Classic Laparoscopy Technique Still Preferred for Gallbladder Surgery

May 06, 2011

NEW YORK - Procedure times are longer and complications more frequent with single-port laparoscopic cholecystectomy than with the traditional four-port technique, an Oregon team has found.

Dr. Paul D. Hansen and colleagues at Providence Portland Medical Center note in the Annals of Surgery online April 13th that multiple port sites may contribute significantly to postop pain, and there's a potential hernia risk at port sites.

The authors therefore compared single-port and four-port laparoscopic cholecystectomy, randomizing 43 patients to surgery with one or the other approach.

The two groups had similar results for intraoperative complications, blood loss or length of stay, according to the report, and there were no conversions to open laparotomy.

However, mean operative time was twice as long with the single-port technique (89 vs 45 minutes). Over the course of the study, mean operative time with the single-port device fell from 100 to 82 minutes, suggesting a learning-curve effect, but the difference wasn't statistically significant.

Postoperative pain scores at discharge were slightly higher in the single-port group than the 4-port group (2.7 vs. 1.8; p=0.06). Patient satisfaction with the procedure was 8.9 on a 10-point scale for the single-port procedure and 9.2 for the classic technique (p=0.59), and corresponding satisfaction rates for the cosmetic results were 9.3 vs. 8.9.

Three patients in each group had wound infections requiring oral antibiotics, but other complications occurred only in the single-port group; these included one case each of retained bile duct stone, port-site hernia, and a port-site postop hemorrhage, the investigators report.

"In summary, on the basis of our randomized controlled trial, single-port laparoscopic cholecystectomy had a longer operative time and seemed to incur more postoperative complications, which may be related to the learning curve," Dr. Hansen and colleagues conclude. "However, both single-port laparoscopic cholecystectomy and classic laparoscopic cholecystectomy produced similar levels of patient satisfaction and pain, as well as patient-perceived functional health status."

They add, "Larger randomized trials performed later in the learning curve with single-port laparoscopic cholecystectomy may identify more subtle advantages of one method over another."


Ann Surg 2011.