A Scarless Cholecystectomy Made Easy By the Hidden Suprapubic Approach

Currently, a new trend for no scar procedures has become very popular, mainly for cholecystectomy. The needlescopic surgery is not suitable for complicated cases and the incisions are located at visible points. TUES procedure has a limited critical view and requires at least a 25 mm umbilical incision. NOTES requires a sophisticate endoscope through the vagina and a 2mm abdominal port to seize the gallbladder, and the real potential is still under scrutiny and excludes obese patients, complicated disease, nubile females and males. AIM: To report a new technique based on our previous experience with the suprapubic appendectomy and with the use of bariatric instruments (45cm long) Technique: We did substituted the sub-costal ports for two 5mm ports located below the pubic hair line and above the pubic bone under direct vision, just medial to the left lateral umbilical ligament for the gallbladder’s fundus and medial to the opposite one for the Hartmann’s pouch, in order to avoid any damage to the deep epigastric vessels or the bladder. The 10-12mm camera port is placed into the umbilicus and a sigle 3mm working port is placed below the xyphoid as the usual manner, with the surgeon at the patient’s left side and the assistant/cameraman behind the surgeon. This port location provides an excellent surgical view and an ample rank of movements to manipulate the gallbladder even if a cholangiogram or a trans-cystic CBD exploration is required and the 5mm bariatric graspers allows to seize the gallbladder, even with a thick wall. It is also ergonomic due to the lack of need to raise the left elbow; we avoid clips, just coagulating the artery and tying the cystic duct. The gallbladder is retrieved through the umbilicus changing to a 5mm telescope to the pubis. The cosmetic result is superb and the pain at the suprapubic ports minimal. Results: Since 2005 to date, we have operated 54 consecutive patients with no complications and no substantial difference compared with the standard technique as the operating time (19 min-95 min, average 45min), adding a superb cosmetic result, finding besides an unexpected low pain perception at the level of the pubis as well as a surprisingly high acceptance rate by the patients. Conclusion: We encourage the use of this simple modification of the port placement for all the patients suitable for laparoscopic cholecystectomy with no major previous surgery at the lower abdomen, mainly in young women.

Session: Poster

Program Number: P512

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