Single-Port-Access-Cholezystektomie als sichere Alternative zum 4-Port-Vorgehen: Ein retrospektiver Vergleich

Zusammenfassung

Einleitung: Mit der Weiterentwicklung der laparoskopischen Chirurgie ist ein Ziel, Narben und operatives Trauma auf ein Minimum zu reduzieren. Die Single-Port-Chirurgie erfolgt über lediglich eine einzige Inzision in der Nabelgrube. Wir berichten über unsere Erfahrungen mit 69 Single-Port-Cholezystektomien im Vergleich zum Standard-4-Port Vorgehen.

Methode: Innerhalb von zwei Jahren führten wir 69 Single-Port-Cholezystektomien durch. Diese wurden in einer Fall-Kontroll-Studie mit in diesem Zeitraum durchgeführten 4-Port-Cholezystektomien verglichen. Dazu wurden demografische Daten der Patienten, Schnitt-Naht-Zeiten, postoperative Krankenhausaufenthaltsdauer, intra- und postoperative Komplikationen sowie Konversionsraten retrospektiv erfasst.

Ergebnisse: Zwischen der Single-Port-Methode und der Standard-4-Port-Cholezystektomie ergaben sich keine Unterschiede hinsichtlich der Rate intra- oder postoperativer Komplikationen. Die Schnitt-Naht-Zeiten waren abhängig vom Operateur und unterschieden sich zwischen beiden Methoden nicht. Die postoperative Krankenhausaufenthaltsdauer war tendenziell in der Single-Port-Gruppe kürzer, dies war jedoch statistisch nicht signifikant.

Schlussfolgerung: In ausgewählten Patientengruppen ist die Single-Port-Cholezystektomie dem Standard-4-Port-Vorgehen ebenbürtig. Der kosmetische Vorteil wird dabei nicht mit einem Verlust von Patientensicherheit erkauft.

Abstract

Purpose: As laparoscopic surgery develops, one current goal is the reduction of scarring and operative trauma to a minimum. Single-port access surgery (SPA) uses a single small incision hidden in the umbilicus. This report describes our experiences with 69 SPA cholecystectomies compared to the conventional laparoscopic approach.

Methods: Within two years 69 SPA cholecystectomies were performed. Data including demographic distribution, incision to closure time, duration of the postoperative hospital stay, rates of intraoperative and postoperative complications, and conversion rates were collected retrospectively. Data for a matched control group treated by standard laparoscopic cholecystectomy were gathered within the same time frame and then compared.

Results: There were no significant differences in the rates of intraoperative or postoperative complications in the SPA group when compared to the standard laparoscopy group. The incision-to-closure time strongly depended on the surgeon but did not depend on the method. The duration of postoperative hospital stay was slightly decreased in the SPA group. However, this effect was statistically not significant.

Conclusions: For selected patient groups, SPA cholecystectomy is on par with the conventional laparoscopic method. The cosmetic advantage that it offers does not come at the cost of any loss of safety.

Schlüsselwörter

Abdominalchirurgie - laparoskopische Chirurgie - chirurgische Technik

Key words

abdominal surgery - laparoscopic surgery - surgical technique

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