Artikel
Is It Safe To Perform SIL-Cholecystectomy As A Teaching Procedure?
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Veröffentlicht: | 23. April 2012 |
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Introduction: While learning single incision transumbilical laparoscopy (SIL), the surgeon is constrained by the intersection of the instruments and the modified angles.
Materials and methods: We report on a comparison of SI-CHE performed by senior surgeons (A, n=20), fellows (B, n=20) or trainees (C, n=20) comparing total procedural time, intraoperative/postoperative complications, and length of umbilical incision. All surgeons had passed preoperative wet-lab training. The procedures were performed in a regular laparoscopic setting. Exposure and dissection of Calot`s triangle was performed using a suspension suture (cystopexia), one articulating instrument, and a 5 mm optical device. Statistical analysis were performed using the Mann-Whitney-U test with significance assumed at p<0.05.
Results: All 60 procedures could be completed laparoscopically. Additional trocars were used for difficult dissection in 5%, 20% and 5% in groups A, B, and C (p< 0.0001 for comparison of group A vs B and B vs C, respectively). Procedural time was 64,1± 30,0 min, 81,4±35,3 min and 76,9±19,4 min (p< 0.0001 for all comparisons). One intraperitoneal hematoma required redo-laparoscopy (1,7%; group C). All other patients were on oral diet and started mobilization at the day of surgery. The follow-up was uneventful in all patients. Incisional length at the navel showed no difference between the groups.
Conclusion: With significant differences in handling and procedural time, SIL-CHE can be proctored safely at least in selected cases, and can thereby be regarded as a teaching procedure.