Single-incision Multiport Laparoendoscopic Cholecystectomy Using a Newly Developed Short-type Flexible Endoscope: A Combined Procedure of Flexible Endoscopic and Laparoscopic Surgery

Nobutsugu Abe, MD PhD, Hirohisa Takeuchi, MD, Atsuko Ooki, MD PhD, Toshiyuki Mori, MD PhD, Masanori Sugiyama, MD PhD. Kyorin University School of Medicine, Department of Surgery


 Objective: We hypothesized that using a flexible endoscope as a working scope might provide many merits with single-port surgery (SPS). To this end, a short-type flexible endoscope with a working length of 60 cm was developed. The aim of this study was to evaluate the technical feasibility of our new approach, single-incision multiport laparoendoscopic (SIMPLE) cholecystectomy, using this endoscope.
Methods: Eight pigs were subjected to SIMPLE cholecystectomy. The endoscope was inserted through a 12-mm trocar in a SILSTM Port followed by the insertion of two additional 5-mm trocars in the SILSTM Port. Encirculation and ligation of the pedicle of the cystic artery and duct were carried out using laparoscopic instruments through the 5-mm trocars, while the dissection of the gallbladder from the infrahepatic fossa was predominantly performed using a cutting device (Mucosectome, a device for endoscopic submucosal dissection) through the endoscope.
Results: The mean operating time was 58 minutes (range, 34 to 78 minutes). A complete gallbladder excision, with complete encirculation and ligation of the pedicle, was achieved in all pigs. The endoscope provided an excellent view of the operating field. Dissection of the gallbladder using the cutting device through the endoscope was easier than that using the laparoscopic device, because the articulating instruments together with the endoscope enabled operation with triangulation. The water-jet and suctioning functions and the self-cleaning lens capability of the endoscope served well for the SPS.
Conclusions: SIMPLE cholecystectomy using the short-type flexible endoscope is a technically feasible procedure. Letting this flexible endoscope do various works, such as resection, suctioning, and smoke evacuation, can make the surgical procedures easier.

Session Number: Poster – Poster Presentations
Program Number: P513
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