@article{3121617,
    title = "Two-center prospective comparison of the trocar and seldinger techniques for percutaneous cholecystostomy",
    author = "Reppas, L. and Arkoudis, N.-A. and Spiliopoulos, S. and Theofanis, M. and Kitrou, P.M. and Katsanos, K. and Palialexis, K. and Filippiadis, D. and Kelekis, A. and Karnabatidis, D. and Kelekis, N. and Brountzos, E.",
    journal = "AJR.  AMERICAN JOURNAL OF ROENTGENOLOGY",
    year = "2020",
    volume = "214",
    number = "1",
    pages = "206-212",
    publisher = "American Roentgen Ray Society",
    issn = "0361-803X",
    doi = "10.2214/AJR.19.21685",
    keywords = "abscess;  acute cholecystitis;  aged;  Article;  bedside ultrasound guided trocar technique;  bile leakage;  bleeding;  cholecystostomy;  controlled study;  echography;  female;  fluoroscopy;  fluoroscopy guided Seldinger technique;  follow up;  gallbladder disease;  human;  intermethod comparison;  major clinical study;  male;  operation duration;  pain assessment;  patient safety;  percutaneous cholecystostomy;  postoperative complication;  postoperative pain;  priority journal;  prospective study;  surgical technique;  tertiary care center;  treatment outcome;  ultrasound guided Seldinger technique;  university hospital;  cholecystostomy;  clinical trial;  comparative study;  controlled clinical trial;  devices;  middle aged;  multicenter study;  procedures;  surgical equipment;  very elderly, Aged;  Aged, 80 and over;  Cholecystostomy;  Female;  Humans;  Male;  Middle Aged;  Prospective Studies;  Surgical Instruments",
    abstract = "OBJECTIVE: 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). SUBJECTS AND METHODS: 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. RESULTS: 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; p = 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; p < 0.0001). Significantly more procedure-related complications were noted in the Seldinger group than in the trocar group (11.5% vs 1.9%; p = 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; p = 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; p = 0.0001). CONCLUSION: 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. © American Roentgen Ray Society."
}