Page 26 - World Journal of Laparoscopic Surgery
P. 26
John Suresh Kumar TR
Thus modified LC should be performed by surgeons
only after gaining enough experience and in selected
group of patients.
REFERENCES
1. Haribhakti SP, Mistry JH. Techniques of laparoscopic chol-
ecystectomy: nomenclature and selection. J Minim Access
Surg 2015 Apr-Jun;11(2):113-118.
2. Kumar M, Agrawal CS, Gupta RK. Three-port versus stand-
ard four-port laparoscopic cholecystectomy: a randomized
controlled clinical trial in a community-based teaching
hospital in eastern Nepal. JSLS 2007 Jul-Sep;11(3):358-362.
3. Gurusamy KS, Vaughan J, Ramamoorthy R, Fusai G,
Davidson BR. Miniports versus standard ports for laparo-
scopic cholecystectomy. Cochrane Database Syst Rev 2013
Aug 1;8:CD006804.
4. Al-Azawi D, Houssein N, Rayis AB, McMahon D, Hehir DJ.
Three-port versus four-port laparoscopic cholecystectomy in
acute and chronic cholecystitis. BMC Surg 2007 Jun 13;7:8.
5. Deveci U, Barbaros U, Kapakli MS, Manukyan MN, Simşek S,
Kebudi A, Mercan S. The comparison of single incision
laparoscopic cholecystectomy and three port laparoscopic
cholecystectomy: prospective randomized study. J Korean
Surg Soc 2013 Dec;85(6):275-282.
6. Novitsky YW, Kercher KW, Czerniach DR, Kaban GK,
Khera S, Gallagher-Dorval KA, Callery MP, Litwin DE,
Kelly JJ. Advantages of mini-laparoscopic vs conventional
laparoscopic cholecystectomy: results of a prospective
Fig. 5: First view of gall bladder randomized trial. Arch Surg 2005 Dec;140(12):1178-1183.
7. Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung HY,
very important that the standard established principles Lee KW. Two-port versus four-port laparoscopic cholecys-
of LC should not be violated. Compromising the vision tectomy. Surg Endosc 2003 Oct;17(10):1624-1627.
and increasing the risk of bile duct injury to the patient 8. Piskun G, Rajpal S. Transumbilical laparoscopic cholecystec-
with a presumable advantage of better esthetic outcome tomy utilizes no incisions outside the umbilicus. J Laparoen-
dosc Adv Surg Tech A 1999 Aug;9(4):361-364.
is not acceptable. 9. Pan MX, Jiang ZS, Cheng Y, Xu XP, Zhang Z, Qin JS, He GL,
The decision to perform a modified LC may be taken Xu TC, Zhou CJ, Liu HY, et al. Single-incision vs three-port
after placing the telescope through first trocar and evalu- laparoscopic cholecystectomy: prospective randomized
ating the liver and gallbladder, including the Calot’s area. study. World J Gastroenterol 2013 Jan 21;19(3):394-398.
The First View (Fig. 5) described by Dr. RK Mishra in his 10. Markar SR, Karthikesalingam A, Thrumurthy S, Muirhead L,
lectures may be helpful in deciding to perform modified Kinross J, Paraskeva P. Single-incision laparoscopic surgery
(SILS) vs Conventional multiport cholecystectomy: systematic
LC, i.e., once you enter into the abdomen look for: review and meta-analysis. Surg Endosc 2012 May;26(5):
• Inferior margin of the liver: If thin and wavy means 1205-1213.
no fatty infiltration and retraction will be easy. 11. Zorrón R, Filgueiras M, Maggioni LC, Pombo L, Lopes
• Fundus of GB: If projected beyond the inferior edge Carvalho G, Lacerda Oliveira A. NOTES. Transvaginal
of the liver, holding and pushing it toward the cholecystectomy: report of the first case. Surg Innov 2007
Dec;14(4):279-283.
diaphragm will be easy. In intrahepatic gallbladder 12. Phillips MS, Marks JM, Roberts K, Tacchino R, Onders R,
retraction will be difficult. DeNoto G, Rivas H, Islam A, Soper N, Gecelter G, et al.
• Distance between the anterior surface of liver and Intermediate results of a prospective randomized controlled
ribcage: If more than 6 cm, more space for retraction. trial of traditional four-port laparoscopic cholecystectomy
It is also important that during modified LC if versus single-incision laparoscopic cholecystectomy. Surg
Endosc 2012 May;26(5):1296-1303.
any difficulty is encountered, timely decision should 13. Gurusamy KS, Vaughan J, Rossi M, Davidson BR. Fewer-than-
be taken to add an additional trocar or convert to four ports versus four ports for laparoscopic cholecystectomy.
standard LC. Cochrane Database Syst Rev 2014 Feb 20;2.
74