Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: A comparative study

Table 1 Demographic and preoperative patient characteristics n (%)

	CL-LCBDE(n = 20)	nSIL-CBDE(n = 20)	P value
Age (yr)	51.0 ± 19.3	60.5 ± 17.2	0.068
Male:female	9:11	9:11
Body mass index (kg/m²)			0.064
mean ± SD	25.00 ± 3.97	22.55 ± 2.69
median (range)	25.10 (19.60-34.80)	22.45 (17.16-27.69)
ASA classification			0.010
1	3 (15)	10 (50)
2	15 (75)	10 (50)
3	2 (10)	0 (0)
Comorbidity			0.231
CCI = 0	17 (85)	20 (100)
CCI ≥ 1	3 (15)	0 (0)
Previous abdominal surgery)	4 (20)	4 (20)	1.000
Laboratory parameters
Total leukocyte count (cells/mm3)	9117 ± 3756	9123 ± 2569	0.274
ALT (IL/dL)	319 ± 267	215 ± 240	0.068
Total bilirubin (mg/dL)	3.71 ± 2.24	2.18 ± 2.02	0.079
Alkaline phosphatase (IL/dL)	610 ± 321	453 ± 342	0.069
Radiological parameters
Gallbladder wall thickening (≥ 4 mm)	4 (20)	7 (35)	0.480
Acute cholangitis	17 (85)	14 (70)	0.294
CBD stone(s)			1.000
Definite	18 (90)	19 (95)
Suspicious	2 (10)	1 (5)
Indication of CBDE			0.025
Primary intervention	7 (35)	15 (75)
Secondary intervention	13 (65)	5 (25)
After ERCP failure	7 (35)	5 (25)
Remnant CBD stone(s) after ERCP	6 (30)	0 (0)
Admission route			1.000
ER	12 (60)	13 (65)
OPD	8 (40)	7 (35)

ALT: Alanine transaminase; CBD: Common bile duct; CCI: Charlson comorbidity index; CL-CBDE: Conventional laparoscopic common bile duct exploration; ER: Emergency room; ERCP: Endoscopic retrograde cholangiopancreatography; nSIL-CBDE: Needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration; OPD: Outpatient clinic.

Table 2 Operative results of patients who underwent laparoscopic common bile duct exploration n (%)

	CL-LCBDE(n = 20)	nSIL-CBDE(n = 20)	P value
Operative time (skin to skin, min)			0.007
mean ± SD	192 ± 39	238 ± 76
median (range)	197.5 (115-245)	215.0 (125-365)
Estimated blood loss (mL)	132 ± 309	75 ± 161	0.101
Completion cholangiogram	5 (25)	0 (0)	0.018
Completion choledochoscopy	16 (80)	20 (100)	0.037
Stone clearance	20 (100)	20 (100)	1.000
CBD stone			0.348
Single CBD stone	12 (60)	9 (45)
Multiple CBD stones	8 (40)	11 (55)
Mean number of CBD stone extracted	1.9 ± 1.7	3.0 ± 3.2	0.316
The largest diameter of CBD stone (mm)			0.624
mean ± SD	12.3 ± 3.8	14.1 ± 4.6
median (range)	14.0 (5.0-15.8)	13.6 (7.0-20.0)
Open conversion	0	0	1.000
Addition of another port	0	0	1.000
Gallbladder pathology			0.234
Gangrene/empyema	1 (5)	4 (20)
Acute inflammation	3 (15)	3 (15)
Chronic inflammation	16 (80)	13 (65)
Drain placed	19 (95)	3 (15)	< 0.001
Pethidine dose (mg/kg)	92.5 ± 120.1	46.5 ± 63.5	0.010
Postoperative hospital stay (d)			0.010
mean ± SD	5.1 ± 1.7	3.8 ± 2.0
median (range)	5.0 (2.0-8.0)	3.0 (2.0-9.0)
Postoperative complication			0.275
Infected subhepatic collection	1	0
Minor bile leak	0	1
Subhepatic seroma	0	1

CBD: Common bile duct; CL-CBDE: Conventional laparoscopic common bile duct exploration; nSIL-CBDE: Needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration.