PDF(2305 KB)
Comparison of efficacy between indocyanine green fluorescence-guided transumbilical single-port and multi-port laparoscopic cholecystectomy: a propensity score matching study
QIN Hao-kun, JIA Lin, LIANG Ze, WEN Jun-ye, ZHANG Wan-xing, GUO Huai-bin
Chinese Journal of Practical Surgery ›› 2026, Vol. 46 ›› Issue (9) : 1238-1243.
PDF(2305 KB)
PDF(2305 KB)
Comparison of efficacy between indocyanine green fluorescence-guided transumbilical single-port and multi-port laparoscopic cholecystectomy: a propensity score matching study
Objective To compare the perioperative efficacy and safety of indocyanine green (ICG) fluorescence-guided transumbilical single-port and traditional multi-port laparoscopic cholecystectomy, so as to provide a basis for surgical procedure optimization and clinical selection. Methods Clinical data of patients who underwent laparoscopic cholecystectomy in the Department of Hepatobiliary and Pancreatic Surgery of Hebei General Hospital from January 2023 to February 2025 were retrospectively included. According to the surgical procedure, the patients were divided into a single-port group and a multi-port group. Propensity score matching (PSM) was used for 1:1 matching, obtaining 50 pairs of comparable samples. The operative time, intraoperative blood loss, postoperative hospital stay, usage rate of analgesics within 24 h postoperatively, and postoperative liver function indicators, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), were compared between the two groups. Results After matching, there was no statistically significant difference in baseline characteristics between the two groups. The operative time in the single-port group was longer than that in the multi-port group [90 (80, 105) min vs. 69 (55, 90) min], and the intraoperative blood loss was lower than that in the multi-port group [5 (2, 5) mL vs. 5 (2.75, 6.25) mL], with statistically significant differences (both P<0.05).The usage rate of analgesics within 24 h postoperatively in the single-port group was lower than that in the multi-port group (40% vs. 66%, P<0.05).Comparison of postoperative liver function showed that the levels of ALT and AST in the single-port group were lower than those in the multi-port group [ALT: 26.600 (15.300, 43.150) U/L vs. 42.550 (29.850, 62.200) U/L; AST: 29.550 (19.500, 39.925) U/L vs. 44.650 (32.700, 56.875) U/L], with statistically significant differences (both P<0.05).There was no statistically significant difference in postoperative hospital stay between the two groups [4 (3, 4) d vs. 4 (3, 5) d, P>0.05]. No severe complications such as biliary leakage, common bile duct injury, reoperation for bleeding, or incisional infection were observed in either group. Conclusion Under comparable baseline conditions, single-port laparoscopic cholecystectomy has lower analgesic requirements, less intraoperative blood loss, and better postoperative liver function indicators than the traditional multi-port procedure, with comparable overall safety; its main disadvantage is prolonged operative time. Combining the efficacy and safety results, the single-port procedure under ICG fluorescence navigation can serve as an effective complementary option to the traditional multi-port procedure.
single-port / multi-port / indocyanine green / laparoscopic cholecystectomy
| [1] |
Laparoscopic cholecystectomy, being a prevalent abdominal surgical procedure, has transitioned through various innovative stages aimed at reducing the procedure's invasiveness. These stages encompass Single-Incision Laparoscopic Cholecystectomy (SILC), Mini Laparoscopic Cholecystectomy (MLC), Natural Orifice Transluminal Endoscopic Surgery (NOTES), and Robotic-Assisted Laparoscopic Cholecystectomy (RALC). The purpose of this review is to trace the evolution of minimally invasive cholecystectomy techniques, assess their status, and identify emerging trends and challenges in the field.An extensive review was performed to explore the evolution and characteristics of SILC, MLC, NOTES, and RALC. The approach involved an in-depth examination of literature available on PubMed, coupled with a critical assessment of surgical outcomes, associated complications, and technical hurdles posed by these methods.SILC, despite its potential for reduced scarring, exhibits an elevated risk of bile duct damage and incisional hernia occurrences. MLC, mirroring the standard technique closely, presents minor benefits without amplifying postoperative complications, hence, positing itself as a feasible choice for routine elective cholecystectomy. NOTES, although still facing technical challenges, the hybrid transvaginal procedure is gaining clinical interest. RALC, heralded for its augmented precision and dexterity, emerges as a potential future avenue, although necessitating further exploration to ascertain its efficacy and safety.The progression of laparoscopic cholecystectomy methodologies embodies the surgical society's aspiration to minimize invasiveness whilst enhancing patient outcomes. This review endeavors to offer a structured discourse on SILC, MLC, NOTES, and RALC, aspiring to aid the ongoing deliberation on the judicious selection of surgical techniques in clinical practice.© 2024. The Author(s).
