Chi-Ming Poon

Two-port versus four-port laparoscopic cholecystectomy

Background: Two-port laparoscopic cholecystectomy has been reported to be safe and feasible. However, whether it offers any additional advantages remains controversial. This study reports a randomized trial that compared the clinical outcomes of two-port laparoscopic cholecystectomy versus conventional four-port laparoscopic cholecystectomy. Methods: One hundred and twenty consecutive patients who underwent elective laparoscopic cholecystectomy were randomized to receive either the two-port or the four-port technique. All patients were blinded to the type of operation they underwent. Four surgical tapes were applied to standard four-port sites in both groups at the end of the operation. All dressings were kept intact until the first follow-up 1 week after surgery. Postoperative pain at the four sites was assessed on the first day after surgery using a 10-cm unscaled visual analog scale (VAS). Other outcome measures included analgesia requirements, length and difficulty of the operation, postoperative stay, and patient satisfaction score on surgery and scars. Results: Demographic data were comparable for both groups. Patients in the two-port group had shorter mean operative time (54.6 ± 24.7 min vs 66.9 ± 33.1 min for the four-post group; p = 0.03) and less pain at individual subcostal port sites [mean score using 10-cm unscaled VAS: 1.5 vs 2.8 (p = 0.01) at the midsubcostal port site and 1.3 vs 2.3 (p = 0.02) at the lateral subcostal port site]. Overall pain score, analgesia requirements, hospital stay, and patient satisfaction score on surgery and scars were similar between the two groups. Conclusion: Two-port laparoscopic cholecystectomy resulted in less individual port-site pain and similar clinical outcomes but fewer surgical scars compared to four-port laparoscopic cholecystectomy. Thus, it can be recommended as a routine procedure in elective laparoscopic cholecystectomy.

Patient-controlled sedation versus intravenous sedation for colonoscopy in elderly patients: A prospective randomized controlled trial

BACKGROUND A prospective randomized trial was conducted to compare the safety, effectiveness, and patient acceptance of patient-controlled sedation and intravenous sedation for colonoscopy in a group of elderly patients undergoing outpatient colonoscopy. METHODS One hundred patients over 65 years of age were recruited and randomized to patient-controlled sedation (n = 50) or intravenous sedation (n = 50) groups by means of computer-generated numbers. In the patient-controlled sedation group, a mixture of propofol and alfentanil was delivered by means of a patient-controlled pump; each bolus delivered 4.8 mg propofol and 12 microg alfentanil. No loading dose was used and the lockout time was set at zero. In the intravenous sedation group, fixed doses of diazemuls (0.1 mg/kg) and meperidine (0.5 mg/kg) were given with further increases in dosages administered at the discretion of the endoscopist. Outcome measures assessed included cardiopulmonary complications, recovery time, pain score, and satisfaction score. RESULTS The mean (SD) age of patients in the patient-controlled sedation and intravenous sedation groups were, respectively, 72.4 years (5.3) and 73.5 years (6.1). The mean dose of propofol consumed in the patient-controlled sedation group was 0.79 (0.46) mg/kg. The mean doses of diazemuls and meperidine consumed in intravenous sedation group were, respectively, 5.8 (1.3) mg and 30.1 (6.8) mg. Hypotension occurred in 2 (4%) patients in the patient-controlled sedation group and 14 (28%) in the intravenous sedation group (p < 0.01). Oxygen desaturation was recorded for 4 patients (8%) in the intravenous sedation group. The median (interquartile range [IQR]) recovery time was significantly shorter in the patient-controlled sedation group compared with the intravenous sedation group (respectively, 0 minutes [IQR 0-5] vs. 5 minutes [IQR 5-10]; p < 0.01). There were no statistically significant differences between groups for pain and satisfaction scores. CONCLUSIONS Patient-controlled sedation appears to be safer than intravenous sedation, with comparable effectiveness and acceptance, in elderly patients undergoing elective outpatient colonoscopy.

Two-Port Laparoscopic Cholecystectomy: Initial Results of a Modified Technique

BACKGROUND AND PURPOSE Two-port laparoscopic cholecystectomy has been reported to be safe and feasible with a higher patient satisfaction score. However, it was technically difficult even in expert hands because of the small operating field. We have modified the operating telescope to achieve a wide field of view. PATIENTS AND METHODS Since September 2000, 14 patients have been enrolled for two-port laparoscopic cholecystectomy. The male to female ratio was 5:9. The median age was 54.5 years (interquartile range [IQR] 45-67.75 years). RESULTS The median operative time was 53 minutes (IQR 38-61 minutes). Two patients required one additional 5-mm port or a traction suture because of dense adhesions. There was no conversion to open surgery. The median postoperative hospital stay was 2 days (IQR 1-2.25 days). The median oral postoperative analgesia requirement was 1 dose (IQR 0-3 doses). There were no major or minor complications, and there were no deaths. CONCLUSION The modified two-port technique greatly facilitates two-port laparoscopic cholecystectomy and improves the clinical outcome.

Primary malignant melanoma of the oesophagus: A case report and literature review

We report a case of primary malignant melanoma of the oesophagus (PMMO), followed by a review of recent literature. Surgical resection for operable tumours remains the current practice. In general, the prognosis of PMMO is poor, with a median survival of 10 months. Recent advances, including chemoendocrine and chemoimmunotherapy, might help improve overall survival. Combined endoscopic and systemic therapy is an alternative for patients unfit for surgery, or in patients with metastatic disease.