Virtually scarless laparoscopy for gastrointestinal and gynecologic procedures: a novel technique

Gabriel Garnica, MD, Juan F Molina-Lopez, MD, Isaac Baley, MD, Karla S Martin, MD, Luis C Valencia, Rafael Padilla, Fernando Quijano, Angel Martinez – Munive. The American British Cowdray Medical Center.

 Introduction:

We propose a laparoscopic approach which presumes better cosmetic results than single incision laparoscopic surgery (SILS) and the same results as conventional laparoscopic technique for four different gastrointestinal and gynecologic procedures.
Today, laparoscopy is the gold standard for different surgical scenarios including cholecystectomy, appendectomy, antireflux and different gynecologic procedures. Great efforts have been done in search of less invasive procedures, with aims of reducing morbidity and improving cosmetic results. This led to the development of techniques such as SILS and natural orifice transluminal endoscopic surgery (NOTES), but with considerable disadvantages: special equipment is required, increases in costs are significant and a need of a new learning curve is required.

Methods:
We performed a retrospective chart review of patients who underwent scarless laparoscopic (SL) cholecystectomies (SLC), appendectomies (SLA), oophorectomies (SLOP) and antireflux procedures (SLAP) between January 2008 and August 2013. Two laparoscopic surgeons performed all different procedures. Baseline characteristics of groups are presented as mean and standard deviation or median and ranges according to data distribution.

Technique: The abdomen is accessed through an open technique, a 30º 10-mm scope is inserted through a 11mm trocar at the umbilicus, two 5-mm trocars are placed in the right and left suprapubic region, just medial to the lateral umbilical ligaments, one 3-mm trocar is placed as needed according to the requirement of each procedure. Only the SLAP obligates for an extra 10 mm left upper quadrant. Longer, 45cm bariatric instruments are used. For vascular or thermal dissection a 3mm pulsated bipolar coagulator (Gyrus ACMI, Olympus Corporation) is required. The extraction of gallbladder/apendix is done by a retrieval endoscopic bag through the umbilical port. Only the 10mm port aponeurosis needs to be closed.

Results:
154 patients underwent SL, the most common operation was cholecystectomy (n = 85), followed by appendectomy (n=40), oophorectomy (n = 21) and antireflux procedure (n = 8). Demographic and surgical data is presented in table 1. There was no mortality or readmission.

 
Conclusion:

We present a novel technique that requires no special equipment, it is viable using traditional laparoscopic instruments, no additional training for surgeons is necessary and results are comparable with those reported in published data, but with better cosmetic results.

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