Page 3 - Journal of Laparoscopic Surgery - WALS Journal

WJOLS
WJOL S

10.5005/jp-journals-10033-1259
Two-port Laparoscopic Cholecystectomy
ORIGINAL ARTICLE

Two-port Laparoscopic Cholecystectomy: An Initial

Experience of 25 Cases with a New Technique

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1 Aswini K Misro, Prakash Sapkota

1
ABSTRACT does not aggravate postoperative pain. Many of the
Background: In Nepal, it is quite common to find patients with 11 mm epigastric wounds land up in a dimension of
large stone burden and thick gallbladder wall which often leads 13 to 14 mm or more at times at the completion of the
to incision extension. We have used this extended incision to procedure. However, we have used this wound extension
our advantage. The present technique of two-port Laparoscopic to our advantage by introducing another 5 mm port
cholecystectomy not only helps overcoming the specimen
extraction difficulties but also contributes to better cosmesis. through the epigastric wound from the outset. This not
only obviates the need for any additional port insertion
Patients and methods: Total of 25 patients were underwent
the surgery in 2008 to 2010. but also aids in specimen extraction. This forms the
rationale behind two-port laparoscopic cholecystectomy.
Results: The mean operating time was 50 minutes. None had
significant procedural blood loss, iatrogenic injury, perforation With the technique described in this article, one will
of gallbladder, bile spillage, significant gas leak or subcutaneous be able to perform laparoscopic cholecystectomy with
emphysema at either port site. All patients were comfortable only two incisions leading to a more cosmetic scar and
in the postoperative period and were routinely discharged on less postoperative pain. The last decade has seen many
2nd postoperative day except for 2 patients who has surgical
site infection and fever respectively. Although 3 cases were innovations like single-incision laparoscopic surgery,
converted to standard four-port technique, none required natural orifice transluminal and endoscopic surgery from
conversion to open cholecystectomy. Out of 25 patients, 7 the health care industries driven by an ever-increasing
cases have completed 3 months follow up and did not show demand for cosmesis. However, the cost factor keeps
any complication like port site hernia.
them out of the reach of the common man in developing
Conclusion: The described method of performing 2 port countries. This technique certainly adds to cosmesis still
laparoscopic cholecystectomy is safe, simple and inexpensive
yet cosmetically rewarding. fitting to the budget of the common man.
Keywords: Cholecystectomy, Gallbladder, Laparoscopy, Port.
PATIENTS AND METHODS
How to cite this article: Misro AK, Sapkota P. Two-port
Laparoscopic Cholecystectomy: An Initial Experience of 25 A total of 25 patients underwent the operation in 2008
Cases with a New Technique. World J Lap Surg 2016;9(1):1-4. to 2010 after the hospital ethical committee approval.
Source of support: Nil Informed consent was obtained from all the patients.

Conflict of interest: None All the surgeries were performed by the same team of
surgeons. Every single patient had investigation-proven
BACKGROUND gallstone or related complications. Operative time, hos-
pital stay, and complications were recorded in each case.
In Nepal, it is quite common to find patients with large The patient characteristics are mentioned below.
stone burden and thick gallbladder wall, which often There were 10 male and 15 female patients and none of
leads to specimen extraction difficulties. Out of all the the patients had any abdominal surgery in the past. The
available methods to facilitate extraction like fascial mean age was 40.5 years (27–55 years). All the patients
dilatation, stone crushing, ultrasonic high-speed rotary, had body mass index below 30. A total of 14 patients
or laser lithotripsy, we prefer to use incision extension were American Society of Anesthesiologists (ASA) grade
since it has been described as the optimal method and I and 11 were ASA grade II (8 patients were controlled
hypertensives and 3 were controlled diabetics).

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1 Assistant Professor, Lecturer
Operative Technique
1,2 Department of Surgery, Lumbini Medical College and
Research Centre, Palpa, Nepal Peritoneal entry is done by open technique with insertion
Corresponding Author: Aswini K Misro, Assistant Professor of a 10 mm port through the umbilicus. After creating

Department ofSurgery, Lumbini Medical College and Research pneumoperitoneum, a 1 cm transverse skin incision is
Centre, Pravas, Tansen, Palpa, Nepal, Phone: 0097775691344 taken in the midline at a level 1 inch cephalad to the level
e-mail: draswini@gmail.com
of the inferior border of liver for the epigastric port. A
World Journal of Laparoscopic Surgery, January-April 2016;9(1):1-4 1