Gloria Gonzalez Uribe, MD1, Fausto Jesus Davila Avila, MD2, Jose Lemus Allende, MD2, Hiram Raul Munoz Gonzalez, MD3, Martha Ruth Davila Centeno, MD4, Juan Carlos Orellana, MD4, Daniel Tsin, MD5. 1ISSSTECALI, 2HOSPITAL FAUSTO DAVILA PXA RICA VER. MEX, 3INSTITUTO NACIONAL DE NUTRICION SALVADOR SUBIRAN INNSZ MEX, 4HOSP. GRAL. DR. MANUEL GEA GONZALEZ, 5PRIVATE PRACTICE
INTRODUCTION: The obvious advantage generated when we reduce tissue damage through minimally invasive techniques such as single-port surgery or the use of mini instruments have led us to create hybrid combinations that take advantage of each of the techniques or tools in order to maximize the results. In this case we combined the use of percutaneous needles and minilaparoscopy instruments taking advantage of the benefits of each technique, this lead to satisfactory results that allowed us to put this combination as a viable and beneficial option for minimally invasive cholecystectomy.
METHODS AND PROCEDURES: We analyzed the results of 64 patients who underwent hybrid laparoscopic cholecystectomy combining the benefits of the mini instruments technique and the percutaneous needles used in CL1P technique. We replaced the traditional ports, the 10 mm subxiphoid was replaced by a 3.5 mm mini instrument port and the 5 mm subcostal by a 1.8 mm percutaneous needle, we had an adequate exposure and a good development of the technique. This was done by a single experienced surgical team during a 20 month period, from January 1st 2015 to august 31st 2016 in a private hospital. From 214 gallblader procedures performed, this technique represented 30% of all cholecystectomies, acute or not acute benign pathology, calculous or acalculous, and performed under these exclusion criteria: obese (BMI 35 or more), senile (over 60 years) and comorbid patients (sepsis, cancer or choledocholithiasis). Partial conversion was considered anytime we replaced any port but the surgery was still under laparoscopic technique and total conversion when it was replaced by open cholecystectomy.
RESULTS: The surgery results showed the feasibility to develop this combination of techniques in 90.6% (58) of our patients; of the remaining 9.4%(6) patients conversion we only had 6.2% (4) patients that required replacement of the percutaneous needle for a 5 mm port, 1.5% (1) required a traditional 4 ports laparoscopy and 1.5% (1) case required open laparotomy. Drains were left in 3.1% (2) patients . There were no postoperatory complications, no extensions of hospital stay and no change in any other evaluation parameter (pain, etc) compared to traditional laparoscopy, except the better cosmesis results when hybrid technique was done.
CONCLUSIONS: The combination of mini instruments and the use of percutaneous needle generates a hybrid technique making minimally invasive techniques feasible while aiming at reducing tissue damage in laparoscopic cholecystectomy
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80506
Program Number: P580
Presentation Session: Poster (Non CME)
Presentation Type: Poster