Comparative Study Between Transumbilical Single Port Laparoscopic And Conventional Laparoscopic Cholecystectomy

Background and Objective:As much as possible to reduce surgical trauma is the entire surgeon's pursuit and the development direction of surgery. With the development of minimally invasive surgery, abdominal surgery without scars becomes a new goal to pursue. The basic approach is through natural orifice transluminal endoscopic surgery (NOTES), as the natural cavity (stomach, rectum,bladder or vagina), and the aims are to achieve the abdominal wall without scar, lighter postoperative pain, more minimally invasive, and aesthetic effect. The real NOTES is still in research stage because we can not overcome the difficulties and equipment constraints. As a natural pore in umbilical embryonic period, umbilicus both can hide abdominal scar, and avoid infection, and we can also use conventional abdominal equipment, so embryonic natural orifice transumbilical endoscopic surgery (E-NOTES, NOTUS) become the fastest-growing endoscopic surgical technique. Cholecystectomy is the earliest application technology of E-NOTES, so transumbilical single port laparoscopic cholecystectomy has the trend of becoming mainstream laparoscopic cholecystectomy.The objective of this study is to discuss the feasibility, advantages and clinical application of transumbilical single port laparoscopic cholecystectomy.Methods:The documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone transumbilical single port laparoscopic and conventional laparoscopic cholecystectomy by professor HU San-Yuan in the period of November 2008 to November 2009 were reviewed. All the patients are divided into transumbilical single port laparoscopic cholecystectomy group (group A) and conventional laparoscopic cholecystectomy group (group B). Contrasts in their operation time, blood loss, hospitalization time after operation, complications rate and the total cost. SPSS 15.0 software is used for the t test or Wilcoxon test andx2 test between groups (P<0.05).Results:In the period of November 2008 to November 2009, professor HU San-Yuan has completed 12 cases of transumbilical single port laparoscopic cholecystectomy surgery. Meanwhile 23 cases of conventional laparoscopic cholecystectomy fit for the requests of this study. No post-operative complications occurred in both groups, as to blood loss, group A and B have no significant difference (P> 0.05).As to hospitalization time and the total hospital cost, group A is superior to group B (P<0.01).However, as to operation time, group B is superior to group A (P<0.01). The same time, comparison in group A, operation time of transumbilical single port laparoscopic cholecystectomy has a decreasing trend, in which the operation time of the later 4 cases is significantly less than the former 4 cases (P<0.01).Conclusions:Transumbilical single port laparoscopic cholecystectomy is a safe and feasible operation. It has the advantages of mini-invasion, rapid recovery, short hospitalization and less total cost. Although the operation is more difficult than the traditional one, and need further development and improvement in surgical instruments, but with the improvement of surgical instruments and the accumulation of experience, operational improvements in technology, transumbilical single port laparoscopic cholecystectomy will demonstrate the superiority and become the mainstream laparoscopic cholecystectomy.