Evolution of segmental anesthesia for Laparo-Endoscopic Single Site (LESS) cholecystectomy

Area of Science:

• Minimally Invasive Surgery
• Anesthesiology
• Gastroenterology

Background:

• Transumbilical Laparo-Endoscopic Single Site (LESS) surgery offers cosmetic and recovery benefits.
• Regional anesthesia, specifically epidural anesthesia, is explored for LESS procedures due to the minimal incision.
• This study details the transition from combined spinal-epidural to thoracic epidural anesthesia for LESS cholecystectomy.

Purpose of the Study:

• To evaluate the safety and feasibility of LESS cholecystectomy using regional anesthesia.
• To assess patient satisfaction, cosmesis, and recovery outcomes.
• To describe the evolution of anesthetic techniques for LESS cholecystectomy.

Main Methods:

• Prospective evaluation of 15 patients with chronic cholecystitis or symptomatic cholelithiasis undergoing LESS cholecystectomy.
• Anesthetic technique evolved from combined spinal-epidural to thoracic epidural anesthesia alone.
• Outcomes measured included operative time, blood loss, complications, length of hospital stay, pain scores (VAS), and patient satisfaction/cosmesis scores.

Main Results:

• All 15 patients successfully underwent LESS cholecystectomy with regional anesthesia.
• Postoperative pain was well-tolerated, with low Visual Analog Scale (VAS) scores.
• Patients reported high satisfaction (10/10) and cosmesis (9.3/10) at 14 days postoperatively.

Conclusions:

• LESS cholecystectomy with epidural anesthesia is a safe and effective procedure.
• High patient satisfaction and excellent cosmetic results are key advantages.
• Epidural anesthesia is a viable option for selected patients undergoing LESS cholecystectomy.