Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Endoscopy

Background:

• Natural orifice transluminal endoscopic surgery (NOTES) and transumbilical endoscopic surgery (TUES) represent advancements in minimally invasive surgery.
• The single-trocar (ST) technique for TUES was previously developed using a triple-channel trocar.
• The two-trocar (TT) technique was developed to further enhance surgical efficiency and reduce risks.

Purpose of the Study:

• To compare the clinical outcomes of the two-trocar (TT) and single-trocar (ST) transumbilical endoscopic surgery techniques.
• To evaluate the efficacy and safety of the optimized TT approach versus the established ST approach for cholecystectomy.

Main Methods:

• A randomized study involving 32 patients with chronic gallbladder disease undergoing cholecystectomy.
• Patients were assigned to either the TT technique (17 patients) or the ST technique (15 patients).
• The TT technique involved two 5-mm trocars in the umbilicus and one 2-mm trocar, while the ST technique used a single 15-mm triple-channel trocar.

Main Results:

• The mean operative time was significantly shorter for the TT technique (35.71 min) compared to the ST technique (125.25 min) (p < 0.001).
• Postoperative analgesic use was significantly lower in the TT group (0) versus the ST group (7) (p < 0.05).
• There was no significant difference in postoperative hospital stay between the two groups (p > 0.05).

Conclusions:

• The TT transumbilical approach is a faster and less painful alternative to the ST approach for cholecystectomy.
• Both techniques are based on the transumbilical approach, offering minimally invasive benefits.
• Cosmetic results were minimally different between the TT and ST techniques.