Junko Takita, MD, Norihiro Haga, MD, Norihiro Masuda, MD, Yuta Shibasaki, MD. NHO Utsunomiya National Hospital
Introduction: Single port surgery (SPS) has been reported to reduce the abdominal wall damages. To reduce the length of umbilical scar and to keep the triangulation, we use 2 additional fine needle forceps for laparoscopic cholecystectomy (LC).
Patients and Methods: From 2007 to May 2018, 597 consecutive LC patients were retrospectively investigated. There were 345 male and 252 female. Severe cholecystitis was observed in 30% of the cases. We use two 5mm ports (1 for the scope and 1 for the operator’s right hand forceps) through an umbilical multi-channel port and 2 additional 2.4mm fine needle instruments are pierced. One of the forceps is placed on the right side of the lower end of sternum and the other is on the right side of abdomen. A 5mm flexible scope allowed us to keep the triangular formation easily. We performed cholecystectomy by this plus two punctures SPS (PTP-SPS) for 464 patients. The rest of patients were operated by one 11mm port, one 5mm port and two fine needle forceps as conventional reduced port surgery (RP). We employed the RP method until 2011, however from 2012 to now, we perform cholecystectomy by PTP-SPS. We studied the safety and usefulness of PTP-SPS from the viewpoints of operation time and the complications.
Results: Median operation time of PTP-SPS (464 cases) was 83 (28-227) minutes, while RP (133 cases) was 84 (26-191) minutes. In PTP-SPS, 66 cases (14.2%) needed 1 or 2 additional 5mm ports and 7 (1.5%) were converted to open surgery. Postoperative complications were conservatively treated 2 bile leakage (0.4%) and 3 incisional hernia (0.6%). There was no severe wound infection in our series. In RP, 2 cases were converted to open surgery (1.5%). Severe postoperative complication was 1 incisional hernia (0.75%) that needed surgical repair. Umbilical scars and the pierced needle instrument scars became gradually invisible within 1 or 2 months. There was no learning curve with operators changing over from RP to PTP-SPS method.
Conclusions: There were no differences between PTP-SPS and RP in operation time and complications. Operative scar of PTP-SPS is smaller than RP because of using the fine needle forceps instead of 5mm port. Therefore, the patients appreciate PTP-SPS by better cosmesis than the conventional LC or RP. PTP-SPS may become the standard approach as less invasive laparoscopic cholecystectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93840
Program Number: P231
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster