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Two-port needlescopic cholecystectomy: prospective
study of 100 cases
KW Lee, CM Poon, KF Leung,
DWH Lee, CW Ko
Department of Surgery, Tuen Mun Hospital, Tsing Chung Koon Road,
Tuen Mun, Hong Kong
OBJECTIVE. To test the feasibility of needlescopic
cholecystectomy using a two-port technique with 3-mm miniaturised
instruments.
DESIGN. Prospective study.
SETTING. Regional hospital, Hong Kong.
PATIENTS. One hundred consecutive patients undergoing elective cholecystectomy
from September 2001 to August 2002.
INTERVENTION. Two-port needlescopic cholecystectomy all performed
or supervised by a single laparoscopic surgeon.
MAIN OUTCOME MEASURES. Conversion of the procedure, the operating
time, postoperative analgesic requirement, pain score using the
10-cm visual analog scale, complications, and the postoperative
stay. To determine the technical difficulty of this new technique,
the data from the first 50 patients were compared with those of
the latter 50. Outcome variables were also compared with a group
of 58 patients operated on with the standard two-port laparoscopic
cholecystectomy in a previous randomised trial.
RESULTS. One conversion to open cholecystectomy was reported. Three
patients required the enlargement of epigastric port to a size of
5 mm and six patients required an additional port to complete the
operation. The median operating time was 62 minutes (range, 33-168
minutes). The median pain score was 3.5 (range, 0-9) and the median
postoperative stay was 2 days (range, 1-14 days). Six patients had
postoperative complications. When the first 50 patients were compared
with the latter 50, there were no differences in the conversion
rate, operating time, complication rate, and duration of hospital
stay. However, the latter 50 patients had significantly lower pain
scores (median, 3.5 vs 4.9; P=0.007) and faster resumption of diet
(median, 5 vs 9 hours; P<0.001). The median operating time of
needlescopic cholecystectomy was notably longer (62 vs 46 minutes;
P<0.001) compared with that of the two-port laparoscopic cholecystectomy.
Patients undergoing needlescopic cholecystectomy had a better resumption
of diet (median, 5 vs 7 hours; P<0.001) and less postoperative
pain (overall pain score, median, 3.5 vs 4.8; P=0.052) than the
two-port laparoscopic cholecystectomy group. Pain scores at individual
port sites were also lower in needlescopic cholecystectomy group
(umbilical port: median, 3 vs 4.4, P=0.015; epigastric port: median,
2.0 vs 3.6, P=0.036).
CONCLUSION. Two-port needlescopic cholecystectomy is technically
feasible and may further improve the surgical outcomes in terms
of postoperative pain and cosmesis. It can be considered for routine
practice by surgeons who are familiar with the two-port laparoscopic
cholecystectomy technique.
Hong Kong Med J 2005;11:30-5
Key words: Cholecystectomy, laparoscopic; Fiber
optics; Laparoscopes; Miniaturization; Needles
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