Needlescopic Surgery: The Cosmetic Alternative to SILS

Introduction: Minimally invasive procedures have revolutionized the art of surgical practice. Laparoscopic cholecystectomy (LC) is the gold standard for management of gall bladder disease. In an attempt to further improve on the benefits of the standard multiple incision LC, less invasive methods have been described, including smaller incisions, fewer incisions, and use of single incisions. Needlescopic cholecystectomy (NC) utilizes 2 or 3 mm instruments and has been shown to provide improved cosmesis. Single incision is a newer approach to cholecystectomy, with theoretical advantage of improved cosmesis and reduced postoperative wound complications.

Methods: All 404 operations at TEI were done by a single surgeon from 1995-2008. 86% of subjects were female, and average age of all subjects was 41.9 years (range 14-82). Average BMI was 25.7 (range 16.4 -39.2). 19.6 % of patients had previous abdominal surgery. Ultrasound findings most commonly was cholelithiasis; no patients had preoperative imaging indicating common duct stones, and only one patient was found to have a dilated (>1cm) CBD on preoperative ultrasound. We performed intraoperative cholangiograms on all patients regardless of preoperative diagnosis, laboratory values or ultrasound findings.

Only once was a CBD stone found on cholangiogram, and a CBDE, stone extraction and T-Tube placement was performed. Average operating time was 59.3 minutes (range 30- 200). One 200 minute operation required laparoscopic CBDE, accounting for the extended time. Average estimated intraoperative blood loss (EBL) was < 15 cc ( range 0-50cc). 2% of cases required conversion to standard 5 mm LC and was completed without incident. Since 1995, only one patient presented with a hernia at the umbilical site. Otherwise, no wound, bile duct, bile leaks, bleeding complications or hernias have been identified.

Conclusion: We propose that NC currently provides a better cosmetic result over standard LC and SILS cholecystectomy, with fewer theoretical and actual wound and hernia complications.

Session: Poster of Distinction

Program Number: P013

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