In the Era of NOTES, a Cosmetic and Secure Approuch to Laparoscopic Cholecystectomy.

Background: Since 1993, our group has been doing Laparoscopic Cholecystectomy (LC) using a three-port approach with excellent results. Many papers showed that Needlescopic and two or three 5mm ports approaches may reduce the postoperative pain, but did not gained popularity.
Aim: Describe a variant three-port approach with excellent cosmetic results without losing the benefits and security of conventional LC.
Methods: We operated 20 consecutive patients (14 women, 6 men) with a 3 port approach – 1) umbilicus – 5 or 10 mm work channel; 2) sub costal – 3mm grasper and 3) right from the pubis – 10mm(0o scope). There are 3 grade I obese patients and 1 patient with a previous open gastrectomy.
Results: Mean operative time was 50 minutes, there were no conversions and we did not observe any complications. Postoperative pain and return to normal activities were similar to our previous experience.
Discussion: NOTES still an experimental procedure and the potential complications due to an opening in the stomach may not compensate the scar less surgery. Our technique is very similar to a conventional LC, but offers the possibility of better cosmetic results without an increase in complications. It also facilitates the procedure for the patient with a previous gastrectomy, because we entered the abdominal cavity out from the scar adhesions. Obesity is not a contra indication for our method.
Conclusion: To improve cosmetic results of laparoscopic cholecystectomy it is not necessary to create a gastrotomy in the stomach. Our technique proved to be very secure and with excellent cosmetic results. It also can be adopted in almost any patient, independent of weight, sex and previous abdominal surgery.


Session: Poster

Program Number: P425

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