Nobumi Tagaya, PhD, Yawara Kubota, MD, Asami Suzuki, MD, Nana Makino, MD, Kosuke Hirano, MD, Shinichiro Kouketsu, PhD, Emiko Takeshita, PhD, Yoshitake Sugamata, PhD, Hidemaro Yoshiba, PhD, Shinichi Sameshima, PhD, Masatoshi Oya, PhD. First Department of Surgery, Dokkyo Medical University Koshigaya Hospital
Background: Laparoscopic cholecystectomy with needlescopic instruments has been progressed. However, this refinement has several limitations to perform surgical procedure. We performed a consecutive study to evaluate the feasibility and safety of needlescopic cholecystectomy.
Patients and Methods: Recent 10 years we performed needlescopic cholecystectomy in 160 patients. They were 63 men and 96 women with mean age of 51.6 years (range: 27-79). After creation of pneumoperitoneum, the port sites consisted of three 2-mm or 3-mm ports at the right upper quadrant and one 12-mm port at the umbilicus. The operation was divided into two procedures. The operator manipulated dissecting forceps, electrocautery, clipping, cutting and intraoperative cholangiography (IOC) in the left hand and 2-mm needlescope in the right hand during all procedures. The assistant manipulated two grasping forceps form the right subcostal ports. In the other, the operator manipulated two dissecting or grasping forceps under 10-mm laparoscope. The assistant manipulated grasping forceps from the right subcostal port and 10-mm laparoscope from the umbilical port. When performing clipping or cutting of cystic duct and artery, IOC and removal of gallbladder, 2-mm needlescope is moved from the umbilical port to the epigastric port.
Results: IOC was successfully performed in selected patients. The conversion to standard laparoscopic cholecystectomy was required in 8 patients (5.0%) due to the difficulty of continuing procedure. The mean operative time was 84 min (range: 45-195 min) and postoperative hospital stay was 3.4 days (range: 2-10 days). Postoperative complications were intra-abdominal abscess in one patient, wound infection in one, respectively. There were no major intra or postoperative complications.
Conclusion: The use of needlescope and needlescopic instruments was feasible and safe to perform laparoscopic cholecystectomies with low morbidity and no mortality.
Session Number: Poster – Poster Presentations
Program Number: P328