Abstract
Amaç: Laparoskopik kolesistektomi (LK) semptomatik kolelitiazis tedavisinde altın standart tedavidir ve dünyada en sık uygulanan cerrahi prosedürdür. Estetik açından açık kolesistektomiye göre üstündür fakat günümüzde estetik kaygıların artması nedeniyle trokar girişlerinin görünürlüğü kozmetik açıdan sorun oluşturmaktadır. Konvansiyonel dört port LK’yi tüm insizyonlarının bikini çizgisi altında kalacak şekilde uyguladığımız hastaların sonuçlarını sunuyoruz.
Materyal ve Metod: Çalışmaya kliniğimizde 01.11.2020 – 31.11.2021 tarihleri arasında bikini insizyonla LK uygulanan hastalar dahil edildi. Hastaların yaş, cinsiyet, ek hastalıkları, kolesistektomi endikasyonları, geçirilmiş batın cerrahileri, anestezi skorları, vücut kitle indeksleri (VKİ) kaydedildi. Prosedür, akut kolesistit ve diğer nedenlere bağlı acil ameliyat edilen hastalara uygulanmadı.
Bulgular: Çalışmada tümü kadın olmak üzere 9 hasta yer aldı. Hastaların ortalama yaşı; 30 ±7.8, ortalama VKİ’si; 23.1 ±4.3’tü. Ortalama ameliyat süresi; 33.9 ± 8.5 dakikaydı. Hiçbir hastada açık operasyona geçilmedi. Yatış süre tüm hastalar için bir gündü. Hastaların hiçbirinde komplikasyon gelişmedi. Dokuz hastanın sekizi (%89) ameliyattan sonraki ilk ayda kozmetik olarak memnun kaldığını ifade etti.
Sonuç: LK prevalansı, daha az yara izi bekleyen hasta sayısında artışa neden olur. Burada kolay uygulanabilen, güvenli, ek maliyet gerektirmeyen ve yüksek hasta memnuniyeti ile modifiye edilmiş dört portlu laparoskopik kolesistektomi öneriyoruz.
References
- 1. Begum S, Khan MR, Gill RC. Cost effectiveness of Glove Endobag in Laparoscopic Cholecystectomy: Review of the available literature. J Pak Med Assoc. 2019 Feb;69(Suppl 1)(1):S58-S61. PMID: 30697021.
- 2. Gulaydin N. Laparoscopic cholecystectomy by the modified bikini line approach as a simple and safe technique. Rev Assoc Med Bras (1992). 2021 Aug;67(8):1172-1176. doi: 10.1590/1806-9282.20210589. PMID: 34669865.
- 3. Lirici MM, Tierno SM, Ponzano C. Single-incision laparoscopic cholecystectomy: does it work? A systematic review. Surg Endosc. 2016 Oct;30(10):4389-99. doi: 10.1007/s00464-016-4757-5. Epub 2016 Feb 19. PMID: 26895901.
- 4. Shah MY, Somasundaram U, Wilkinson T, Wasnik N. Feasibility and Safety of Three-Port Laparoscopic Cholecystectomy Compared to Four-Port Laparoscopic Cholecystectomy. Cureus. 2021 Nov 29;13(11):e19979. doi: 10.7759/cureus.19979.
- 5. Nemani A, Sankaranarayanan G, Olasky JS, Adra S, Roberts KE, Panait L et al. A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis. Surg Endosc. 2014 Aug;28(8):2443-51. doi: 10.1007/s00464-014-3495-9.
- 6. Ersoz F, Ozcan O, Sari S, Bektas H, Arikan S. Laparoscopic cholecystectomy on the bikini line for invisible scar. Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e7-e10. doi: 10.1097/SLE.0b013e3182064d5f.
- 7. Sanford DE. An Update on Technical Aspects of Cholecystectomy. Surg Clin North Am. 2019 Apr;99(2):245-258. doi: 10.1016/j.suc.2018.11.005.
- 8. Kim SS, Donahue TR. Laparoscopic Cholecystectomy. JAMA. 2018 May 1;319(17):1834. doi: 10.1001/jama.2018.3438. PMID: 29715356.
- 9. Hauters P, Auvray S, Cardin JL, Papillon M, Delaby J, Dabrowski A et al. Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club Coelio. Surg Endosc. 2013;27(5):1689-1694. doi:10.1007/s00464-012-2657-x
- 10. Zanghì G, Leanza V, Vecchio R, Malaguarnera M, Romano G, Rinzivillo NM et al. Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature. G Chir. 2015;36(6):243-246. doi:10.11138/gchir/2015.36.6.243.
- 11. Nijhawan S, Barajas-Gamboa JS, Majid S, Jacobsen GR, Sedrak MF, Sandler BJ et al. NOTES transvaginal hybrid cholecystectomy: the United States human experience. Surg Endosc. 2013;27(2):514-517. doi:10.1007/s00464-012-2470-6
- 12. Peng C, Ling Y, Ma C, Ma X, Fan W, Niu W et al. Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech. 2016;26(5):347-353. doi:10.1097/SLE.0000000000000284
- 13. de la Cruz-Munoz N, Koniaris L. Alternative port site selection (APSS) for improved cosmesis in laparoscopic surgery. J Gastrointest Surg. 2010;14(12):2004-2008. doi:10.1007/s11605-010-1282-z
- 14. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010 Jul;211(1):132-8. doi: 10.1016/j.jamcollsurg.2010.02.053.
Abstract
Objective: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis and is the most commonly performed surgical procedure worldwide. It is superior to open cholecystectomy in terms of aesthetics, but the visibility of the trocar ports is a cosmetic problem due to increasing aesthetic concerns. We report the results of patients who underwent conventional four port LK with all incisions below the bikini line.