|
| [2] |
|
| [3] |
Conventional multi-port laparoscopic cholecystectomy (CMLC) has become the current 'gold standard' technique in gallbladder disease. Single-incision laparoscopic cholecystectomy (SILC) has gained attention due to its benefits in improving patient cosmetic results and pain reduction. We aim to assess the latest evidence on the feasibility, safety and surgical outcomes of SILC and CMLC.We conducted searches for randomized controlled trials (RCTs) in PubMed, PubMed Central (PMC), and Europe PMC between December 2011 and 2021. The latest search was conducted in January 2022. We analyzed several outcomes, including perioperative complications, estimated blood loss, operation time, conversion to open surgery, hospital stay, pain score, cosmesis, and days of return to work. Cochrane Risk of Bias (RoB) 2.0 tool was used to evaluate quality of studies. Mantel-Haenszel's formula and Inverse Variance method were conducted to synthesize results. This study was accomplished in accordance with the PRISMA guidelines.A total of 37 studies were eligible, with a total of 2,129 and 2,392 patients who underwent SILC and CMLC. Our study demonstrated a superiority of SILC for the visual analog score (VAS) at six hours post-operation [mean difference (MD) -0.58 (95% CI -1.11, -0.05), p=0.03], cosmesis one-month post-operation [standard MD 2.12 (95% CI 1.10, 3.13), p<0.0001], and cosmesis six months post-operation [standard MD 0.53 (95% CI 0.06, 0.99), p<0.0001]. Meanwhile, SILC showed a longer operation time [MD 10.45 (95% CI 6.74, 14.17), p<0.00001]. In terms of VAS at four time points (4, 8, 12, and 24 hours), perioperative complications, estimated blood loss, conversion to open surgery, hospital stay and days to return to work, SILC did not differ from CMLC.SILC is a safe, feasible and favorable procedure in terms of pain reduction and cosmetic results. The option between both procedures is based on surgeon preferences. PROSPERO ( CRD42022306532; 23 February 2022).Copyright: © 2024 Rudiman R et al.
|
| [4] |
|
| [5] |
|
| [6] |
To compare the outcomes of three-port and four-port laparoscopic cholecystectomy. In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port vs four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model. The risks of type 1 or type 2 error in the meta-analysis model were assessed using trial sequential analysis model. The certainty of evidence was assessed using GRADE system. Random effects modelling was applied to calculate pooled outcome data. Analysis of 2524 patients from 17 studies showed that both techniques were comparable in terms of operative time (MD:- 0.13, P = 0.88), conversion to open operation (OR:0.80, P = 0.43), gallbladder perforation (OR: 1.43, P = 0.13), bleeding from gallbladder bed (OR:0.81, P = 0.34), bile duct injury (RD: 0.00, P = 0.97), iatrogenic visceral injury (RD: - 0.00, P = 0.81), bile or stone spillage (OR:1.67, P = 0.08), port site infection (OR: 0.90, P = 0.76), port site hernia (RD: 0.00, P = 0.89), port site haematoma (RD: - 0.01, P = 0.23), port site seroma (RD: 0.00, P = 1.00), and need for reoperation (RD: - 0.00, P = 0.94). However, the three-port technique was associated with lower VAS pain score at 12 h (MD: - 0.66, P < 0.00001) and 24 h (MD: - 0.54, P < 0.00001) postoperatively, shorter length of hospital stay (MD:-0.09, P = 0.41), and shorter time to return to normal activities (MD: - 0.79, P = 0.02). Trial sequential analysis confirmed that the meta-analysis was conclusive with no significant risks of type 1 or type 2 error. Robust evidence (level 1 with high certainty) suggests that in an elective setting with uncomplicated cholelithiasis as indication for cholecystectomy, three-port laparoscopic cholecystectomy is comparable with the four-port technique in terms of procedural and morbidity outcomes and may be associated with less postoperative pain, shorter length of hospital stay and shorter time to return to normal activities.
