Comparative Study Between Transumbilical Single Port Pneumoperitoneum And Sudpended Transumbilical Single Port Pneumoperitoneum Laparoscopic Operation Technology

Background and Objective:The transumbilical single port pneumoperitoneum laparoscopic operation technology is the laparoscopic surgery with laparoscopic instruments through umbilicus.Compared by the natural orifice surgery (NOTES) in a variety of restrictions, the umbilical single port laparoscopic surgery is the minimally invasive surgery with minimal trauma and better cosmetic results。However, there is a variety of CO2 pneumoperitoneum specific complications such as subcutaneous emphysema, gas embolism, hypercapnia, arrhythmia, pneumothorax, pneumomediastinum and so on. Particularly determined to pulmonary dysfunction for older patients with cardiopulmonary dysfunction patients, suspended transumbilical single port laparoscopic operating techniques emerged. This study compared transumbilical single port pneumoperitoneum laparoscopic operation technology and suspended transumbilical single port laparascopic operation technology by the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications and so on, to discuss the feasibility of the suspended trnsumbilical single port laparoscopic operation technology. Methods:The documents of the patients who had been admitted into the department of General Surgery of Qilu Hospital, and undergone transumbilical single port pneumoperitoneum laparoscopic and suspended trnsumbilical single port laparoscopic cholecystectomy by professor HU San-Yuan in the period of 2008 to January 2010 were reviewed, ASA standards by the United States before the operation, select ASAⅠ,Ⅱgrade were randomly carried out by single umbilical port pneumoperitoneum laparoscopic surgery and suspended transumbilical single port laparoscopic surgery. The patients were divided into two groups:The single umbilical port pneumoperitoneum laparoscopy patients and suspended transumbilical single port laparoscopic surgery patients. Two groups were compared, the mean arterial pressure (MAP), operation time, recovery time, SpO2, body mass index, hospital costs, blood loss, complications. The statistics is analysed by SPSS 15.0 software with the t test or Wilcoxon test andx2 test between groups (P<0.05).Results:In the period of November 2008 to January 2010, there were 28 paitents who accept transumbilical single port laparoscopic cholecystectomy and suspended transumbilical single port laparoscopic cholecystectomy, of which comply with ASAⅠ,Ⅱstandard of a total of 24 cases. Pneumoperitoneum group of surgical patients before, after establishing pneumoperitoneum MAP increased significantly within 15min (P＜0.001), suspension group MAP remained at baseline level; two surgical operating time was not statistically different (P> 0.05), although operational exposure is poor in the suspension group, but basically the same operation time; recovery time after surgery was not statistically different (P> 0.05); there is significantly different in hospital costs (P<0.05), suspension group surgical is lower to pneumoperitoneum group; there is no significant difference in body mass index; less bleeding, no significant statistical difference.Conclusions:Suspended transumbilical single port laparoscopic surgery does not require carbon dioxide for the establishment of pneumoperitoneum, avoid specific complications of pneumoperitoneum for elderly patients with cardiopulmonary dysfunction. Suspended operation by the umbilical single port laparoscopic technique is similar to the insufflation as umbilical single port laparoscopic operation techniques in cosmetic results, and better hemodynamic stability, rapid recovery,also there is advantage in economy by avoiding one-off consumables.