Randomized clinical study for assessment of incision characteristics and pain associated with LESS versus laparoscopic cholecystectomy

Background Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0–4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complicat...

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Published in:	Surgical endoscopy Vol. 27; no. 3; pp. 1009 - 1015
Main Authors:	Madureira, Fernando Athayde Veloso, Manso, José Eduardo Ferreira, Madureira Fo, Delta, Iglesias, Antonio Carlos Garrido
Format:	Journal Article
Language:	English
Published:	New York Springer-Verlag 01-03-2013 Springer Nature B.V
Subjects:	Abdominal Surgery Adolescent Adult Aged Cholecystectomy Cholecystectomy, Laparoscopic - adverse effects Cholecystectomy, Laparoscopic - methods Endoscopy, Digestive System - adverse effects Endoscopy, Digestive System - methods Female Gallbladder Gallbladder diseases Gallbladder Diseases - surgery Gallstones Gastroenterology Gynecology Hepatology Hernias Humans Infections Laparoscopy Male Medicine Medicine & Public Health Middle Aged Operative Time Pain Pain, Postoperative - etiology Patients Proctology Prospective Studies Skin Statistical analysis Surgery Umbilicus - surgery Young Adult Brazil Rio de Janeiro Brazil Cholecystectomy Single port LESS Laparoscopic Minimally invasive
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Summary:	Background Laparoendoscopic single-site surgery (LESS) has emerged as a technique that uses a natural scar, the umbilicus, within which a multiple-entry portal is placed into a 3.0–4.0-cm single incision to perform operations. The objective of this study was to compare incision size, wound complications, and postoperative pain of LESS compared with those of laparoscopic cholecystectomy (LC). Methods A prospective randomized controlled study was conducted between January and June 2011 at two university hospitals in Rio de Janeiro, Brazil. Fifty-seven patients were randomly assigned to undergo laparoscopic or LESS cholecystectomy. Skin and aponeurosis wound sizes were recorded. A 10-point visual analog scale (VAS) was used to assess pain at postoperative hours 3 and 24. Healing and wound complications were assessed at follow-up. Results A total of 57 patients, 53 women and 4 men with a mean age of 48.7 years, were randomly assigned to undergo LESS ( n = 28) or LC ( n = 29). The mean length of the umbilical skin incision was 4.0 cm (range = 2.1–5.8) in LESS and 2.7 cm (1.5–5.1) in LC ( p < .0001). The mean internal aponeurosis diameter was 3.5 cm (2.0–5.5) in LESS and 2.3 cm (1.2–3.5) in LC ( p < .0001). The mean operative time was 60.3 min (32–128) for LESS and 51.3 min (25–120) for LC ( p = 0.11). Gallbladder perforation at detachment occurred in 15.69 % of the LESS cases and in 5.88 % of the LC cases ( p = 0.028). The mean VAS score for pain at hour 3 was 2.0 points (0–7) for the LESS group and 4.0 (0–10) for the LC group ( p = 0.07), and at postoperative hour 24 it was 0.3 points (0–6) for LESS and 2.3 (0–10) for LC ( p = 0.03). There were no significant differences in wound complications. Incisional hernias were not found in either group. Conclusions The LESS single-port (SP) operations demand a bigger incision than LC surgery. However, there were no differences in healing, wound infections, and hernia development. We found a tendency of less postoperative pain associated with LESS/SP than with LC.
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ISSN:	0930-2794 1432-2218
DOI:	10.1007/s00464-012-2556-1