Abstract
Introduction
NOTES cholecystectomy, may eliminate complications related to abdominal incisions. However, the nonmandatory gastrotomy and its safe closure is the main controversy accompanying this approach. Transvaginal access has minimal closure consequences but the safety of inserting extralong instruments between the intestines and having the angle of approach from below rather than from above is questionable. We conducted a study for performing cholecystectomy using a single laparoscopic trocar.
Methods
The single-trocar cholecystectomy technique was developed on five porcine animal models weighing 35–40 kg each. A 15-mm trocar was used, inserted transumbilicaly. Retraction of the gallbladder was achieved using an endoloop and transabdominal anchoring. Hartman’s pouch was manipulated with an endoscopic grasper, which was passed through the working channel of the endoscope, while dissection of the triangle of Callot was performed using articulating laparoscopic instruments.
Results
Single-trocar cholecystectomy was successfully performed in four of five porcine models. Average surgery time was 90 min (35–180 min). The technique was modified and improved throughout the study. No intraoperative complications occurred.
Conclusions
Single-trocar cholecystectomy is feasible and offers safe approach to this procedure. We assume that a single incision at the umbilicus generates minimal somatic pain, and achieves excellent cosmetic results. The translation of this technique to human subjects seems straightforward and raises the question of whether NOTES is the preferred technique for cholecystectomy.
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Abbreviations
- LC:
-
Laparoscopic cholecystectomy
- NOTES:
-
Natural orifice translumenal endoscopic surgery
References
Legorreta AP et al (1993) Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA 270:1429–1432
Lam CM, Murray FE, Cuschieri A (1996) Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland. Gut 38:282–284
Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP (1994) Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Engl J Med 330:403–408
Slim K, Pezet D, Stencl J Jr et al (1995) Laparoscopic cholecystectomy: an original three-trocar technique. World J Surg 19:394–397
Kagaya T (2001) Laparoscopic cholecystectomy via two ports, using the “Twin-Port” system. J Hepatobiliary Pancreat Surg 8:76–80
Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8:171–179
Flora ED, Wilson TG, Martin IJ, O’Rourke NA, Maddern GJ (2008) A review of natural orifice translumenal endoscopic surgery (NOTES) for intra-abdominal surgery: experimental models, techniques, and applicability to the clinical setting. Ann Surg 247:583–602
Rolanda C, Lima E, Pego JM et al (2007) Third-generation cholecystectomy by natural orifices: transgastric and transvesical combined approach. Gastrointest Endosc 65:111–117
Marescaux J, Dallemagne B, Perretta S, Wattiez A, Mutter D, Coumaros D (2007) Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 142:823–826
Zhu JF, Hu H, Ma YZ, Xu MZ, Li F (2008) Transumbilical endoscopic surgery: a preliminary clinical report. Surg Endosc [Epub ahead of print]
Rané A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-Port). Urology 72:260–264
Mintz Y, Horgan S, Savu MK, Cullen J, Chock A, Ramamoorthy S, Easter DW, Talamini MA (2008) Hybrid natural orifice translumenal surgery (NOTES) sleeve gastrectomy: a feasibility study using an animal model. Surg Endosc 22:1798–1802
Acknowledgement
This study was funded by Ethicon Endosurgery, Cincinnatti, OH, USA.
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Elazary, R., Khalaileh, A., Zamir, G. et al. Single-trocar cholecystectomy using a flexible endoscope and articulating laparoscopic instruments: a bridge to NOTES or the final form?. Surg Endosc 23, 969–972 (2009). https://doi.org/10.1007/s00464-008-0289-y
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DOI: https://doi.org/10.1007/s00464-008-0289-y