|
| [7] |
|
| [8] |
|
| [9] |
|
| [10] |
Laparoscopic techniques induced a tremendous revolution in surgery of the biliary tract, mainly due to improved results compared with the open approach and secondary because of their cosmetic advantage. A trend toward even more minimally invasive approaches has led to techniques of single-incision and natural orifice laparoscopic surgery. Because the evaluation of single-incision laparoscopic cholecystectomy (SILC) is rather fragmentary by single-institution small patient series, this article intends to examine the success and the risks of the technique, and attempts to determine its potential limitations.A systematic review of the literature was performed to identify relevant articles. Studies enrolling at least ten patients who underwent SILC and reporting on analytical complication data were considered for inclusion.The literature search identified 29 studies, which included a total of 1,166 patients. Success and complication rates were 90.7% and 6.1%, respectively. Mean adjusted operative time was 70.2 min and mean adjusted hospital stay was 1.4 days. Analysis of outcome exhibited higher complication rates for studies with a mean patient age older than 45 years (p=0.04), and higher operative time for studies with a mean body mass index>30 kg/m2 (83.4 vs. 74.5 min) and female percentage lower than 70% (78.7 vs. 68.5 min). Acute cholecystitis as inclusion criterion was a factor for technical failure (success rate 59.9 vs. 93.0%, p=0.005) and resulted in an increase of operative time (78.1 vs. 70.6 min). Suture suspension of the gallbladder yielded significantly lower complication rates compared with instrument usage (3.3 vs. 13.3%, p<0.0001).The clinical application of SILC exhibited satisfactory results. Cases of acute cholecystitis and older patients should be approached with caution, whereas improvement of the instrumentation is necessary.
|
| [11] |
Natural orifice transluminal endoscopic surgery (NOTES) and single-incision surgery (SIS) are less invasive alternatives to traditional laparoscopic techniques. Concerns exist over the safety of these new approaches, and randomized controlled trials have yet to confirm a net benefit. If NOTES and SIS techniques are to become standard practice, then they should be shown to be safe and hold clear benefits to patients. We aim at comparing the available results by using these techniques in a standard laparoscopic operation (cholecystectomy).A systematic review using available databases (MEDLINE, EMBASE, and the Cochrane Controlled Trials Register) and the published English language medical literature was performed. All the archived articles were cross-referenced. Outcome data obtained from a Cochrane review of laparoscopic cholecystectomy were used as the control group. All the operations performed via a single incision were grouped under SIS, and operations in which a natural orifice (alone or as a hybrid technique) was analyzed, under NOTES group. Mortality and complications were the primary outcome measures.One hundred thirty-five papers including 4703 patients (714 NOTES, 3989 SIS) were selected for analysis. Overall complication rate was 4.2% in the NOTES group versus 4.3% in the SIS group, with a distinct complication profile. No mortality was reported in either group. NOTES procedures had a longer mean operative time than SIS techniques (107 versus 79 minutes). The conversion rate between NOTES and SILS was similar (3.4% versus 3.3%, respectively).No difference in the incidence of complications was observed with the newer techniques. Adequately powered randomized control trials are needed to clarify whether SIS/NOTES cholecystectomy has a similar length of hospital stay to traditional laparoscopic cholecystectomy. The increased occurrence of specific types of complications and their use in acute pathology needs further investigation to warrant further use in routine surgical practice.
