Reduced Port Laparoscopic Cholecystectomy Maintains Safety and Feasibility

Kan Tanabe, MD, Shinichiro Mori, PhD, Kenji Baba, Yoshiaki Kita, Masayuki Yanagi, Kousei Maemura, Hiroshi Kurahara, Yuko Mataki, Hiroyuki Shinchi, Fumio Kijima, Shoji Natsugoe. Department of Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University School of Medicine

OBJECTIVE: Laparoscopic cholecystectomy (LC) has become a standard surgical treatment for the patients with benign disease of gallbladder. Reduced port surgery is a novel technique that may be performed when considering minimally invasive surgery and desiring a cosmetic benefit for selected patients. The aim of this study was to evaluate safety and feasibility of reduced port LC in our institutions.

METHODS: Between July 2009 and June 2013, 59 patients who underwent reduced port LC for benign disease of gallbladder were included (17 male and 42 female, age: 55.8 years old, 23 cases were single-incision LC and 36 cases were double-incision LC). The outcomes were evaluated in terms of operation time, intraoperative blood loss, incidence of conversion to open surgery, incidence of additional port and perioperative complications.

SUGICAL PROCEDURES: The patients were placed in the broad base and the operator stood between the legs. An access device with the wound-protector was inserted through an umbilical skin incision. Two 5-mm trocars were placed through access device for a 5-mm laparoscope and 5-mm instrument. Pneumoperitoneum was maintained at 10 mmHg using CO2. We added one port into the right flank and one needle puncture into the epigastrium for double-incision LC. A flexible laparoscope was inserted from access device port. The serosa of the gallbladder was dissected using an Electric cautery. And the Calot’s triangle was dissected free of all tissue except for the cystic duct and artery using the ultrasonic laparoscopic coagulation shears, and the cystic plate was exposed. After this view was achieved, the cystic duct and artery were dissected with clips. The gallbladder was then removed through the wound-protector of umbilical incision. We cut cystic duct after confirmed the critical view of safety for all patients.

RESULTS: Reduced port LC was performed in 17 patients with chronic cholecystitis, 39 with gallbladder stone with symptoms, and 3 with adenomyomatosis of gallbladder. The mean operative time was 114.3 minutes, the mean blood loss was 4.2ml. There was one (1.7%) conversion to open surgery. One (1.7%) patient received 3 additional ports, 4 (6.8%) other patients received one additional port. 5 patients (8.5%) experienced intraoperative complications, gallbladder injury (n=4) and bleeding (n=1). One patient experienced surgical site infection. There was no severe intraoperative and postoperative complications.

CONCLUSION: Our experience and surgical technique suggest that reduced port LC for the patients with benign disease of gallbladder is a safe and feasible procedure.