Kazunori Shibao, MD PhD, Aiichiro Higure, MD PhD, Koji Yamaguchi, MD PhD. Dept. of Surgery I, School of Medicine, University of Occupational and Environmental Health
BACKGROUND: Laparoendoscopic single-site (LESS) surgery has developed as a new surgical modality producing increased cosmetic benefits over conventional endoscopic surgery. However, to date, there are no reports about LESS surgery in common bile duct exploration. This report presents a LESS surgery to manage CBD stones by laparoscopic choledochotomy and c-tube placement with favorable outcomes.
METHODS: This retrospective review analyzes five patients who underwent LESS common bile duct exploration (Multiple trocars method) with c-tube drainage for choledocholithiasis. The technique is described, and outcomes are measured. Radius Surgical System (Radius) which is flexible manual manipulator was applied for suturing and ligation to overcome the difficulty in LESS surgery.
RESULTS: The median age of the patients was 76.8 years. The diameters of the CBDs ranged from 12 to 20 mm, the median number of stones was 5.8, and the median diameter of stones was 9 mm. All our routine procedures including choledochotomy, intra-operative ultrasound, choledochoscopy, and intra-operative cholangiography guidance were performed with LESS surgery. Stone clearance from the CBD was achieved for all the patients. As for closure of the common bile duct opening with regular forceps, it’s possible, but needed extra-efforts comparing to conventional laparoscopic surgery. On the other hands, Radius enabled us to achieve the optimal penetration angle and was useful for both intracorporeal suturing and ligation for the closure of the common bile duct opening. Radius also was of value to overcome in-line viewing and hand/instruments collisions, which are common problems in LESS surgery, No mortality was associated with this procedure, and one wound infection was drained without anesthesia. No recurrent stone was observed during follow-up period.
CONCLUSIONS: The LESS surgery has been successfully applied to common bile duct exploration as an available alternative to conventional laparoscopic surgery. This method is technically feasible and results in superior cosmesis. Radius may have advantages in LESS surgery.
Program Number: V033