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Prospective Assessment of Trocar-Specific Morbidity in Laparoscopy

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Abstract

Background

The purpose of the present study was to challenge the hypothetical advantage of single port laparoscopy (SPL) over conventional laparoscopy by measuring prospectively the morbidity specifically related to conventional trocar sites (TS).

Methods

From November 2010 to December 2011, 300 patients undergoing various laparoscopic procedures were enrolled. Patient, surgery, and trocar characteristics were recorded. We evaluated at three time points (in-hospital and at 1 and 6 months postoperatively) specifically for each TS, pain (Visual Analog Scale), morbidity (infection, hematoma, hernia), and cosmesis (Patient Scar Assessment Score; PSAS). Patients designated their “worst TS,” and a composite endpoint “bad TS” was defined to include any adverse outcome at a TS.

Results

We analyzed 1,074 TS. Follow-up was >90 %. Pain scores of >3/10 at 1 and 6 months postoperatively, were reported by 3 and 1 % of patients at the 5 mm TS and by 9 and 1 % at the larger TS, respectively (5 mm TS vs larger TS; p = 0.001). Pain was significantly lower for TS located in the lower abdomen than for the upper abdomen or the umbilicus (p = 0.001). The overall complication rate was <1 % and significantly lower for the 5 mm TS (hematoma p = 0.046; infection p = 0.0001). No hernia was found. The overall PSAS score was low and significantly lower for the 5 mm TS (p = 0.0001). Significant predictors of “bad TS” were larger TS (p = 0.001), umbilical position (p = 0.0001), emergency surgery (p = 0.0001), accidental trocar exit (p = 0.022), fascia closure (p = 0.006), and specimen extraction site (p = 0.0001).

Conclusions

Specific trocar morbidity is low and almost negligible for 5 mm trocars. The umbilicus appears to be an unfavorable TS.

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References

  1. Markar SR, Karthikesalingam A, Trumurthy S et al (2012) Single-incision laparoscopic surgery (SILS) vs conventional multiport cholecystectomy: systematic review and meta-analysis. Surg Endosc 26:1213–1250

    Google Scholar 

  2. Ahmed K, Wang T, Patel VM et al (2011) The role of single-incision laparoscopic surgery in abdominal and pelvic surgery: a systematic review. Surg Endosc 25:378–396

    Article  PubMed  Google Scholar 

  3. Luna R, Nogueira DB, Varela PS et al (2012) A prospective, randomized comparison of pain, inflammatory response, and short-term outcomes between single port and laparoscopic cholecystectomy. Surg Endosc 27:1254–1259

    Article  PubMed  Google Scholar 

  4. Pisanu A, Reccia I, Porceddu G et al (2012) Meta-analysis of prospective randomized studies comparing single incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC). J Gastrointest Surg 16:1790–1810

    Article  PubMed  Google Scholar 

  5. Song T, Liau B, Liu J et al (2012) Single-incision versus conventional laparoscopic cholecystectomy: a systematic review of available data. Surg Laparosc Endosc Percutan Tech 22:e190–e196

    Article  PubMed  Google Scholar 

  6. Fung AKY, Aly EH (2012) Systematic review of single-incision laparoscopic colonic surgery. Br J Surg 99:1353–1364

    Article  PubMed  Google Scholar 

  7. Aprea G, Coppola Battazzi E, Guida F et al (2011) Laparoscopic single site (LESS) versus classic video-laparoscopic cholecytectomy: a randomized prospective study. J Surg Res 166:e109–e112

    Article  PubMed  Google Scholar 

  8. Kurien A, Rajapurkar S, Sinha L et al (2011) Standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25:365–370

    Article  PubMed  Google Scholar 

  9. Wewers ME, Lowe NK (1990) A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health 13:227–236

    Article  CAS  PubMed  Google Scholar 

  10. Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  PubMed  Google Scholar 

  11. Deslauriers V, Rouleau DM, Alami G et al (2009) Translation of the Patient Scar Assessement Scale (PSAS) to French with cross-cultural adaptation, reliability evaluation and validation. Can J Surg 52:259–263