Material and Method: The study included patients who underwent LK through bikini incision in our clinic between 01.11.2020 and 31.11.2021. Age, gender, comorbidities, indications for cholecystectomy, previous abdominal surgeries, anesthesia scores, and body mass index (BMI) were recorded. The procedure was not performed in patients undergoing emergency surgery for acute cholecystitis and other causes.
Results: The study included 9 patients, all of whom were female. The mean age was 30 ± 7.8 years and mean BMI was 23.1 ± 4.3. Mean operative time was 33.9 ± 8.5 minutes. Open operation was not performed in any patient. The hospitalization period was one day for all patients. There were no complications in any of the patients. Eight of the nine patients (89%) expressed cosmetic satisfaction in the first month after surgery.
Conclusion: The prevalence of LC leads to an increase in the number of patients expecting less scarring. Here, we propose a modified four-port laparoscopic cholecystectomy that is easy to perform, safe, requires no additional cost, and has high patient satisfaction
References
- 1. Begum S, Khan MR, Gill RC. Cost effectiveness of Glove Endobag in Laparoscopic Cholecystectomy: Review of the available literature. J Pak Med Assoc. 2019 Feb;69(Suppl 1)(1):S58-S61. PMID: 30697021.
- 2. Gulaydin N. Laparoscopic cholecystectomy by the modified bikini line approach as a simple and safe technique. Rev Assoc Med Bras (1992). 2021 Aug;67(8):1172-1176. doi: 10.1590/1806-9282.20210589. PMID: 34669865.
- 3. Lirici MM, Tierno SM, Ponzano C. Single-incision laparoscopic cholecystectomy: does it work? A systematic review. Surg Endosc. 2016 Oct;30(10):4389-99. doi: 10.1007/s00464-016-4757-5. Epub 2016 Feb 19. PMID: 26895901.
- 4. Shah MY, Somasundaram U, Wilkinson T, Wasnik N. Feasibility and Safety of Three-Port Laparoscopic Cholecystectomy Compared to Four-Port Laparoscopic Cholecystectomy. Cureus. 2021 Nov 29;13(11):e19979. doi: 10.7759/cureus.19979.
- 5. Nemani A, Sankaranarayanan G, Olasky JS, Adra S, Roberts KE, Panait L et al. A comparison of NOTES transvaginal and laparoscopic cholecystectomy procedures based upon task analysis. Surg Endosc. 2014 Aug;28(8):2443-51. doi: 10.1007/s00464-014-3495-9.
- 6. Ersoz F, Ozcan O, Sari S, Bektas H, Arikan S. Laparoscopic cholecystectomy on the bikini line for invisible scar. Surg Laparosc Endosc Percutan Tech. 2011 Feb;21(1):e7-e10. doi: 10.1097/SLE.0b013e3182064d5f.
- 7. Sanford DE. An Update on Technical Aspects of Cholecystectomy. Surg Clin North Am. 2019 Apr;99(2):245-258. doi: 10.1016/j.suc.2018.11.005.
- 8. Kim SS, Donahue TR. Laparoscopic Cholecystectomy. JAMA. 2018 May 1;319(17):1834. doi: 10.1001/jama.2018.3438. PMID: 29715356.
- 9. Hauters P, Auvray S, Cardin JL, Papillon M, Delaby J, Dabrowski A et al. Comparison between single-incision and conventional laparoscopic cholecystectomy: a prospective trial of the Club Coelio. Surg Endosc. 2013;27(5):1689-1694. doi:10.1007/s00464-012-2657-x
- 10. Zanghì G, Leanza V, Vecchio R, Malaguarnera M, Romano G, Rinzivillo NM et al. Single-Incision Laparoscopic Cholecystectomy: our experience and review of literature. G Chir. 2015;36(6):243-246. doi:10.11138/gchir/2015.36.6.243.
- 11. Nijhawan S, Barajas-Gamboa JS, Majid S, Jacobsen GR, Sedrak MF, Sandler BJ et al. NOTES transvaginal hybrid cholecystectomy: the United States human experience. Surg Endosc. 2013;27(2):514-517. doi:10.1007/s00464-012-2470-6
- 12. Peng C, Ling Y, Ma C, Ma X, Fan W, Niu W et al. Safety Outcomes of NOTES Cholecystectomy Versus Laparoscopic Cholecystectomy: A Systematic Review and Meta-Analysis. Surg Laparosc Endosc Percutan Tech. 2016;26(5):347-353. doi:10.1097/SLE.0000000000000284
- 13. de la Cruz-Munoz N, Koniaris L. Alternative port site selection (APSS) for improved cosmesis in laparoscopic surgery. J Gastrointest Surg. 2010;14(12):2004-2008. doi:10.1007/s11605-010-1282-z
- 14. Strasberg SM, Brunt LM. Rationale and use of the critical view of safety in laparoscopic cholecystectomy. J Am Coll Surg. 2010 Jul;211(1):132-8. doi: 10.1016/j.jamcollsurg.2010.02.053.
Details
| Primary Language | English |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Original Research Articles |
| Authors | |
| Publication Date | April 30, 2023 |
| Submission Date | April 9, 2022 |
| Published in Issue | Year 2023 Volume: 16 Issue: 1 |
Van Health Sciences Journal (Van Sağlık Bilimleri Dergisi) başlıklı eser bu Creative Commons Atıf-Gayri Ticari 4.0 Uluslararası Lisansı ile lisanslanmıştır.
