Two-Center Prospective Comparison of the Trocar and Seldinger Techniques for Percutaneous Cholecystostomy

• Published in: American journal of roentgenology (1976) Vol. 214; no. 1; pp. 206 - 212
• Main Authors: Reppas, Lazaros, Arkoudis, Nikolaos-Achilleas, Spiliopoulos, Stavros, Theofanis, Michail, Kitrou, Panagiotis M., Katsanos, Konstantinos, Palialexis, Konstantinos, Filippiadis, Dimitris, Kelekis, Alexis, Karnabatidis, Dimitrios, Kelekis, Nikolaos, Brountzos, Elias
• Format: Journal Article
• Language: English
• Published: United States 01.01.2020
• Subjects: Aged; Aged, 80 and over; Cholecystostomy - instrumentation; Cholecystostomy - methods; Female; Humans; Male; Middle Aged; Prospective Studies; Surgical Instruments; Seldinger; cholecystostomy; cholecystitis; fluoroscopy; interventional; trocar
• ISSN: 0361-803X; 1546-3141; 1546-3141
• DOI: 10.2214/AJR.19.21685

The purpose of this study is to compare the safety and efficacy of the bedside ultrasound (US)-guided trocar technique versus the US- and fluoroscopy-guided Seldinger technique for percutaneous cholecystostomy (PC). This prospective noninferiority study compared the bedside US-guided trocar technique for PC (the trocar group; 53 patients [28 men and 25 women]; mean [± SD] age, 74.31 ± 16.19 years) with the US- and fluoroscopy-guided Seldinger technique for PC (the Seldinger group; 52 patients [26 men and 26 women], mean age, 79.92 ± 13.38 years) in consecutive patients undergoing PC at two large tertiary university hospitals. The primary endpoints were technical success and procedure-related complication rates. Secondary endpoints included procedural duration, pain assessment, and clinical success after up to 3 months of follow-up. PC was successfully performed for all 105 patients. The clinical success rate was similar between the two study groups (86.8% in the trocar group vs 76.9% in the Seldinger group; = 0.09). Mean procedural time was significantly lower in the trocar group than in the Seldinger group (1.77 ± 1.62 vs 4.88 ± 2.68 min; < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; = 0.02). Among patients in the Seldinger group, bile leak occurred in 7.7%, abscess formation in 1.9%, and gallbladder rupture in 1.9%. No procedure-related death was noted. Minor bleeding occurred in one patient (1.9%) in the trocar group, but the bleeding resolved on its own. The mean pain score during the procedure was significantly lower in the Seldinger group than in the trocar group (3.2 ± 1.77 vs 4.76 ± 2.17; = 0.01). At 12 hours after the procedure, the mean pain score was significantly lower for patients in the trocar group (0.78 ± 1.0 vs 3.12 ± 1.36; = 0.0001). Use of the bedside US-guided trocar technique for PC was equally effective as the Seldinger technique but was associated with fewer procedure-related complications, required less procedural time, and resulted in decreased postprocedural pain, compared with fluoroscopically guided PC using the Seldinger technique.