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Umbilicus saving three-port laparoscopic cholecystectomy

Posted by Dr. Johanna Laukkarinen on 03 Nov 2011 10:40:31 AM GMT

1	Is the subject of the article within the scope of the subject category?	Yes
2	Are the interpretations / conclusions sound and justified by the data?	No
3	Is this a new and original contribution?	Yes
4	Does this paper exemplify an awareness of other research on the topic?	Yes
5	Are structure and length satisfactory?	Yes
6	Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience?	No
7	Can you suggest any reductions in the paper, or deletions of parts?	Yes
8	Is the quality of the diction satisfactory?	Yes
9	Are the illustrations and tables necessary and acceptable?	Yes
10	Are the references adequate and are they all necessary?	Yes
11	Are the keywords and abstract or summary informative?	Yes

Other Comments:
The authors decribe a series of patients operated on two different techniques, 3-port or 4-port laparoscopic cholecystectomy. The study is not randomised or controlled. However, no difference in the patient characteristics appears between the two groups.

The main finding of the study is that 3-port LC seems to be as safe as 4-P LC. The study is nicely written and the reviewed literature is well chosen.

Corrections and suggestions:

1. Patients and methods: the authors should describe how they chose one of the two techniques for each patient.

2. Results: the conversion rate with acute cholecystitis patients was very high, with 3-port LC 50% of acute cholecystitis and with 4-port LC 60% of acute cholecystitis patients. The authors should comment this in discussion.

3. Results: To me it does not sound correct to exclude bleeding complications from the final analysis (as was done with the patients that had a conversion to open cholecystectomy). At least the data should be shown, even separately

4. Results and Discussion and Conclusion: there was no STATISTICALLY significant difference in the requirement on analgesia between the two groups. Thus I would suggest that this conclusion is removed from discussion, as well as the last sentence in discussion-section modified by leaving "better post-operative recovery" out.
Invited by the author to review this article? :
No
Have you previously published on this or a similar topic?:
No
References:
None
Experience and credentials in the specific area of science:

GI surgeon.

Some own publications related to gall stone disease.
How to cite: Laukkarinen J .Umbilicus saving three-port laparoscopic cholecystectomy[Review of the article 'Umbilicus Saving Three-Port Laparoscopic Cholecystectomy ' by Baba H].WebmedCentral 2011;2(11):WMCRW001091

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Dear Dr. Johanna Laukkarinen Thank you very much for your constructive comments on our manuscript and time taken to review it. According to your comments, we revised the manuscript as below. Sincerely yours, Masahiko Hirota, M.D., Ph.D. Department of Surgery, Kumamoto Regional Medical Center 5-16-10 Honjo, Kumamoto-city, 860-0811 JAPAN Tel: 81-96-363-3311 Fax: 81-96-362-0222 E-mail: mhirota@krmc.or.jp Comment to review Q; Patients and methods: the authors should describe how they chose one of the two techniques for each patient. Re: According to the comment, we reviewed the patients and methods section. The umbilicus-saving 3-port LC was carried out by 2 of 6 surgeons according to a decision of each operator. Q; Results: the conversion rate with acute cholecystitis patients was very high, with 3-port LC 50% of acute cholecystitis and with 4-port LC 60% of acute cholecystitis patients. The authors should comment this in discussion. Re: We described about the conversion rates in the discussion section. In our study, conversion rate was 21.6% in 4-port LC and 5.6% in 3-port LC. We believe that the high conversion rate in 4-port LC is the reflection of first priority in patients’ safety. Our small sample size might also affect the conversion rates. Q; Results: To me it does not sound correct to exclude bleeding complications from the final analysis (as was done with the patients that had a conversion to open cholecystectomy). At least the data should be shown, even separately. Re: According to the comment, we described the reasons of conversion to open procedure in the results section. The reasons of conversion were intra-operative bleeding in one patient in 4-port LC and inflammation and adhesion in the other 8 patients. Q; Results and Discussion and Conclusion: there was no STATISTICALLY significant difference in the requirement on analgesia between the two groups. Thus I would suggest that this conclusion is removed from discussion, as well as the last sentence in discussion-section modified by leaving "better post-operative recovery" out. Re: According to the comment, we reviewed the discussion section. Although it was not significant and sample size of this study was small, analgesia requirement after 3-port LC was less frequent than those after 4-port LC in this study. This indicates that 3-port LC may bring not only cosmetic benefits but also post-operative recovery. And we shortened the last sentence in conclusion section modified by leaving "better post-operative recovery" out.
Responded by Dr. Daisuke Hashimoto on 12 Nov 2011 02:57:45 AM

