Prospective Evaluation of Barriers to Microlaparoscopy

William C Beck, MD, Rebeccah Baucom, MD, William J Lee, MS, Michael D Holzman, MD, MPH, Kenneth W Sharp, MD, Benjamin K Poulose, MD, MPH

Vanderbilt University Medical Center

INTRODUCTION: Microlaparoscopy offers potential advantages of improved cosmesis and less postoperative discomfort when compared to traditional laparoscopy. As with any emerging new approach, frequent concerns include identifying in whom to utilize the technology and what changes in technique are required to accommodate successful adoption. Perceived problems with using microlaparoscopic instrumentation include patient habitus and instrument characteristics. The goal of this study was to evaluate these issues and their impact on conversion of microlaparoscopic instrumentation to standard laparoscopy.

METHODS AND PROCEDURES: Patients undergoing planned laparoscopic general surgery procedures were prospectively enrolled. Characteristics including body mass index (BMI) and detailed ultrasound-based anthropomorphic abdominal wall measurements were recorded at 5 standardized locations. All cases were initiated with 3mm microlaparoscopic instruments. The main outcome measure was conversion of any microlaparoscopic port to a traditional laparoscopic port.

RESULTS: Forty-three patients were prospectively enrolled for planned microlaparoscopic procedures. Nine patients underwent a traditional laparoscopic procedure due to lack of available instrumentation or surgeon judgment. A total of 78 microlaparoscopic ports were utilized in 34 patients. Of these patients, the mean age was 50±2.7 years (mean±standard error) with 68% women. Mean BMI and operative time were 27.4±1.0 kg/m2 and 94.1±7.5 minutes. Procedures included cholecystectomy (14), foregut (18) and hernia (2). A 3mm laparoscope was used in 18% of cases. Sixty-two percent had at least one microlaparoscopic port used, 26% had at least two used. Conversion to either 5mm (89%) or 10mm (11%) ports occurred with 36 ports (46%). Chief reasons for conversion included no available instrument for a specific task (61%), inadequate grasping ability (17%), excessive bending (11%), and inadequate length (8%). No complications occurred as a result of microlaparoscopic instrumentation. Subcutaneous fat, preperitoneal body fat, or BMI did not predict the need for conversion.

CONCLUSION: Instrument characteristics and availability have greater impact on the successful completion of microlaparoscopic operations than patient factors. Additional refinement of instrumentation may improve the acceptance and success of microlaparoscopy.

Session: Poster Presentation

Program Number: P389

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