2mm Laparoscopic Cholecystectomy: The Correct First Step Before Advancing to NOTES

Background: The laparoscopic cholecystectomy (LC) has been the standard of care for two decades. LC is usually preformed with two 10-12mm ports and two 5mm ports. Some investigators have looked to improve the procedure by limiting the port sizes to improve outcomes. In our Department, a single surgeon and his trainees have been performing 2mm laparoscopic cholecystectomy (2LC) since 1996. We believe that, before attempting LC by natural orifice transluminal endoscopic surgery (NOTES), the next logical step to improving outcomes in LC, for most surgeons, is to reduce the size and number of ports, as we have by utilizing 2mm technology.

Methods: A retrospective review of a prospectively maintained database of 1309 consecutive LC patients was evaluated. Use of 2LC started in July 1996. Initially, all procedures were started with a 10mm port and three 2mm ports. Since 2000, all cases are started with a 10mm port and two 2mm ports. All procedures were preformed by a single surgeon (PRR), or a senior-level trainee. Data recorded included age, BMI, surgery time (OT), placement of additional ports (AP), enlargement of ports (EP), complications, number of ports used, and indications for the procedure. Data sets were not complete for all patients. Since 1990, all patients requiring cholecystectomy who were not undergoing laparotomy for another procedure were initiated laparoscopically, with no exceptions.

Results: 965 consective patients were operated on using 2mm LC at The Methodist Hospital over the last 12 years. Values are reported as Mean ± SD, (range), [n]; OT 67.32 ± 0.023 min, (20 – 420), [965]; Age 53.9 ± 15.9 yr, (16-96), [965]; BMI; 28.85 ± 6.75 kgm-2 (13.99 – 74.27), [910]. AP/EP for all cases: 35.3% (341/965); 14mm cases: 42% (274/652); 16mm cases: 21.4% (67/313). 2mm AP for all cases: 13.5% (130/965); 14mm cases 19.2% (125/652); 16mm cases 1.6% (5/313). EP for all cases: 21.9% (211/965); 14mm cases: 22.9% (149/652); 16mm cases 19.8 (62/313). Major and minor complications were recorded in a total of 42 patients (4.4%): 28 (2.9%) major; 16 (1.7%) minor. There were no conversions to open cholecystectomy.

Conclusion: 2LC is safe and effective in treating symptomatic gallbladder disease. Overall AP or EP rate was 35.3%. Only 2mm non-umbilical ports were used in 77.8% (751/965). No patients required open cholecystectomy. There was a low complication rate of 4.4%. Decreased port size and number, such as in 2LC, should be considered the next logical step, for most surgeons, before progressing to NOTES.

Session: Poster

Program Number: P444

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