Clinical efficacy of transumbilical single- port laparoscopic cholecystectomy with ultrasonic knife for directly handling cystic artery

Objective To investigate the clinical feasibility and value of transumbilical single- port laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery.Methods A retrospective analysis was performed on the clinical data of 231 patients who underwent laparoscopic cholecystectomy with intraoperative ultrasonic knife for directly handling the cystic artery in our department from March 2011 to December 2012.According to the required surgical approaches, the patients were divided into transumbilical single- port laparoscopic group (n = 125, group A) and three- port laparoscopic group (n = 106, group B) .The two groups were compared in terms of operative time, intraoperative blood loss, postoperative analgesia, postoperative food intake, length of postoperative hospital stay, and postoperative complications, as well as the performance of the ultrasonic knife in directly handling the cystic artery.Comparison of continuous data between groups was made by t test, while comparison of categorical data was made by chi- square test.Results Group A had a significantly longer mean operative time than group B (20.21 ± 1.86 min vs 18.43 ± 1.37 min, P < 0.05) .There was no significant difference in mean intraoperative blood loss between groups A and B (23.23 ± 6.25 ml vs 22.34 ± 5.49 ml, P > 0.05) .Group A had significantly fewer patients who needed postoperative analgesia than group B (5 vs 21, P < 0.05) .The time to postoperative food intake showed no significant difference between groups A and B (6.56 ± 1.23 h vs 6.67 ± 1.45 h, P > 0.05) .The mean length of postoperative hospital stay was (2.98 ± 0.23) d in group A, versus (3.02 ± 0.18) d in group B (P > 0.05) .No indwelling drainage tube was used after operation in either group.There were no postoperative bleeding, bile duct injury, bile leakage, incisional wound infection, and other complications in the two groups.The ultrasonic knife had reliable hemostatic effect when directly sealing the cystic artery, without causing postoperative secondary bleeding.All patients were followed up for 2- 12 months (mean, 6.5 months) ;they recovered well without incisional hernia, and the umbilical scar was not obvious, with relatively good cosmetic results.Conclusion Transumbilical single- port laparoscopic cholecystectomy has a comparable clinical effect to three- port laparoscopic cholecystectomy, causing little trauma, postoperative pain, and scar, and it is suitable for patients with a high demand for incision appearance.Directly sealing the cystic artery with the ultrasonic knife can reduce bleeding due to careful separation of the cystic artery and shorten the operative time.Therefore, it is a safe, feasible surgical approach and worthy of clinical application.