Single-Port-Cholezystektomie: Ein Vergleich mit dem Goldstandard

Zusammenfassung

Hintergrund: Derzeit gilt die Standard-4-Port-Cholezystektomie (LC) als Goldstandard bei der Gallenblasenresektion. Die weniger invasive 1-Port-Cholezystektomie (SILC) könnte zukünftig die LC als führende Technik ablösen. Allerdings bestehen bis dato immer noch Unklarheiten hinsichtlich der Sicherheit und Anwendbarkeit von SILC. Methoden: In der vorliegenden Studie wurde eine retrospektive Analyse prospektiv erhobener Daten von 459 Patienten durchgeführt, die entweder in SILC- oder LC-Technik cholezystektomiert wurden. Ergebnisse: Zwischen 2010 und 2011 wurden 115 SILC- (25 %) und 344 LC-Eingriffe (75 %) durchgeführt. Das mittlere Follow-up betrug 13,2 (2,1/24,6) Monate. Die SILC-Gruppe enthielt mehr weibliche (SILC: m : w 1 : 3,4 vs. LC: 1 : 1,2) und jüngere Patienten (SILC: 44,7 vs. LC: 54,9 Jahre) mit geringgradig niedrigerem ASA-Score (SILC: 1,7 ± 0,3 vs. LC: 1,9 ± 0,5). SIL-Cholezystektomien wurden häufiger als Elektiveingriff durchgeführt (SILC: 81,7 vs. LC: 55,5 %). Die Komplikationsraten waren in beiden Gruppen niedrig und ohne statistisch signifikanten Unterscheid (Wundinfektionen: SILC: 2,6 vs. LC: 3,19 %; Trokarhernien: SILC: 0,86 vs. LC: 2,3 %; Gallenleckage: SILC: 0,87 vs. LC: 0,87 %). SILC war mit verkürzter Operations- (SILC: 70 ± 31 vs. LC: 80 ± 27 Minuten; p < 0,001) sowie Aufenthaltsdauer assoziiert (postoperative Tage: SILC: 3,02 ± 1,4 vs. LC: 4,6 ± 2,8; p < 0,001). SILC bedurfte keiner Konversion zur offenen Chirurgie, verglichen zu LC (6 %; 21/334). Jedoch wurde bei SILC in 2,6 % (3/115) zumindest 1 zusätzlicher Trokar eingebracht. Schlussfolgerung: Bei reduziertem Trauma zeigt SILC ein im Vergleich zu LC gleichwertiges Risikoprofil ohne Nachteil in Bezug auf Operations- und Krankenhausaufenthaltsdauer. Unseres Erachtens stellt SILC die natürliche Evolution im Zeitalter der minimalstinvasiven Chirurgie dar.

Abstract

Background: Currently multiport laparoscopic cholecystectomy (LC) represents the gold standard for gall bladder removal. However, a single-incision approach might succeed it as the future leading technique. To date, final proof for safety and applicability remain elusive. Methods: A retrospective analysis of prospectively collected data from 459 patients subjected to multiport (LC) or single incision laparoscopic cholecystectomy (SILC) was performed. Results: From 2010 to 2011, 115 SILC (25 %) and 344 LC (75 %) interventious were performed. Mean follow-up was 13.2 (2.1/24.6) months. The SILC group comprised more females (SILC: m : f 1 : 3.4 vs. LC: 1 : 1.2) and younger patients (SILC: 44.7 vs. LC: 54.9 years) with a slightly lower (ASA) score (SILC:1.7 ± 0.3 vs. LC:1.9 ± 0.5). SIL cholecystectomy was performed more frequently in an elective setting (SILC: 81.7 vs. LC: 55.5 %). Complication rates were low and did not differ significantly between groups (wound infections: SILC: 2.3 vs. LC: 3.19 %; incisional hernias: SILC: 0.86 vs. LC: 2.3 %, bile leakage: SILC: 0.86 vs. LC: 0.57 %). SILC was associated with shorter operative times (SILC: 70 ± 31 vs. LC: 80 ± 27 minutes; p < 0.001) and reduced postoperative hospital stay (SILC: 3.02 ± 1.4 vs. LC: 4.6 ± 2.8 days; p < 0.001). No conversion to open surgery was required with SILC when compared to LC (6 %; 21/334). Within the SILC group, additional ports had to be placed in 2.6 % (3/115).

Conclusion: SILC displays a minimised surgical trauma. Compared to LC, SILC showed no disadvantage concerning risk profiles, operative times or hospital stay. We believe that SILC can be regarded as a natural evolution in the era of minimally invasive surgery.

Schlüsselwörter

laparoskopische Chirurgie - minimalinvasive Chirurgie - Cholezystektomie - Single-Port-Cholezystektomie

Key words

Laparoscopic surgery - minimally invasive surgery - cholecystectomy - single incision cholecystectomy

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