Hirotsugu Ohara, MD. Fujieda heisei Memorial Hospital
Background: Since 1994, We have performed 400 cases of laparoscopic cholecystectomy(LC)with good results by an abdominal wall lifting method using our original lifting bars. The bar consisted of a bent stainless steel rod 5mm in diameter. Our lifting method is suitable for not only cardiopulmonary compromised patients but also the patients with severe inflammation. Single – incision laparoscopic cholecystectomy ( SILS) has recently emerged as a less invasive alternative to standard multi –incision LC. We have tried to perform SILS by using our lifting method. This method, including the cost assessment of laparoscopic instrument, will be discussed.
Method: Ten patients underwent SILS between April 2015 and April 2017. One patient showed a negative cholecystogram in preoperative intravenous cholangiography. After placement of wound protector to umbilical incision, two lifting bars were inserted and drawn by winches into positions, that were to the bilateral side of the patient. A mini – loop retractor introduced subcostally was used to retract the GB and visualize Calot's triangle. All these operations were performed with conventional straight laparoscopic instrument.
Results: Only one cases was converted to three – port surgery in liver chirrosis case, but no cases were converted to conventional open surgery. The mean operation time was 97.1 min, and the estimated blood los was 18 ml. The postoperative course was uneventful in all cases.
Conclusion: We didn’t have to use the specific multi – channel port and the disposable roticulater, which were expensive. Furthermore, we were able to perform SILS without sacrificing safety. Our lifting method is reasonable and reliable in SILS, too.