title: Optimized transumbilical endoscopic cholecystectomy: a randomized comparison of two procedures.
abstract: BACKGROUND
  Natural orifice transluminal endoscopic surgery (NOTES) and transumbilical endoscopic surgery (TUES) are being developed to improve minimally invasive surgery further. In 2006, the authors developed TUES using a single triple-channel trocar or single-trocar (ST) technique. To minimize the risk and improve the surgical efficiency further, the procedure was optimized using a two-trocar (TT) technique, with both trocars in the umbilicus. This study compared the clinical results for the TT and ST techniques.
  
  
  METHODS
  For this study, 32 patients with chronic gallbladder disease and indications for cholecystectomy were randomly assigned to undergo surgery with either the TT technique (17 patients) or the ST technique (15 patients). With the TT procedure, two modified 5-mm trocars with small handles were inserted through the navel, one above and one below the umbilicus. Another 2-mm trocar was inserted for a grasper in the right upper abdomen. With the ST procedure, one 15-mm umbilical incision was made for insertion of a previously developed triple-channel trocar to apply the laparoscope, grasper, and dissector individually. Operation time, postoperative hospital stay, and postoperative pain were compared between the two procedures.
  
  
  RESULTS
  The mean operative time was significantly shorter with the TT technique (35.71 +/- 9.74 min) than with the ST technique (125.25 +/- 18.9 min (p < 0.001). Use of analgesics after surgery also was less in the TT group than in the ST group (0 vs. 7, respectively; p < 0.05). The postoperative hospital stay did not differ significantly between the two groups (p > 0.05).
  
  
  CONCLUSIONS
  Although both procedures were based on the transumbilical approach, the TT approach was found to be faster and less painful than the ST approach. The difference in the cosmetic result was minimal.
authors.affiliation: Department of Minimally Invasive Surgery, Tongji University Affiliated Shanghai East Hospital, 150 Jimo Road, Pudong New District, Shanghai, 200120 People's Republic of China. huhailc@sina.com
authors.forename: Hai
authors.initials: H
authors.lastname: Hu
authors.forename: Jiangfan
authors.initials: J
authors.lastname: Zhu
authors.forename: Weidong
authors.initials: W
authors.lastname: Wang
authors.forename: Anhua
authors.initials: A
authors.lastname: Huang
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000639:trends; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D020706:Laparoscopes; D007902:Length of Stay; D008297:Male; D016896:Treatment Outcome; D014472:Umbilicus