Retrospective Non-Inferiority Analysis of Comparative of Performance on Single Incision Laparoscopic Cholecystectomy (SILC) between Using a Conventional Equipment and a Commercially Available Equipment

Background: Single incision laparoscopic cholecystectomy (SILC) is a modern technique for cholecystectomy via a single transumbilical incision. Original surgical equipment including an articulated minimally invasive surgical instrument was necessary for SILC procedures. However, the articulated long length with flexible rotatable tip instrument is expensive and could not be reimbursed by the Thai National Health Insurance. The present study used conventional laparoscopic equipment that is a non-articulated, shorter, and rigid tip to perform SILC. Objective: To compare the effectiveness between conventional and original equipment for the SILC procedure by evaluating the difficulty of SILC indicated by the length of operative time. Materials and Methods: The patients that underwent SILC in Thammasat University Hospital between October 2014 and December 2020 were reviewed from the electronic medical database. The primary outcome was the difficulty of the SILC procedure, determined from the operative time, to evaluate the performance of the SILC procedure between using the conventional or the original equipment in a non-inferiority trial. The secondary outcome was intraoperative and post-operative complications. Results: The eligibility criteria included 592 SILC procedure that was categorized as conventional equipment group with 351 (59.29%) patients and original equipment group with 241 (40.71%) patients. The multivariate analysis reported the number of difficult SILC procedures was less frequent in SILC using conventional equipment when compared with original equipment, significantly with 37 (10.54%) versus 43 (17.84%) relative risk (RR) (1.75, 95% CI 1.081 to 2.822, p=0.023). The intraoperative bile leakage, cystic artery injury, wound infection and 3-months follow-up of incisional hernia were not different in SILC procedures using eithers equipment. Conclusion: The application of conventional equipment that is used in multiple-port LC procedure to perform in SILC procedure was safe and not related to difficulty of SILC. This can reduce the cost of surgery, especially for articulated instrument that cannot be reimbursed from the National Health Insurance in Thailand. Keywords: Laparoscopic cholecystectomy; Single-incision laparoscopic cholecystectomy; Articulated minimally invasive surgical instrument; Difficult laparoscopic cholecystectomy.

COMPARATIVE EVALUATION OF COSMETIC OUTCOME BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY & SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

Aim: Comparative analysis of cosmetic outcome between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy. Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included cosmetic outcome, Results: The body image score for SILC group ranged from 30 to 44 with mean score of 40.76 ± 2.773 while that for cLC group ranged from 33 to 42 with mean score of 38.28 ± 1.969. p-value for the comparison stands 0.001 which shows that patients undergoing SILC had better cosmetic perception of their body image compared to cLC group Conclusion: SILC is better cosmetic perception as compare to cLC Keywords: SILC, cLC, Cosmetic outcome

COMPARATIVE EVALUATION OF POST-OPERATIVE PAIN BETWEEN CONVENTIONAL LAPAROSCOPIC CHOLECYSTECTOMY & SINGLE INCISION LAPAROSCOPIC CHOLECYSTECTOMY

AIM: Comparative analysis of post-operative pain between Single Incision Laparoscopic Cholecystectomy and conventional Laparoscopic Cholecystectomy. Method: Patients suffering from symptomatic cholelithasis were randomly subjected to Single Incision Laparoscopic Cholecystectomy (SILC) and conventional four ports Laparoscopic Cholecystectomy (cLC). Data analyzed included duration of surgery, post-operative pain, For assessment of post-operative pain numeric pain scale scoring system was used and pain scoring done at four hours, twelve hours and twenty-four hours post-operatively. Results: The study included fifty patients operated upon from June, 2014 to May, 2014. Twenty-five patients were subjected to SILC and rest of the twenty-five underwent cLC. Pre-operative characteristics of two groups were similar and there was no significant difference between two groups based on age, sex and Body Mass Index. Post-operative pain score was higher for cLC compared to SILC at four, twelve and twenty-four hours post-operatively. The mean pain score at four hours was 4.64 ± 1.89 for SILC versus 7.72 ± 0.84 for cLC (p-value < 0.0001). While the score at twelve and twenty-four hours were 2.96 ± 1.88 and 1.80 ± 1.44 for SILC compared to 5.08 ± 1.15 and 3.80 ± 1.11 for cLC respectively. Conclusion: SILC is superior to cLC compared to post-operative pain as per our study. Keywords: SILC, cLC, post-operative pain