The Feasibility of 2mm Needle Forceps for Laparoscopic Cholecystectomy

Akiko Umezawa, MD, Hideharu Shimizu, MD, Yosuke Seki, MD, Yuka Negishi, MD, Kazunori Kasama, MD FACS, Yoshimochi Kurokawa, MD. Minimally invasive surgery center, Yotsuya Medical Cube

Objective: To determine the feasibility and limit of needle forceps for laparoscopic cholecystectomy (LC) and its usability for single incision laparoscopic cholecystectomy (TANKO) and choledocholithotomy.

Materials and methods: During 4-year period, 346 cases of LC were performed. 334 were conventional LC and 12 were TANKO. Conventional LC is perfomed with 2 puncture and 2 incision. 2 punctures are applied through thin caliber trocar ‘Mini-Port’ (Covedien, USA) with needle forceps ‘BJ needle’ (Niti-On Company, Japan). BJ-needle is a thin caliber grasper with a diameter of 2.1mm. The puncture sites are below the right costal margin on the mid-clavicular line (MC) and on the anterior-axillary line of the navel level (AA). Other incisions are 12mm trocar at umbilical site and 5mm below the left costal margin. TANKO is performed with one puncture at MC. We performed intraoperative cholangiography (IOC) routinely during cholecystectomy.

Results: Of 334 LC cases 304 (91%) were successfully completed with BJ-needle. Of other 30 cases 2 had to change to 5mm at MC and 28 changed to 5mm both MC and AA. 18 of 29 cases with history of biliary inflammation (4 were cholangitis and 25 were acute cholecystitis) were also completed without change of trocar (62%). There was no complication caused by using BJ-needle. It was comparable to conventional 5mm grasper during LC. Additionally, IOC can be performed through Mini-Port with catheter. IOC success rate was 99%. In all cases of TANKO with one puncture (10 cases), BJ-needle was very usefull in grasping and retracting the gallbladder, and performing IOC was comfortable. BJ-needle was also useful during laparoscopic choledocholithotomy (Lcdl) not only using as an aid forceps and also as an alternative to 5mm grasper.

Conclusion: BJ-needle was feasible for conventional LC, Lcdl and TANKO. More than 90% of LC cases could be performed successfully. One of the limitation was inflammation, but even in inflammatory cases, 60% of the cases could be completed.