Transumbilical Single-Access Laparoscopic Toupet Fundoplication

Giovanni Dapri, MD, FACS, FASMBS, HonFPALES, Sergio Carandina, MD, Perrine Mathonet, MD, Jacques Himpens, MD, Guy-Bernard Cadière, MD, PhD

Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium

Background: Different procedures have been reported to be feasible and safe through single-access laparoscopy (SAL). The authors report a transumbilical SAL Toupet fundoplication.

Video: A young lady sought care for gastroesophageal reflux disease associated to grade B esophagitis, hiatal hernia and esophageal dyskinesia. The SAL procedure was performed by the opening of the umbilicus through the Hasson technique. An 11-mm reusable trocar was inserted for a 10-mm, 30° angled, non flexible, and standard length scope. Curved reusable instruments were introduced through the same scar without trocars. The gastroesophageal junction was exposed thanks to the insertion of a millimetrical wire (2mm) under the xiphoid access. Crura repair and fundoplication were realized by intracorporeal knots, using curved needle-holder. The umbilicus was finally closed in layers.

Results: No extraumbilical trocar was necessary, and no peroperative complications were registered. Operative time was 172 minutes and final umbilical scar 15 mm. The postoperative pain was kept minimal, and the patient was allowed to be discharged on the 3rd postoperative day, after a satisfied gastrograffin swallow.

Conclusions: Transumbilical SAL Toupet fundoplication is feasible. Use of curved and reusable instruments permits to avoid the conflict between the instruments tips intracorporeally or between the surgeons’ hands externally. Thanks to this technique the cost of SAL is similar to multitrocar laparoscopy.

Session: Video Channel Day 1

Program Number: V043

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