which translates into less post-surgical pain but above all a more accepted and preferred aesthetic result for the patient.

Comparision of Needlescopic Appendectomy versus Conventional Laparoscopic Appendectomy in Children / 대한내시경복강경외과학회지

PURPOSE: This clinical study evaluated the feasibility of needlescopic appendectomy (NA) in young patients with acute appendicitis, and we compare the outcome of this new technique with that of conventional laparoscopic appendectomy (LA). METHODS: Two groups of young patients who underwent laparoscopic appendectomy at Sanggye Paik Hospital between January 2009 and December 2009 were studied. In the first group, a 2-mm instrument appendectomy was performed in 13 patients. These patients were compared with the second group, which were 21 patients who underwent conventional laparoscopic appendectomy. Statistical significance was set at p values<0.05. RESULTS: The patient demographics and operative findings were similar in both groups. There was no conversion to open appendectomy in either group. Postoperative ileus was occurred in 3 patients who underwent LA, but there was no statistical difference between the both groups (p=0.154). The needlescopic group had a shorter mean operative time (p=0.65), but there was no statistically significance. The mean hospital stay was significantly shorter (p=0.026) in the needlescopic group than that in the conventional laparoscopic group. CONCLUSION: According to our experience, needlescopic laparoscopic appendectomy is a safe and feasible procedure as compared with that of conventional laparoscopic appendectomy in young patients.