Page 23 - World Journal of Laparoscopic Surgery

WJOL S
WJOLS

10.5005/jp-journals-10033-1275
Modifications of Laparoscopic Cholecystectomy
RevieW ARticLe

Modifications of Laparoscopic Cholecystectomy

John Suresh Kumar TR

ABSTRACT How to cite this article: Kumar TRJS. Modifications of Lapa-
roscopic Cholecystectomy. World J Lap Surg 2016;9(2):71-74.
Aims: More than 30 different ways of performing laparoscopic
cholecystectomy (LC) are described in the literature. These were Source of support: Nil
developed by surgeons with the aim to improve postoperative Conflict of interest: None
and esthetic outcome following LC. The modifications included
reduction in port size and/or number than what is used in
standard LC. The aim of this literature review was to evaluate INTRODUCTION
the technical feasibility of the modifications of LC without
compromising safety and the benefits associated with these Professor Dr. Med Erich Muhe of Boblingen, Germany,
modifications in terms of safety, postoperative pain, cosmesis, performed the first laparoscopic cholecystectomy (LC) on
early recovery, and patient satisfaction.
September 12, 1985. Currently, it is the most commonly
Materials and methods: Literature review was performed performed laparoscopic procedure and the procedure
on articles describing different techniques of LC, variations in
port number and size, and their advantages over one another. of choice for gallbladder diseases. Apart from the
The search was made by using search engines like Google, standard technique of performing LC, several surgeons
PubMed, Springer link, and HighWire Press. have come up with their own versions of doing LC by
Observation: Reduction in number of ports and port size reducing the size and/or number of ports with the aim
especially in epigastric site gave advantages in terms of of improving cosmetic and postoperative outcomes. The
decreased postoperative pain score and esthesis. There was most recent modification of this procedure is the single-
an increase in the number of transumbilical single-site surgery site laparoscopic cholecystectomy (SSLC).
(TUSS) being performed in recent years with advantages like
decreased postoperative pain and increased patient acceptance
being documented in various studies. Hybrid technique of Standard Laparoscopic Cholecystectomy
using additional ports during single-site laparoscopic surgery (4 Ports Standard LC) (Fig. 1)
(SSLS) may be used as a bridge to single-site surgery while
the surgeon is in a learning curve from a multiport surgery to The four ports in standard LC are:
SSLS. Currently NOTES cholecystectomy is under evaluation 1. One 10 mm optical port through the umbilical area –
and not routinely performed. But current literature does not 10 mm 30° telescope is routinely used.
provide enough evidence of any clear benefit of any of these 2. 10 mm operating port on the epigastric area.
modifications over standard LC.
3. 5 mm operating port in right subcostal region in
Conclusion: This literature review showed that even though midclavicular line.
there are some advantages in postoperative pain score,
esthetic outcome, and patient acceptance while doing the 4. 5 mm assistant port in right subcostal anterior axillary
different types of LC in selected patients, there is no evidence line to retract the fundus.
of any clear benefit over conventional LC. It is not acceptable Operating ports and camera follows base-ball diamond
to compromise the vision and increase the risk of bile duct concept. With left hand Hartmann’s pouch is retracted
injury to the patient while doing LC. Hence, modified LC may be
performed by surgeons only after gaining enough experience
and in selected group of patients without violating the basic
principles of laparoscopic surgery.
Keywords: Laparoscopic cholecystectomy, Miniport laparo-
scopic cholecystectomy, NOTES, SILS, Single-site laparoscopic
surgery, Three-port laparoscopic cholecystectomy, Trans-
umbilical single-site surgery, Two-port cholecystectomy.

Assistant Professor
Department of Surgery, Dr. Somervell Memorial CSI Medical
College, Thiruvananthapuram, Kerala, India
Corresponding Author: John Suresh Kumar TR, Assistant
Professor, Department of Surgery, Dr. Somervell Memorial CSI
Medical College, Thiruvananthapuram, Kerala, India, Phone:
+919447582576, e-mail: drjohnsuresh@yahoo.com
Fig. 1: Ports in standard LC
World Journal of Laparoscopic Surgery, May-August 2016;9(2):71-74 71