|
| [12] |
Single-incision laparoscopic surgery (SILS) is feasible and safe for most situations that indicate a need for cholecystectomy in normal-weight patients. SILS might offer several potential benefits over multiport laparoscopy. However, the effect of obesity on the surgical outcomes of single-incision laparoscopic cholecystectomy (SILC) has not been sufficiently investigated and is controversial. The aim of this study was to compare normal-weight and obese patients who had undergone SILC. All single-incision laparoscopic cholecystectomies performed between December 2008 and December 2014 were reviewed and grouped according to patient's body mass index (BMI). Obese patients with a BMI ≥30 kg/m who had undergone SILC were matched in a 1:2 ratio with non-obese patients. One hundred six obese patients after SILC were compared with 212 non-obese patients according to age, gender, and indication for operation. Operation in obese patients was longer but without significant difference (53.9 minutes versus 62.3 minutes; = .189). In each group, 4 patients needed conversion to multiport laparoscopy or open procedure (1.9% versus 3.8% for non-obese versus obese; = .236). No significant difference was noted for postoperative complications (4.3% versus 5.7% for non-obese versus obese; = .790) and the length of hospital stay (3.3 days versus 3.3 days; = .958). Obese patients have a significantly ( = .027) higher incisional hernia rate (9.8%) than non-obese patients (1.9%), with obesity being a risk factor for hernia development in the univariate analysis. SILC in obese patients is technically feasible and safe compared with non-obese patients in regard to postoperative complications, conversion rates, and length of hospital stay but with an almost sixfold risk of umbilical incisional hernia on the long run.
|
| [13] |
|
| [14] |
朱建平, 牟东成, 薛晨辉, 等. 常规器械行经脐单孔腹腔镜胆囊切除术[J]. 中国微创外科杂志, 2019, 19(8):702-704.DOI:10.3969/j.issn.1009-6604.2019.08.008.
|
| [15] |
Although single-incision laparoscopic cholecystectomy (SILC) has no advantage over conventional laparoscopic cholecystectomy (LC), except for better cosmesis, few reports have discussed the criteria for SILC. The aim of this study was to evaluate the suitability of our criteria for SILC.During the study period, SILC was performed at our institution under the following criteria. The inclusion criteria were elective surgery, age of < 60 years, and body mass index of < 30 kg/m. The exclusion criteria were a thick gallbladder wall, history of choledocholithiasis, previous abdominal surgery, and serious concomitant disease. We reviewed data regarding consecutive patients who underwent LC at our institution from November 2009 to March 2016. The data were assessed with respect to patient characteristics, operative data, and postoperative outcomes.A total of 1093 patients underwent elective LC, and 232 (21.2%) of these patients underwent SILC using our criteria. Fourteen patients (6.0%) who underwent SILC required extra ports. Among the patients aged < 60 years, 50.2% (232/462) underwent SILC. There were few adverse events, including intra- and postoperative complications, among the patients who underwent SILC.The above-mentioned criteria are safe, necessary, and sufficient for SILC over conventional LC.Copyright © 2016. Published by Elsevier Taiwan.
|
| [16] |
Study Design: Retrospective cohort study. Purpose: To assess long-term clinical outcomes of adjacent segment disease (ASD) in patients who underwent lumbar interbody fusion with percutaneous pedicle screw (PS) instrumentation. Overview of Literature: ASD is a well-known sequela of spinal fusion, and is reported to occur at a rate of 2%–3% per year. There is debate as to whether ASD is a result of the instrumentation and fusion method or is the natural history of the patient’s disease. Minimally invasive percutaneous PS augmentation of lumbar interbody fusion aims to prevent the disruption of posterior soft tissue stabilizers. Methods: From 2004–2014, 419 consecutive patients underwent anterior, lateral, or minimally invasive transforaminal lumbar interbody fusion with percutaneous PS placement at a single institution. The mean follow-up was 4.5 years. The primary outcome measure was reoperation due to ASD. Patients were divided into two cohorts: those who underwent revision surgery secondary to ASD and those who did not require further surgery. Radiographic parameters were performed using postoperative radiographs. Patients with a pelvic incidence–lumbar lordosis (PI–LL) mismatch >10° were noted. Results: Revision proportion secondary to ASD was 4.77% (n=20). Mean time to revision surgery was 2.5 years. Revision rate secondary to ASD was 1.1% per year. Patients who developed ASD were younger than those who did not (50.5 vs. 56.9 years, p=0.015). There was no difference in number of levels fused between cohorts. Revision proportion secondary to ASD was similar between approaches (anterior, lateral, minimally invasive). There was no significant difference in PI–LL mismatch between those who underwent revision for ASD and those who did not (22.2% vs. 18.8%, p=0.758). Conclusions: ASD rates in patients who underwent percutaneous PS placement were lower than those previously published after open PS placement, possibly related to greater preservation of the posterior stabilizing elements of the lumbar spine.
