Reduced-Port Laparoscopic Cholecystectomy Using a Port-Free Organ Retractor: A Comparative Study with Conventional...

Area of Science:

• Minimally Invasive Surgery
• Surgical Innovation
• Laparoscopic Cholecystectomy

Background:

• Reduced-port surgery (RPLC) offers potential solutions to surgeon shortages by enabling solo procedures.
• Single-incision laparoscopic cholecystectomy faces challenges like instrument collision and extended operative times.
• Free jaw (FJ) clip-assisted RPLC was evaluated as a solo-surgery approach.

Purpose of the Study:

• To assess the feasibility and safety of FJ clip-assisted RPLC as a solo-surgery technique.
• To evaluate the learning curve associated with FJ clip-assisted RPLC.
• To compare operative outcomes between FJ clip-assisted RPLC and conventional laparoscopic cholecystectomy (CLC).

Main Methods:

• A comparative study involving 14 patients undergoing FJ clip-assisted RPLC and 25 patients undergoing CLC.
• Operative time, blood loss, complications, and postoperative hospital stay were primary and secondary outcomes.
• Cumulative sum (CUSUM) analysis was used to evaluate the learning curve.

Main Results:

• The learning curve for FJ clip-assisted RPLC was completed by case 6.
• Operative times were comparable between RPLC (85.5 min) and CLC (90.0 min) groups (P = .121).
• Estimated blood loss was significantly lower in the RPLC group (1 mL vs 5 mL, P = .013), with no observed complications.

Conclusions:

• FJ clip-assisted RPLC is a safe and feasible solo-surgery technique.
• The procedure has a short learning curve and comparable safety to CLC.
• This approach can help address surgeon shortages while maintaining surgical quality with minimal added cost.