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Single-incision laparoscopic cholecystectomy using flexible endoscopy: saline infiltration gallbladder fossa dissection technique

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Abstract

Background

The introduction of natural orifice translumenal endoscopic surgery has led to the development of new techniques to accomplish minimally invasive procedures using flexible endoscopic instruments. This study evaluated a technique used in endoscopic mucosal resection and applied it to dissection of the gallbladder from the liver bed.

Methods

Eight patients underwent an elective transumbilical single-incision cholecystectomy using a flexible endoscope at the authors’ institution from August 2007 to February 2008. An endoscopic injection needle was used to inject 20 ml of saline strategically into the gallbladder fossa. After infiltration, dissection of the gallbladder and hilum was performed with endoscopic instruments, whereas the cystic duct and artery were clipped using laparoscopic instruments.

Results

None of the eight patients had inadvertent perforation of the gallbladder during dissection. The technique of infiltrating the potential space between the gallbladder and the liver bed leads to a significantly improved visualization of the plane between them.

Conclusion

The injection of saline to develop surgical planes is an effective tool in performing a cholecystectomy using flexible endoscopic instrumentation. The enhancement of this potential space improved visualization in all patients. This technique has great potential value for dissections and requires further evaluation of its effectiveness in other applications.

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References

  1. Giday SA, Kantsevoy SV, Kalloo AN (2006) Principle and history of natural orifice translumenal endoscopic surgery (NOTES). Minim Invasive Ther 15:373–377

    Article  Google Scholar 

  2. Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of translumenal cholecystectomy in a human being. Arch Surg 142:823–827

    Article  PubMed  Google Scholar 

  3. Park PO, Bergstrom M, Ikeda K, Fritscher-Ravens, Swain P (2005) Experimental studies of transgastric gallbladder surgery: cholecystectomy and cholecystogastric anastomosis (videos). Gastrointest Endosc 61:601–606

    Article  PubMed  Google Scholar 

  4. Zorron R, Maggioni LC, Pombo L, Oliviera AL, Caravalho GL (2008) NOTES transvaginal cholecystectomy: preliminary clinical application. Surg Endosc 22:542–547

    Article  CAS  PubMed  Google Scholar 

  5. Bessler M, Stevens PD, Milone L, Parikh M, Fowler D (2007) Transvaginal laparoscopically assisted endoscopic cholecystectomy: a hybrid approach to natural orifice surgery. Gastrointest Endosc 66:1243–1245

    Article  PubMed  Google Scholar 

  6. Filho AJB, Noda RW, Kondo W, Kawahara N, Rangel M, Branco AW (2007) Initial experience with hybrid transvaginal cholecystectomy. Gastrointest Endosc 66:1245–1248

    Article  Google Scholar 

  7. Desai MM, Rao PR, Aron M, Pascal-Haber G, Desai MR, Mishra S, Kaouk JH, Gill IS (2008) Scarless single port transumbilical nephrectomy and pyeloplasty: first clinical report. Br J Urol Int 101:83–88

    Google Scholar 

  8. Raman JD, Bensalah K, Bagrodia A, Stern JM, Caddedu JA (2007) Laboratory and clinical development of single keyhole umbilical nephrectomy. Urology 70:1039–1042

    Article  PubMed  Google Scholar 

  9. Raman JD, Cadeddu JA, Rao P, Rane A (2008) Single-incision laparoscopic surgery: initial urological experience and comparison with natural orifice translumenal endoscopic surgery. Br J Urol Int 101:1493–1496

    Google Scholar 

  10. Bohnacker S, Soehendra N, Maguchi H, Chung JB, Howell DA (2006) Endoscopic resection of benign tumors of the papilla of Vater. Endoscopy 38:521–525

    Article  CAS  PubMed  Google Scholar 

  11. Iishi H, Tatsuta M, Iseki K, Narahara H, Uedo N, Sakai N, Ishikawa H, Otani T, Ishiguro S (2000) Endoscopic piecemeal resection with submucosal saline injection of large sessile colorectal polyps. Gastrointest Endosc 51:697–700

