Department of Surgery, Center for Minimally Invasive Surgery, The Ohio State University, Columbus, OH 43210, USA.
Surg Endosc. 2013 Jan;27(1):104-8. doi: 10.1007/s00464-012-2428-8. Epub 2012 Jul 18.
Recent technological advances in single-incision platforms have allowed many general surgeons to add single-incision laparoscopic cholecystectomy (SILC) to their armamentarium. However, adopting new surgical technologies comes at a cost to the patient and the surgeon. This study compared retrospective case-matched SILC and traditional multi-incision laparoscopic cholecystectomy (MILC) to evaluate the effects of SILC on perioperative outcomes and patient cost.
The study compared 50 patients who underwent SILC with a case-matched population of individuals who underwent traditional MILC. The SILC technique was performed using one of three commercially available single-incision platforms currently used for single-incision laparoscopic surgery (SILS) cholecystectomies. All the SILS platforms were placed in a 2-cm supraumbilical incision. All statistical analyses were performed using Microsoft Excel 2008 for Macintosh, with statistical significance determined by a p value of 0.05 or less.
The average operative time was 42 min for the SILC group and 45 min for the MILC group. The difference was not statistically significant. Similarly, the average estimated blood loss was 14 ml for the SILC group and 11 ml for the MILC group. Again, the difference was not statistically significant. Moreover, the body mass index (BMI) did not differ statistically between the SILC group (28.4 kg/m(2)) and the MILC group (32.2 kg/m(2)). The average patient cost was $18,447 for SILC and $17,701 for MILC, yielding a cost difference of $746. This difference was not statistically significant.
At the authors' institution, SILS cholecystectomy was performed with blood loss, operating room time, and cost equal to that for MILC. Further research is necessary to assess the economic feasibility of SILC and the trade-off of cost with the improved cosmesis, decreased pain, greater patient satisfaction, reduced postoperative analgesic requirement, and faster return to work to determine the overall value and superiority of SILC compared with MILC.
单切口平台的最新技术进步使许多普通外科医生能够在他们的手术工具中添加单切口腹腔镜胆囊切除术（SILC）。然而，采用新的外科技术会给患者和外科医生带来成本。本研究比较了回顾性病例匹配的 SILC 和传统多切口腹腔镜胆囊切除术（MILC），以评估 SILC 对围手术期结果和患者成本的影响。
本研究比较了 50 例接受 SILC 的患者和接受传统 MILC 的病例匹配人群。SILC 技术使用目前用于单切口腹腔镜手术（SILS）胆囊切除术的三种商业上可用的单切口平台之一进行。所有 SILS 平台均放置在 2cm 脐上切口。所有统计分析均使用 Microsoft Excel 2008 for Macintosh 进行，统计学意义由 p 值<0.05 确定。
SILC 组的平均手术时间为 42 分钟，MILC 组为 45 分钟。差异无统计学意义。同样，SILC 组的平均估计出血量为 14ml，MILC 组为 11ml。差异也无统计学意义。此外，SILC 组（28.4kg/m²）和 MILC 组（32.2kg/m²）的体重指数（BMI）差异无统计学意义。SILC 的平均患者成本为 18447 美元，MILC 为 17701 美元，成本差异为 746 美元。差异无统计学意义。
在作者所在机构，SILS 胆囊切除术的出血量、手术室时间和成本与 MILC 相当。需要进一步研究来评估 SILC 的经济可行性以及成本与改善美容效果、减轻疼痛、提高患者满意度、减少术后镇痛需求和更快恢复工作之间的权衡，以确定 SILC 与 MILC 相比的总体价值和优势。
