Laparoscopic surgery with minilap

Quintin Gonzalez, FACS, MD, Monica De Jesus, MD, Jesus Bahena, MD, Guillermo Arana, MD, Sari Mejia, MD. Hospital Humanitas Medical Group Coyoacan

IMAGE 4. Cholecistectomy

Image 3. Fundoplication

BACKGROUND: In recent years laparoscopic techniques have evolved trying to improve surgical results and the mini laparoscopic approach has shown its advantages in terms of morbidity, less incisional pain, greater comfort and better cosmetic results, therefore, shorter hospital stay and return to daily activities early.

OBJECTIVE: To prospectively analyze a sample of 30 patients, underwent to a minimally invasive laparoscopic surgery using minilap percutaneous tweezers (teleflex) determining its advantages.

MATERIAL AND METHOD: A prospective study of 30 patients with a diagnosis of vesicular lithiasis, vesicular dyskinesia and GERD, with cholecystectomy and nissen fundoplication by laparoscopy, respectively, minilap tweezers, TeleflexR, percutaneous clamp type and minigresper clamp, both of 2.3 mm of diameter, which are introduced percutaneously into the abdominal wall without requiring the use of trocars.

RESULTS: The MiniLap percutaneous tweezers were used in the 30 patients, 3 percutaneous forceps and 2 trocars were used in the fundoplication, in the cholecystectomy 2 percutaneous tweezers in the right flank, a subxifoid 5mm and a 10mm umbilical trocar (image 1 and 2), the first atraumatic clamp was used by the assistant to stabilize the gallbladder and raise it to expose the operative field, the second minilap clamp was used in the left hand of the surgeon to expose the calot triangle and facilitate the dissection with cautery hook in cases of Nissen fundoplication, the first clamp was used to pull the liver and expose the operative field and the second to facilitate the dissection of short vessels and esophageal pillars, closure by planes was carried out and steri-strips were placed in the access sites of the Percutaneous tweezers, both procedures were carried out without complications. Postoperative analgesia was achieved with intravenous paracetamol every 8hrs obtaining adequate control and less pain, as well as 2.3mm scars with a satisfactory aesthetic result (image 3 and 4). All patients were discharged the next day and there were no complications during ambulatory follow-up 7 days after surgery.

CONCLUSION: This study demonstrates that percutaneous retraction of the liver and vesicle with the percutaneous system of TeleflexR MiniLap is safe and effective in this series of patients. The complication rate implied by this technique is low and this new method provides less trauma, better cosmetic results than the conventional technique, as well as less postoperative pain and decreased hospital stay

IMAGE. Tweezers percutaneous