Minilaparoscopic Cholecystectomy: The Lessons Learned After 13 Years of Experience and 1.750 Cases

Diego Laurentino Lima, MD, Gildo O Passos Junior, MD, Juscielle S Barros, Yukie C Konishi, Ingrid L V. Rodrigues, Frederico W C. Silva, MD, Gustavo L Carvalho, PhD. University of Pernambuco, Faculty of Medical Sciences.

OBJECTIVE: This review aims to demonstrate that minilaparoscopic cholecystectomy (MLC) provides better results when compared with laparoscopic cholecystectomy (LC), explaining the most important lessons learned after 13 years of experience.

METHODS: From 2000 to 2013, 1.750 patients underwent MLC. Surgical technique: After introduction of 10mm trocar for laparoscope in the umbilical incision, pneumoperitoneum was made and 3 trocars were inserted. Initially, there were 2 of 2mm and 1 of 3mm in diameter; after 2009, with the advent of dilating trocars, atraumatics and with low friction, 3 of 3mm trocars started to be placed. Three millimeters laparoscope or clips were not used. The cystic artery was cauterized safely near the gallbladder and the cystic duct was sealed with surgical knots. The removal of the gallbladder occurred through the umbilical incision, initially using adapted bag made with surgical glove wrist and, in recent years, through manufactured bags for extraction (MTP – 200mL).

RESULTS: The operation video time was 24 minutes. 2.4% of conversion to LC. There was no conversion to open surgery, no bleeding, no bile ducts injury or mortality, no complications in intra and postoperative. Only one case of reoperation occurred for leakage persistence of the Luschka’s duct. There was great satisfaction of patients regarding postoperative pain and reduced hospital stay.

CONCLUSION: (1) The minilaparoscopy is an effective, safe, refined, cost-effective technique and with short learning curve for surgeons familiar with the LC. (2) Use of low friction atraumatics trocars with dilating extremities minimize abdominal wall injury and postoperative pain, besides provide better cosmetic with tiny and almost imperceptible scars. (3) The low friction trocars increase the precision of movements and facilitate the use of minilaparoscopy material. (4) The cauterization of the cystic artery is safe and effective. (5) The making of surgical knots in the cystic duct is easier and faster due to the reduced diameter of the material. (6) The monopolar electrocautery associated with the precision of the minilaparoscopy material presents safety standards similar to the bipolar electrocautery with laparoscopy instruments. (7) The minilaparoscopic instruments provide better visualization for tasks that require greater precision. (8) The removal of the gallbladder in a bag, such as a wrist glove or a manufactured one, is important not only to facilitate its extraction as to minimize trauma and to reduce risk of local infection or dissemination of cancer in cases of malignancy.

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