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Hybrid Single-Port Cholecystectomy Vs Four-Port Cholecystectomy in Children
Federico G Seifarth1, Michael H Liu2, Dimaris Ayala1
1Department of Pediatric Surgery, Cleveland Clinic Children's Hospital, Cleveland, Ohio, USA.
Insights
Single-port hybrid laparoscopic cholecystectomy is a safe and feasible option for children, offering reduced operative time and lower costs compared to the traditional 4-port method. This approach demonstrates similar patient outcomes, making it a cost-effective alternative for uncomplicated gallbladder disease.
Area of Science:
- Pediatric surgery
- Minimally invasive procedures
- Gastrointestinal surgery
Background:
- Single-port laparoscopic cholecystectomy is emerging as a safe alternative for pediatric gallbladder removal.
- The hybrid single-port technique, developed in 2012, offers a potential improvement over traditional methods.
Purpose of the Study:
- To compare the hybrid single-port laparoscopic cholecystectomy with the conventional 4-port approach in pediatric patients.
- To evaluate differences in complications, outcomes, operative time, and costs between the two techniques.
Main Methods:
- A retrospective, single-center study compared 98 pediatric patients undergoing either hybrid single-port or conventional 4-port laparoscopic cholecystectomy.
- Data analyzed included patient characteristics, intraoperative and postoperative outcomes, operative costs, and total hospitalization costs.
Main Results:
- Single-port procedures had a shorter operative time (85 vs. 114 minutes) and lower cholangiogram rates (9% vs. 40%).
- No significant differences in intra- or postoperative outcomes were observed between the groups.
- The single-port approach resulted in lower total hospitalization costs ($7438 vs. $8783) and operative costs ($3918 vs. $4647).
Conclusions:
- Hybrid single-port laparoscopic cholecystectomy is a feasible and safe option for children with uncomplicated gallbladder disease.
- This technique offers comparable outcomes to the 4-port approach while significantly reducing healthcare costs.
Background And Objectives:
Evidence is increasing that single-port or single-incision laparoscopic cholecystectomy is a safe and feasible alternative for cholecystectomy in children. In this study, we sought to compare the single-port hybrid technique, which we originally reported in 2012, with the conventional 4-port approach, in regards of complications, outcome, operative time and cost.
Methods:
A retrospective, single-center comparison of hybrid single-port versus conventional 4-port laparoscopic cholecystectomy was performed in 98 consecutive pediatric patients between January 2010 and October 2014. Patient characteristics, intra- and postoperative outcomes, operative costs, and total hospitalization costs were compared between the 2 approaches using univariate and multivariate analyses.
Results:
The single-port technique was utilized in 56 (57%) pediatric patients who underwent laparoscopic cholecystectomy. The operative time for single-port procedures was shorter than that of the conventional technique (median, 85 minutes vs 114 minutes; P = .003). Patients with single-port procedures were less likely to have a cholangiogram compared to patients who underwent 4-port cholecystectomy. (9% vs 40%; P < .001). No statistically significant differences between the 2 cohorts were observed for intra- or postoperative outcomes. Although the 2 groups shared nearly the same median duration of hospitalization (22 hours vs 21 hours; P = .70), the single-port group demonstrated a lower total cost of hospitalization (median cost, $7438 vs $8783; P = .030) and lower operative cost (median, $3918 vs $4647; P < .001).
Conclusion:
Hybrid single-port laparoscopic cholecystectomy in children with uncomplicated gallbladder disease is feasible and equally safe, with similar intra- and postoperative outcomes compared with the conventional 4-port approach. It can contribute to global cost reduction because of lower operative and total hospitalization costs.