Transvaginal-hybrid vs. single-port-access vs. ‘conventional’ laparoscopic cholecystectomy: a prospective observational study

• Published in: Langenbeck's archives of surgery 2011-06, Vol.396 (5), p.709-715
• Main Authors: Kilian, Maik, Raue, Wieland, Menenakos, Charalambos, Wassersleben, Brit, Hartmann, Jens
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Cardiac Surgery; Cholecystectomy - methods; Cholecystectomy, Laparoscopic - methods; Cholecystitis - surgery; Cholelithiasis - surgery; Female; General Surgery; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Natural Orifice Endoscopic Surgery - methods; Original Article; Pain Measurement; Pain, Postoperative - etiology; Postoperative Complications - etiology; Prospective Studies; Thoracic Surgery; Time and Motion Studies; Traumatic Surgery; Vagina - surgery; Vascular Surgery
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-011-0769-8

Purpose In the recent past, access to the peritoneal cavity has involved primarily ‘natural orifice transluminal’ and ‘single-port access’ techniques, which are based on laparoscopy. The most frequently performed procedure using these new developments is cholecystectomy. Few studies compare more than one ‘new’ method with the ‘golden standard’ of laparoscopic cholecystectomy. Here we present the results of the first prospective observational study comparing standard laparoscopic cholecystectomy with single-port cholecystectomy as well as transvaginal-hybrid cholecystectomy. Methods Fifty-one patients were included in a prospective observational study (20 four-trocar laparoscopic, 15 transvaginal-hybrid, 16 single-port cholecystectomies). Endpoints of the study were operative time, length of hospital stay and postoperative level of pain (numeric analogue score, while coughing). Conversion rates and complications are reported as well. Results Median operating times did not differ among all three access methods [55 (35–135) min vs. 65 (35–95) min vs. 68 (35–98) min]. Hospital stay was significantly shorter in the transvaginal-hybrid group [3 (3–12) days] and in the single-port group [3 (1–9) days], compared to the four-trocar laparoscopic group [4 (2–17) days]. Pain score was significantly diminished in the transvaginal-hybrid group during the early postoperative course. Conclusions Concerning the length of hospital stay, transvaginal-hybrid cholecystectomy and single-port cholecystectomy appear to be superior to ‘conventional’ laparoscopic cholecystectomy. Additionally, transvaginal-hybrid access is associated with significantly less pain in the early postoperative course.