BACKGROUND: The advent of NOTES, surgery without skin scarring, is now challenging every surgeon to improve the esthetic results for patients. Needlescopic Cholecystectomy (NC) represents a refinement in laparoscopic surgery, potentially as cosmetically effective as NOTES. Nevertheless, because of the increased cost and difficulty in managing equipment, NC has not yet been widely accepted by surgeons.
AIMS: To present modifications to the NC technique, which make it possible to conduct NC safely and effectively, leading to a considerable reduction in the cost and availability of NC.
METHOD: 815 unselected consecutive patients suffering from chronic lithiasic cholecystitis or gallbladder polyps (6.4%) undergoing NC between January 2000 and September 2007 were analyzed. Technique: Four trocars are inserted; two of 2-mm, one of 3-mm and one of 10-mm at the umbilical site, through which a laparoscope was inserted. Neither the 3-mm laparoscope, nor clips, nor endobags were used. The cystic artery was safely sealed by electrocautery near the neck of the gallbladder and the cystic duct was sealed using surgical knots. Removal of the gallbladder was carried out using an adapted bag with a glove wrist, inserted through the 10-mm umbilical site.
RESULTS: Surgery time measured using video archives was 31 min. The average hospital stay was 18 hours (96% being discharged within 24 h). There was no conversion to open surgery; 3.2% of patients underwent conversion to standard (5-mm) lap-chole; 2.2% presented minor umbilical site infections, and 1.2% umbilical herniations. There was no mortality, no bowel injury, no bile duct injury, no bile leakage, no postoperative hemorrhage, and no re-operations.
CONCLUSIONS: The NC technique shows no differences in risks as compared to other lap-chole procedures. It also entails a considerable reduction in cost, and, as it does not use the 3-mm laparoscope or disposable materials, it is possible to perform NC on a larger number of patients. Owing to the near invisibility of scars NC may also be considered as cosmetically effective as NOTES.
Program Number: P307