|
| [17] |
The objective of this study was to evaluate the feasibility, safety, efficacy, and indications of percutaneous pedicle screw fixation (PPSF) combined with selective transforaminal endoscopic decompression (TED) in the treatment of thoracolumbar burst fracture (TBLF).From August 2015 to October 2018, a total of 41 patients with single-segment TLBF (28 men and 13 women) were enrolled in this study. X-ray and computed tomography were obtained before surgery, 1 week after surgery, and 1 year after surgery to evaluate spinal recovery. In addition, we used the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association score (JOA), and the Frankel classification of neurological deficits to evaluate the effectiveness of the treatments.The average follow-up time was 22.02 ± 8.28 months. The postoperative Cobb angle, vertebral body compression ratio, vertebral wedge angle, mid-sagittal canal diameter compression ratio, and Frankel grade were significantly improved. There were also significant improvements in the VAS (7.61 ± 1.41 vs. 1.17 ± 0.80, P < 0.001), ODI (89.82 ± 7.44 vs. 15.71 ± 13.50, P < 0.001), and JOA (6.90 ± 2.91 vs. 24.90 ± 3.03, P < 0.001).Our results showed that PPSF combined with selective TED in the treatment of TLBF had excellent efficacy, high safety, less secondary injury than other treatments, and a wide range of indications and that it could accurately distinguish patients who did not need spinal canal decompression after posterior fixation. PPSF combined with selective TED is therefore a good choice for the treatment of TLBF.
|
| [18] |
|
| [19] |
This study compared postoperative pain following four-port laparoscopic cholecystectomy (LC) and single-port cholecystectomy (SPC).This prospective, quasi-randomized, single-centre trial focusing on postoperative pain included 49 patients undergoing elective surgery with either a conventional LC, or SPC using a surgical glove port. Postoperative pain was evaluated using a visual analogue scale (VAS) and postoperative analgesic use as primary outcome measures. Total duration of operation, length of hospital stay, blood test results on the day after surgery and total port cost were secondary outcome measures.Twenty-five LCs and 24 SPCs were undertaken. The VAS score on day 1 after surgery was significantly less in the SPC group than in the LC group: median (range) 24 (12-38) versus 45 (33-57) mm (P = 0·002). Significantly fewer patients in the SPC group required analgesia (9 of 24 versus 19 of 25 in the LC group; P = 0·007). There were no significant differences in total duration of operation, length of hospital stay, and blood test results on the day after surgery.Single-port surgery using a surgical glove port reduces postoperative pain compared with conventional LC.Copyright © 2011 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
|
| [20] |
|
| [21] |
张轶西, 靖超, 郑亚民, 等. 不同剂量吲哚菁绿在日间腹腔镜胆囊切除术荧光胆管造影中效果比较--一项多中心随机对照试验[J]. 中国实用外科杂志, 2025, 45(11):1283-1288.DOI:10.19538/j.cjps.issn1005-2208.2025.11.15.
|
| [22] |
梁力建. 再谈胆囊切除术胆管损伤预防及处理[J]. 中国实用外科杂志, 2025, 45(11):1234-1237.DOI:10.19538/j.cjps.issn1005-2208.2025.11.04.
|
| [23] |
中华医学会外科学分会胆道外科学组, 中国医师协会外科医师分会胆道外科专家工作组. 腹腔镜胆囊切除术中胆管及血管损伤防范中国专家共识(2024版)[J]. 中国实用外科杂志, 2024, 44(3):244-253,258.DOI:10.19538/j.cjps.issn1005-2208.2024.03.02.
|
| [24] |
郭怀斌, 王兰辉, 张万星, 等. 胰岛素抵抗与胆囊三角脂肪堆积及其脂肪酶表达的关系研究[J]. 中国全科医学, 2011, 14(24):2724-2727.DOI:10.3969/j.issn.1007-9572.2011.24.005.
|
利益冲突 所有作者均声明不存在利益冲突
/
| 〈 |
|
〉 |
