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Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study

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Abstract

Background

The umbilicus can be considered as the embryological opening for single-access laparoscopic procedures. We report on single-access transumbilical laparoscopic appendectomy (SATLA) and cholecystectomy (SATLC), performed using new curved reusable instruments.

Patients and methods

A retrospective review of a prospectively maintained database of 30 patients who underwent SATLA and 20 patients who underwent SATLC between May and November 2009 was undertaken. All procedures were performed with an 11-mm nondisposable trocar for the scope, and curved reusable instruments (Karl Storz—Endoskope, Tuttlingen, Germany) placed transumbilically without trocars. Outcome measures were conversion to standard laparoscopy, operative time, scar length, complications, hospital stay, and use of pain medication.

Results

All SATLA patients had acute appendicitis, and SATLC patients had symptomatic gallstones (15), chronic cholecystitis (3), and acute cholecystitis (2). No extraumbilical trocars were necessary. Mean total operative times were 57.3 ± 15.9 min (SATLA) and 73.9 ± 20.1 min (SATLC). Mean laparoscopic times were 39 ± 13.1 min (SATLA) and 57.5 ± 18.9 min (SATLC). Mean scar lengths were 14.8 ± 2.2 mm (SATLA) and 15.8 ± 2.3 mm (SATLC). Five SATLA patients and one SATLC patient developed postoperative complications. Mean hospital stay was 2.9 ± 1.3 days for SATLA patients and 1.8 ± 0.8 days for SATLC patients. Pain medication used was minimal. At the minimum follow-up of 3 months no late complications were registered.

Conclusions

SATLA and SATLC can be performed safely using curved reusable instruments, which helps avoid the conflict between the surgeon’s hands or between the instruments’ tips and allows the surgeon to operate in an ergonomic position. The reusable instruments kept the cost similar to that of classic laparoscopy.

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Disclosures

Giovanni Dapri is a consultant for Karl Storz—Endoskope (Tuttlingen, Germany). Lorenzo Casali, Hélène Dumont, Laurens Van der Goot, Leila Herrandou, Els Pastijn, Maurice Sosnowski, Jacques Himpens, and Guy-Bernard Cadière have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, 322, Rue Haute, 1000, Brussels, Belgium

    Giovanni Dapri, Lorenzo Casali, Jacques Himpens & Guy-Bernard Cadière

  2. Department of Anesthesiology, Saint-Pierre University Hospital, Brussels, Belgium

    Hélène Dumont, Laurens Van der Goot, Leila Herrandou, Els Pastijn & Maurice Sosnowski

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  1. Giovanni Dapri
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  2. Lorenzo Casali
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Correspondence to Giovanni Dapri.

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Dapri, G., Casali, L., Dumont, H. et al. Single-access transumbilical laparoscopic appendectomy and cholecystectomy using new curved reusable instruments: a pilot feasibility study. Surg Endosc 25, 1325–1332 (2011). https://doi.org/10.1007/s00464-010-1304-7

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