    Article  CAS  PubMed  Google Scholar 

  12. Imagawa A, Okada H, Kawahara Y, Takenaka R, Kato J, Kawamoto H, Fujiki S, Takata R, Yoshino T, Shiratori Y (2006) Endoscopic submucosal dissection for early gastric cancer: results and degrees of technical difficulty as well as success. Endoscopy 38:987–990

    Article  CAS  PubMed  Google Scholar 

  13. Neuhaus H, Costamagna G, Deviere J, Fockens P, Ponchon T, Rosch T (2006) Endoscopic submucosal dissection (ESD) of early neoplastic gastric lesions using a new double-channel endoscope (the “R-scope”). Endoscopy 38:1016–1023

    Article  CAS  PubMed  Google Scholar 

  14. Soetikno RM, Gotoda T, Naknishi Y, Soehendra N (2003) Endoscopic mucosal resection. Gastrointest Endosc 57:567–579

    Article  PubMed  Google Scholar 

  15. Caliskan K, Nursal TZ, Yildirmi S, Moray G, Torer N, Noyan T, Haberal MA (2006) Hydrodissection with adrenaline–lidocaine-saline solution in laparoscopic cholecystectomy. Langenbecks Arch Surg 391:359–363

    Article  CAS  PubMed  Google Scholar 

  16. Naude GP, Morris E, Bongard FS (1998) Laparoscopic cholecystectomy facilitated by hydrodissection. J Laparoendosc Adv Surg Tech 8:215–218

    Article  CAS  Google Scholar 

  17. Varadarajulu S, Tamhane A, Slaughter RL (2006) Evaluation of dextrose 50% as a medium for injection-assisted polypectomy. Endoscopy 38:907–912

    Article  CAS  PubMed  Google Scholar 

  18. Yamamoto H, Kawata H, Sunada K, Satoh K, Kaneko Y, Ido K, Sugano K (2002) Success rate of curative endoscopic mucosal resection with circumferential mucosal incision assisted by submucosal injection of sodium hyaluronate. Gastrointest Endosc 56:507–512

    Article  PubMed  Google Scholar 

  19. Memon MA, Deeik RK, Maffi TR, Fitzgibbons RJ (1999) The outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy. Surg Endosc 13:848–857

    Article  CAS  PubMed  Google Scholar 

  20. Tumer AR, Yuksek YN, Yasti AC, Gozalan U, Kama NA (2005) Dropped gallstones during laparoscopic cholecystectomy: the consequences. World J Surg 29:437–440

    Article  PubMed  Google Scholar 

  21. Navarra G, Pozza A, Occhionorelli S, Carcoforo P, Donini I (1997) One-wound laparoscopic cholecystectomy. Br J Surg 84:695

    Article  CAS  PubMed  Google Scholar 

  22. Piskun G, Rajpal S (1999) Transumbilical laparoscopic cholecystectomy utilizes no incisions outside the umbilicus. J Laparoendosc Adv Surg Tech 9:361–363

    Article  CAS  Google Scholar 

  23. Cuesta MA, Benrends F, Veenhof AAFA (2008) The “invisible cholecystectomy”: a transumbilical laparoscopic operation without a scar. Surg Endosc 22:1211–1213

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, St. Luke’s Roosevelt Hospital Center, 1000 10th Avenue, Suite 2B, New York, NY, 10019, USA

    John N. Afthinos, Glenn J. Forrester, Steven J. Binenbaum, E. John Harvey, Grace J. Kim & Julio A. Teixeira

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  1. John N. Afthinos
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  2. Glenn J. Forrester
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  3. Steven J. Binenbaum
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  4. E. John Harvey
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  5. Grace J. Kim
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  6. Julio A. Teixeira
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Correspondence to John N. Afthinos.

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Afthinos, J.N., Forrester, G.J., Binenbaum, S.J. et al. Single-incision laparoscopic cholecystectomy using flexible endoscopy: saline infiltration gallbladder fossa dissection technique. Surg Endosc 23, 2610–2614 (2009). https://doi.org/10.1007/s00464-009-0415-5

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  • DOI: https://doi.org/10.1007/s00464-009-0415-5

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