medigraphic.com

2011, Number 1

Cir Gen 2011; 33 (1)

Needlescopic cholecystectomy with two ports vs Laparoscopic cholecystectmy with three ports. Which is better?

Rodríguez SI, Ramírez AFJ

Language: Español
References: 17
Page: 9-13
PDF size: 259.45 Kb.


ABSTRACT

Objective: To compare needlescopic cholecystectomy with usual laparoscopic cholecystectomy with three ports. Setting: General Hospital, “Dr. Darío Fernández Fierro”, ISSSTE, Mexico City. Second level health care hospital.
Design: A prospective and randomized in parallel controled clinical assay.
Patients and methods: Patients older than 20 years who needed cholecystectomy due to gallbladder pathology confirmed by ultrasound (US) were included in this study. The study was performed in the period from December 2006 to February 2008; patients were divided randomly in two groups. All patients signed the institutional informed consent form. One group of 50 patients was subjected to needlescopic cholecystectomy and the other to laparoscopic cholecystectomy. We recorded, age, gender, surgical time, transoperative complications, pre-surgical diagnosis, length of post-surgery in-hospital stay, intensity and site of post-surgical pain, and aesthetic perception after surgery.
Statistical analysis: We performed a group analysis and then a comparison study between both techniques, using the SPSS version 15 software. Quantitative variables were analyzed using Student’s t test and qualitative variables were assessed with Chi square.
Results: Variables corresponding to age, gender, pre-operative diagnosis, type of intervention according to surgical need, post-surgical in hospital stay, intensity of post-surgical pain at 6, 12, 18, and 24 h revealed no statistically significant differences.
Only four variables were statistically significant: average surgical time (P = 0.0013), pain perceived at 6 hours after surgery (P = 0.0038), localization of post-surgical pain (P = 0.0005), post-surgical aesthetic perception (P = 0.00004).
Conclusions: Given the results of the statistical analysis, we consider that needlescopic cholecystectomy excels by very little the usual laparoscopic cholecystecomy, because the former is a less invasive procedure, which translates into less post-surgical pain but above all a more accepted and preferred aesthetic result for the patient.

References

  1. Franklin ME, Jr, Jaramillo EG, Glass JL, Treviño JM, Berghoff KR. Needlescopic cholecystectomy: lessons learned in 10 years of experience. JSLS 2006; 10: 43-46.

  2. Gagner M, Garcia-Ruiz A. Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 1998; 8: 171-179.

  3. Luo J, Cai Z, Huang Y. Clinical experience of needle-laparoscopic cholecystectomy. Annals of the College of Surgeons of Hong Kong 2000; 4: 17-19.

  4. Carbajal JR, Valsechi SA, Castillo CA, Locatelli Rm, Illich H¡JH. Colecistectomía laparoscópica. Análisis de 234 casos. Revista de Postgrado de la VIa Cátedra de Medicina 2003; 134: 10-15.

  5. Pérez E, Ostos L, Mejía A, García M. Colecistectomía laparoscópica ambulatoria. Rev Med IMSS 2002; 40: 71-75.

  6. Rodríguez LS, Sánchez-Portella CA, Acosta-González LR, Sosa-Hernández R. Costes: colecistectomía laparoscópica frente a colecistectomía convencional. Rev Cubana Cir 2006; 45: 0-0.

  7. Dávila-Ávila F, Sandoval RJ, Montes-Pérez JJ, Dávila-Ávila U, Dávila-Zenteno MR, Alonso-Rivera JM, et al. Sustitución de puertos por agujas percutáneas en cirugía endoscópica. Rev Mex Cir Endosc 2004; 5: 172-178.

  8. Ibáñez AL, Escalona PA, Devaud JN, Montero MP, Ramírez WE, Pimentel F, et al. Colecistectomía laparoscópica: experiencia de 10 años en la Pontificia Universidad Católica de Chile. Rev Chil Cir 2007; 59: 10-15.

  9. Dávila-Avila F, Montes-Pérez JJ, Dávila-Avila U, Dávila-Zenteno MR, Lemus-Allende J, Sandoval RJ. Propuesta de unificación de criterios para la clasificación de la cirugía minilaparoscópica. Rev Mex Cir Endosc 2004; 5: 90-98.

  10. Look M, Chew SP, Tan YC, Liew SE, Cheong DM, Tan JC, et al. Post-operative pain in needlescopic versus convencional laparoscopic cholecystectomy: a prospective randomized trial. J R Coll Surg Edinb 2001; 46: 138-142.

  11. Ros A, Gustafsson L, Krook H, Nordgren CE, Torrell A, Wallin G, et al. Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: a prospective, randomized, single-blind study. Ann Surg 2001; 234: 741-749.

  12. Cheah WK, Lenzi JE, So JB, Kum CK, Goh PM. Randomized trial of needlescopic versus laparoscopic cholecystectomy. British Journal of Surgery 2001; 88: 45-47.

  13. Karayiannakis AJ, Makri GG, Mantzioka A, Karousos D, Karatzas G. Systemic stress response after laparoscopic or open cholecystectomy : a randomized trial. Br J Surg 1997; 84: 467-471.

  14. Dávila-Ávila F, Dávila-Ávila U, Montero-Pérez JJ, Lemus-Allende J, López-Atzin FX, Villegas J. Colecistectomía laparoscópica con un solo puerto visible subxifoideo de 5 mm. Rev Mex Cir Endosc 2001; 2: 16-20.

  15. Squirrell DM, Majeed AW, Troy G, Peacock JE, Nicholl JP, Johnson AG. A randomized, prospective, blinded comparison of post-operative pain, metabolic response, and perceived health after laparoscopic and small incision cholecystectomy. Surgery 1998; 123: 485-95.

  16. Ngoi SS, Goh P, Kok K, Kum CK, Cheah WK. Needlescopic or minisite cholecystectomy. Surg Endosc 1999; 13: 303-305.

  17. De la Torre G, Garza J. Laparoscopic cholecystectomy using 2-mm instruments. Cir Gen 1999; 21: 192-194.

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