Ann Surg Treat Res.  2021 Feb;100(2):67-75. 10.4174/astr.2021.100.2.67.

Comparing the short-term outcomes and cost between solo single-incision distal gastrectomy and conventional multiport totally laparoscopic distal gastrectomy for early gastric cancer: a propensity score-matched analysis

Affiliations
  • 1Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
  • 2Department of Surgery, Ewha Womans University Hospital, Seoul, Korea
  • 3Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Surgery, Seoul National University Hospital, Seoul, Korea

Abstract

Purpose
Single-incision laparoscopic distal gastrectomy (SIDG) requires experienced camera operators for a stable image. Since it is difficult for skilled camera operators to participate in all SIDG, we began performing solo surgery using mechanical camera holders. We aimed to compare the short-term outcomes and cost between solo SIDG and conventional multiport laparoscopic distal gastrectomy (MLDG) for early gastric cancer (EGC).
Methods
From January 2014 to December 2016, a total of 938 consecutive patients underwent laparoscopic gastrectomy for EGC. Solo SIDG (n = 99) and MLDG patients (n = 198) were selected and 1:2 propensity score matching was done to compare the quality of operation and cost-effectiveness. All solo SIDG was performed by a surgeon using a camera holder, without any assistant.
Results
Mean operation time (120 ± 35.3 vs. 178 ± 53.4 minutes, P = 0.001) and estimated blood loss (24.6 ± 47.4 vs. 46.7 ± 66.5 mL, P = 0.001) were significantly lower in the solo SIDG group. Hospital stay, use of analgesics, and postoperative inflammatory markers (WBC, CRP) were similar between the 2 groups. The early (<30 days) complication rate in solo SIDG and MLDG groups was 21.2% and 23.7%, respectively (P = 0.240); the late (≥30 days) complication rate was 7.1% and 11.1%, respectively (P = 0.672). The manpower cost of solo SIDG was significantly lower than that of MLDG (P = 0.001).
Conclusion
This study demonstrated that solo SIDG performed by experienced laparoscopic surgeons is safe and feasible for EGC. Solo SIDG is expected to be a promising potential treatment for EGC.

Keyword

Cost analysis; Laparoscopy; Stomach neoplasms; Surgical wound
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