    Google Scholar 

  12. Dunker MS, Stigglebout AM, vaan Hogezand RA et al (1998) Cosmesis and body image after laparoscopic-assisted and open ileocolic resection for Crohn’s disease. Surg Endosc 12:1334–1340

    Article  CAS  PubMed  Google Scholar 

  13. Saad S, Strassel V, Sauerland S et al (2013) Randomized clinical trial of single-port, minilaparoscopic and conventional cholecystectomy. Br J Surg 100:339–349

    Article  CAS  PubMed  Google Scholar 

  14. Fanfani F, Fagotti A, Gagliardi ML et al (2013) Minilaparoscopic versus single-port total hysterectomy: a randomized trial. J Minim Invasive Gynecol 20(2):192–197

    Article  PubMed  Google Scholar 

  15. Park SK, Olweny EL, Best SL et al (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic and open surgery. Eur Urol 60:1097–1104

    Article  PubMed  Google Scholar 

  16. Dauser B, Görgel A, Stopfer J et al (2012) Conventional laparoscopy vs single port surgery from a patient’s point of view: influence of demographics and body mass index. Wien Klin Wochenschr 124:834–841

    Article  PubMed  Google Scholar 

  17. Bucher P, Pugin F, Ostermann S et al (2011) Population perception of surgical safety and body image trauma: a plea for scareless surgery? Surg Endosc 25:408–415

    Article  PubMed  Google Scholar 

  18. Lamadé W, Friedrich C, Ulmer C et al (2011) Impact of body image on patient’s attitude towards conventional, minimal invasive and natural orifice surgery. Langenbecks Arch Surg 396:331–336

    Article  PubMed  Google Scholar 

  19. Mohammadhosseini B, Shirani S (2011) Intra-abdominal and abdominal wall hematoma from 5 mm port insertion site in laparoscopic cholecystectomy. Videosurgery 6:164–166

    Google Scholar 

  20. Park J, Kwak H, Kim SG et al (2012) Single-port laparoscopic appendectomy: comparison with conventional laparoscopic appendectomy. J Laparoendosc Adv Surg Tech 22:142

    Article  Google Scholar 

  21. Swank HA, Mulder IM, la Chapelle CF et al (2012) Systematic review of trocar-site hernia. Br J Surg 99:315–323

    Article  CAS  PubMed  Google Scholar 

  22. Yilmaz H, Alptekin H, Acar F et al (2013) Experiences of single incision cholecystectomy. Int J Med Sci 10:73–78

    Article  PubMed Central  PubMed  Google Scholar 

  23. Yamamoto M, Minikel L, Zaritsky (2011) Laparoscopic 5-mm trocar site herniation and literature review. JSLS 15:122–126

    Article  PubMed Central  PubMed  Google Scholar 

  24. Khurshid N, Chung M, Horrigan T et al (2012) 5-Millimeter trocar-site bowel herniation following laparoscopic surgery. JSLS 16:306–310

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The authors are grateful to Mrs. Mariotti for administrative help and to Dr. Faouzi for statistical analysis.

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Authors and Affiliations

  1. Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois, 46 rue de Bugnon, 1011, Lausanne, Switzerland

    Alessandra Cristaudi, Marie-Laure Matthey-Gié & Nicolas Demartines

  2. Department of Surgery, Ospedale di Lugano, Lugano, Switzerland

    Dimitri Christoforidis

Authors
  1. Alessandra Cristaudi
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  2. Marie-Laure Matthey-Gié
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  3. Nicolas Demartines
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  4. Dimitri Christoforidis
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Corresponding authors

Correspondence to Alessandra Cristaudi or Nicolas Demartines.

Appendices

Appendix 1

Standardized Data Collection Questionnaire.

Appendix 2

Questionnaire: Patient Scar Satisfaction Score (PSAS) [11].

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Cristaudi, A., Matthey-Gié, ML., Demartines, N. et al. Prospective Assessment of Trocar-Specific Morbidity in Laparoscopy. World J Surg 38, 3089–3096 (2014). https://doi.org/10.1007/s00268-014-2683-z

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  • DOI: https://doi.org/10.1007/s00268-014-2683-z

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