Single Incision Laparoscopic Cholecystectomy Performed Via the 'Marionette' Technique Shows Equivalence in Outcome and Cost to Standard Four Port Laparoscopic Cholecystectomy in a Selected Patient Population

摘要

The aim of our study is to compare single incision laparoscopic cholecystectomy (SILC) performed using the "marionette" technique (m-SILC), to the standard four-port technique [four-port laparoscopic cholecystectomy (4PLC)]. Patient information was extracted from a prospectively maintained database (n 5 188). Our primary endpoint was operative costs (determined by operating time and instruments used). Secondary endpoints were length of stay, operative time, blood loss, and postoperative complication rates. Univariate and adjusted multivariate analysis was used to compare the outcomes. There were a total of 188 patients for this study. Gender, body mass index, American Society of Anesthesiologists class, and resident participation were similar. Patients undergoing m-SILC were younger (43.8 vs 49.8 years old), less likely to have cholangiogram (32% vs 54%), and were more likely to undergo cholecystectomy for chronic cholecystitis (73.3% vs 52%). In univariate analysis, cholecystectomy performed by the "marionette method" as compared with the 4PLC was associated with shorter operative time (67 vs 59 minutes respectively) and shorter hospital stay (1.2 vs 2.08 days respectively). In multivariate analysis, SILC was associated with shorter hospital stay and comparable operative time, blood loss, and postoperative complications. Instrumentation cost was less in SILC (by $94). SILC done by an experienced surgeon with the "marionette" technique on a carefully selected population shows a statistically significant cost benefit while maintaining clinically comparable outcomes to the standard 4PLC. The surgical world changed with the laparoscopic revolution in the 1980s. The first video-laparoscopic cholecystectomy described in literature was performed by Muhle in 1985 and was met with much opposition. Because its advent and increasing popularity, numerous studies have shown laparoscopic cholecystectomy to be superior to its open counterpart in regards to hospital stay, operative time, opiate use, and overall cost. In 1992, the National Institute of Health consensus statement recognized laparoscopic cholecystectomy as "the treatment of choice for many patients." The first single incision laparoscopic cholecystectomy (SILC) was performed in 1995.3 Since that time, over 40 studies have been published, and over 1100 patients underwent SILC in these studies.