Fausto Davila, MD, Gloria Gonzalez, MD, Daniel Tsin, MD, Guillermo Dominguez, MD, Martha Davila, MD, Jose Lemus, MD, Andrea Tinelli, MD, Jose Montero, MD, Sergio Aguilar, MD, Victor Heredia, MD, Ulises Davila, MD, Qaqish Shadie, MD
Reg. Hosp. SESVER, Poza Rica, Veracruz, Mexico. Hosp. ISSSTECALI, Tijuana, B.C., Mexico. Mount Sinai Hospital Queens, N.Y., USA Fundacion Hospitalaria (Hospital Foundation) Buenos Aires, Argentina. Hosp. Gral. Dr. M. GEA Gonzalez, DF, Mexico. Reg. H
The author’s experience in the use of the one CL1P port laparoscopic cholecystectomy technique is presented with casuistry of 2982 procedures collected over 14 years. The exponential growth of minimally invasive surgery, which today accommodates the different techniques with single port laparoscopic cholecystectomy, requires demonstrative results to substantiate the credibility and confidence in innovations. The CL1P technique supported in this wide casuistry is confirmed as a feasible, affordable and accessible approach to any laparoscopic surgery group in our midst.
MATERIAL AND METHODS
A retrospective study of 2982 patients from December 1997 to December 2011 was performed. Patients with acute and non-acute gallbladder diseases were operated on, excluding those with gallbladder cancer and choledocholithiasis. . A laparoscope with a working channel of 6mm and laparoscopic instruments of 5mm x 43cm were utilized with percutaneous needle assistance. We analyzed the following variables: feasibility, age, sex, BMI, ASA anesthetic risk classification, operative time, hospital stay, postoperative pain, complications and their types, and mortality. The analyzed cost refers to the specialized instruments and consumables for the development of the CL1P technique. Descriptive statistics were used with parametric tests, frequency, central tendency and dispersion.
The age ranges were 7 to 96 years, with an average of 48. 79% women vs. 21% men for a 4:1 ratio, with BMI range from 19 to 54, and an average of 30; interventions with ASA classification ASA I = 70.15%, ASA II = 22.03%, ASAIII = 7.1% and ASA IV = 0.7%. Operative time fluctuated in ranges between 14 to 210 minutes with a mean of 68, and had an average hospital stay of 24 hrs. Postoperative pain measured by visual analog scale fluctuated between 1 and 8 with a mean of 4. We had 4.02% results in conversions. In terms of morbidity, complications were reported at 4.22% which divided between omphalitis (3.72%), intra-abdominal collections (0.16%), umbilical hernia (0.13%) and 0.06% for each of the following: intercostal abscess, migration of drain, and intestinal perforation. An 84 year old patient died of pulmonary embolism for a mortality of 0.03%. The average cost of specialized equipment for each procedure was 8.16 dollars.
We conclude that laparoscopic cholecystectomy with 1 port; CL1P is a feasible technique to be performed in 96% of cases. We obtained similar results to traditional laparoscopic surgery, but overcoming the psychological, cosmetic, and functional outcome for the patient. The evident reduction in costs, by reducing the use of 3 ports, and the limited specialized material place it as an accessible technique for any laparoscopic surgical team with a safe and short learning curve.
KEYWORDS: cholecystectomy, laparoscopy, single port, LESS, minimally invasive surgery
Session: Poster Presentation
Program Number: P527