Hugo Bonatti, MD. University of Maryland Community Medical Group
Background: The majority of surgeons use four ports including for laparoscopic cholecystectomy (LC). Multiple efforts have been made to reduce number and size of ports. left upper quadrant (LUQ).
Patients and methods: Of 114 LCs performed from 6/2014 – 4/2017, 109 (96%) were done using three instruments including 55 cases in which 2 trocars and the Teleflex needle grasper were used. In 26 cases only two 5mm trocars were (left upper quadrant (LUQ) and umbilicus) with the minigrasper being placed between the two. The gallbladder (GB) serosa was incised on both sides and a window was created behind the GB midportion and widened towards fundus and infundibulum. Cystic artery (CA) and cystic duct (CD) were dissected out obtaining the critical view and after the last fundus adhesion was cut, CA and CD were secured with clips or endoloop.
Results: Median age of 19 women and 7 men was 42.4 (range 24.1-77.4 ) years. LC was done for acute cholecystitis (n=4), chronic cholecystitis (n=8), biliary dyskinesia (n=9), choledocholithiasis (n=5). Three patients had an ERCP with bile duct clearance prior to the LC. In one case a Keith needle was used to suspend the GB fundus for better exposure. Twelve patients had additional procedures together with their LC (wedge liver biopsy (4), lysis of adhesions (3), umbilical hernia repair (1), mesenteric/lymphnode biopsies (4). Median OR time was 51 (range 34-129) minutes. The specimen was removed through the LUQ port site in 9 patients. There were no vascular or bile duct injuries in this series. 71% of cases were done as outpatient procedures, 25% of patients required 23hours observation only three patients were hospitalized for medical reasons.
Conclusion: In selected cases with either small stones or biliary dyskinesia, LC with only two 5mm ports and a needle grasper is possible. The Teleflex minigrasper can completely replace a port based grasper.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87732
Program Number: P085
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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