The usefulness of reduced port cholecystectomy using the two 2.4mm fine forceps directly penetrating the abdominal wall.

Kazunori Tokuda, MD, Jun Hanaoka, MD, PhD, Hideki Kawasaki, MD, PhD, Masamitsu Harada, MD, PhD, Hiromi Ootani, MD, Masahiko Fujii, MD, PhD. Ehime prefectural central hospital

Background: In recent years, although the reduced port operation method which is excellent in cosmetics, such as SILS, is spread, therefore, the problem that safety is sacrificed or operation difficulty rises has arisen. This study examined the usefulness of reduced port cholecystectomy using the two 2.4mm fine forceps directly penetrating the abdominal wall, which is performed by 21 mm of total surgical wound length, and shows the unique method of insert of the 2.4mm fine forceps whose tip has 5mm in diameter.

Method: From January 2013 to June 2014, one hundred sixty patients performed laparoscopic cholecystectomy in Ehime Prefectural Central Hospital. These 160 patients were divided into two groups. The one group (four port group; n=153) is performed by conventional American style of laparoscopic cholecystectomy, which was used 4 ports, and the another group (two port group; n=7) is performed by 2 ports (12mm umbilical port and 5mm epigastric regional port) and two 2.4mm fine forceps (End Relief, Hope Denshi Corporation, Chiba, Japan) for the assistants gallbladder holding and the operators left-hand handling that is inserted into the abdominal cavity directly. Endo Relief has 5mm tip, however, by inserting in antidromic nature into the abdominal cavity from a 5 mm epigastric port, and deriving the shaft of a handle part out of the abdominal cavity in using a shaft guide, even if a tip is large, without using a port, it can insert into the abdominal cavity directly. Operation factors and complications were examined in both groups.

Result: In 2 port group, the time taken to create the fine forceps in a body in 2 port groups was an average of 4 minutes for three operators. Compared with other 2mm forceps, stiffness has been improved markedly and operator did not feel operation stress. Although total surgical wound length of 4 port group is 30mm, that of 2 port group is 21mm in theory, respectively. Moreover, since the wound of 5mm port part spread in a circle, real surgical wound length is more expanded. A significant difference was not observed in operation time and the amount of blood loss. Complications like bile leakage, bleeding, and surgical infection were not observed in 2 port group. Therefore, hospital stay didn’t show the significant difference in both groups. And actual 2 port laparoscopic cholecystectomy is shown in the video.

Conclusion: Laparoscopic cholecystectomy using the two 2.4mm fine forceps makes the minimum destruction of a body wall, and is excellent in postoperative esthetic outcome and pain control, and also eases the operator's surgical burden, compared with conventional style of laparoscopic cholecystectomy by using 4 port.