Casaccia Marco, Palombo Denise, Razzore Andrea, Firpo Emma, Gallo Fabio, Fornaro Rosario
Surgical Clinic Unit II, Department of Surgical Sciences and Integrated Diagnostics, Genoa University, Italy.
Section of Biostatistics, Department of Health Sciences (DISSAL), Genoa University, Italy.
JSLS. 2019 Jul-Sep;23(3). doi: 10.4293/JSLS.2018.00102.
Safety, efficacy, and costs are still debated issues in single-port laparoscopy. The aim of the study was to compare clinical outcomes and hospital costs for conventional 4-port laparoscopic cholecystectomy (4PLC) and single-port laparoscopic cholecystectomy (SPLC) performed at a single institution.
A series of 40 SPLC patients operated on from October 2016 to May 2017 were compared to a hystorical series of 40 4PLC patients. Primary endpoints were the operative time, blood loss, postoperative pain, analgesia requirement, length of stay, and morbidity. Secondary endpoints were the operative costs and total hospital costs.
No patient required surgical conversion in both groups. Duration of surgery was significantly longer in the SPLC group. Length of hospitalization was shorter for patients operated on by SPLC (1.9 ± 0.9 vs 2.3 ± 1.2 days; = .104). According to visual analogue scale evaluation, the pain profile was similar. Minor postoperative complications were present in 12.5% of the SPLC group and 2.5% in 4PLC group ( = .200). The total hospitalization costs associated with SPLC procedure were lower compared to standard 4PLC procedure. As regards the disposable operating room equipment costs, a statistically significant difference in favor of SPLC technique was found.
SPLC has shown relevant procedure and postoperative outcomes when compared to traditional 4PLC. The technique has proved to be promising even in cases of acute cholecystitis considered to date a relative contraindication. Further studies are needed to confirm its safety and feasibility in this setting. In contrast with the current evidence of increased costs for the single-port technique, a reduction of material and hospitalization costs was experienced in our study.
在单孔腹腔镜手术中，安全性、有效性及成本仍是存在争议的问题。本研究旨在比较在同一机构进行的传统四孔腹腔镜胆囊切除术（4PLC）和单孔腹腔镜胆囊切除术（SPLC）的临床结局及住院费用。
将2016年10月至2017年5月接受手术的40例SPLC患者与一组40例4PLC患者的历史数据进行比较。主要终点指标为手术时间、出血量、术后疼痛、镇痛需求、住院时间及发病率。次要终点指标为手术费用及总住院费用。
两组患者均无需中转手术。SPLC组的手术时间明显更长。SPLC手术患者的住院时间更短（1.9±0.9天对2.3±1.2天；P = 0.104）。根据视觉模拟量表评估，疼痛情况相似。SPLC组术后轻微并发症发生率为12.5%，4PLC组为2.5%（P = 0.200）。与标准4PLC手术相比，SPLC手术的总住院费用更低。在一次性手术室设备成本方面，发现SPLC技术具有统计学上的显著优势。
与传统4PLC相比，SPLC已显示出相关的手术过程及术后结局。该技术即使在迄今为止被视为相对禁忌证的急性胆囊炎病例中也已证明具有前景。需要进一步研究以证实其在此情况下的安全性和可行性。与目前单孔技术成本增加的证据相反，我们的研究中材料和住院成本有所降低。
