LESS Cholecystectomy Using Conventional Instruments Combined with the Clip-Less Technique

[摘要] Background: Laparo-endoscopic single site cholecystectomy (LESS) has gained popularity as a cosmetically better procedure than conventional laparoscopic cholecystectomy. We hereby report our initial experience of 52 cases of LESS cholecystectomy. Materials and Methods: We used a 15-20 mm incision at umbilicus, 2 ports and conventional laparoscopic instruments with occasional use of additional ports (3 mm) and the puppeteer technique for gall bladder retraction using stay sutures. Harmonic scalpel was used for dissecting and dividing the cystic duct (clipless technique) in most of cases (n=42), exceptions being the initial few cases and wider cystic ducts. We were able to achieve Strasburg’s critical view of safety in all the cases. Results: Out of 52 cases, 18 were of acute cholecystitis and the rest were elective cholecystectomies. Complications (tearing of stay sutures, hemorrhage) in our series were managed comfortably and none of the cases needed conversion to conventional laparoscopic cholecystectomy. The mean operating time was 60 minutes for the initial ten cases whereas it was as short as 12 minutes, in an elective cholecystectomy. Average blood loss was 16.5 ml. Post-operative umbilical seroma was noted in initial 5 cases. The patients were followed up for a period of six months and none of them developed port site hernia. Conclusion: In our experience, LESS cholecystectomy using harmonic scalpel is feasible and advantageous in certain aspects. Though loss of triangulation and clashing of instruments are unavoidable, in the hands of a trained laparoscopic surgeon, the learning curve is quite short and results are promising.

[学科分类] 生理学

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