Review on 'umbilicus saving 3-Port laparoscopic cholecystectomy'

Posted by Dr. Daniel Steinemann on 21 Sep 2011 12:41:01 PM GMT

1	Is the subject of the article within the scope of the subject category?	Yes
2	Are the interpretations / conclusions sound and justified by the data?	No
3	Is this a new and original contribution?	No
4	Does this paper exemplify an awareness of other research on the topic?	Yes
5	Are structure and length satisfactory?	Yes
6	Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience?	No
7	Can you suggest any reductions in the paper, or deletions of parts?	No
8	Is the quality of the diction satisfactory?	No
9	Are the illustrations and tables necessary and acceptable?	Yes
10	Are the references adequate and are they all necessary?	Yes
11	Are the keywords and abstract or summary informative?	No

Other Comments:
This is a retrospective non-randomized study comparing 3-Port (n=18) and 4-Port (n=37) cholecystectomy. There was a high conversion rate (22% in the 4-Port-Group), however, converted patients were not included in the analyses. The fact, that none of the outcome parameters were signifantly different is probable due to a very low sample size.

More to the point, I do not understand why it is of advantage to avoid a scar in or around the umbilicus. The recent experience with Single-Port and NOTES-surgery has demonstrated that a incision in the umbilicus is not associated with increased morbidity. Moreover, the scar in the umbilicus is hidden and the cosmesis of such scars is excellent.

The present study is weak due to its low sample size. The high conversion rate raises questions on the used technique. I do not see why the umbilicus should be saved from incisions and why the proposed technique is of advantage.
Competing interests:
No competing interest to declare
Invited by the author to review this article? :
Yes
Have you previously published on this or a similar topic?:
Yes
References:
Cosmesis and Body Image after Single-Port Laparoscopic or Conventional Laparoscopic Cholecystectomy: A multicenter double blinded Randomised Controlled Trial (SPOCC-trial). BMC Surgery [1471-2482] Steinemann yr:2011 vol:11 iss:1 pg:24 -24
Experience and credentials in the specific area of science:

Single-Port and 4-Port lap. Cholecystectomy
How to cite: Steinemann D .Review on 'umbilicus saving 3-Port laparoscopic cholecystectomy'[Review of the article 'Umbilicus Saving Three-Port Laparoscopic Cholecystectomy ' by Baba H].WebmedCentral 2011;2(9):WMCRW00958

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October 3, 2011 Dear Dr. Daniel Steinemann Thank you very much for your constructive comments on our manuscript and time taken to review it. According to your comments, we revised the manuscript as below. Sincerely yours, Masahiko Hirota, M.D., Ph.D. Department of Surgery, Kumamoto Regional Medical Center 5-16-10 Honjo, Kumamoto-city, 860-0811 JAPAN Tel: 81-96-363-3311 Fax: 81-96-362-0222 E-mail: mhirota@krmc.or.jp Comment to review The present study is weak due to its low sample size. Re: According to the comment, we described significance of our manuscript in the discussion section. Although our sample size was small, the 3-port technique did not increase the bleeding and operating time and there were no post-operative complication such as common bile duct injuries, when performed on usual acute and chronic cholecystitis. It indicated that the 3-port technique was safe, comparable with previous reports. The high conversion rate raises questions on the used technique. Re: According to the comment, we described about the conversion rates in the discussion section. In our study, conversion rate was 21.6% in 4-port LC and 5.6% in 3-port LC. We believe that the high conversion rate in 4-port LC is the reflection of first priority in patients’ safety. Our small sample size might also affect the conversion rates. I do not see why the umbilicus should be saved from incisions and why the proposed technique is of advantage. Re: According to the comment, we described significance of saving the umbilicus in the introduction and discussion section. Recent laparoscopic surgery accepts an incision around the umbilicus. However, the umbilicus, in the opinion of the authors, is a significant aesthetic unit of the abdominal area. It should have a natural, vertically long and deep depression without conspicuous scars, especially in young ladies. Primary reconstruction of the umbilicus due to surgery or trauma has been the goal of plastic surgeons from the early times of modern plastic surgery.
Responded by Dr. Daisuke Hashimoto on 03 Oct 2011 05:58:18 PM

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Umbilicus Saving Three-Port Laparoscopic Cholecystectomy