Page 6 - World Journal of Laparoscopic Surgery

Aswini Kumar Misro, Prakash Sapkota
a single port) by T Kagaya et al, 2 or 3 mm endograspers make this 2 port laparoscopic cholecystectomy an amaz-
by Lee KW, have been used to accomplish the procedure ing reality in one’s own surgical practice.
without the need of additional ports. However, traction
sutures on gallbladder may end up in tearing of the organ REfERENCES
leading to stone spillage and associated consequences like 1. Bordelon BM, Hobday KA, Hunter JG. Incision extension
abscess, fistula formation and other septic complications is the optimal method of difficult gallbladder extraction at
4-7
later on. This possibility further increases in patients laparoscopic cholecystectomy. Surg Endosc 1992 Sep-Oct;
6(5):225-227.
with high stone burden. So, we aim at gentle handling 2. Shimura T, Suehiro T, Suzuki H, Mochida Y, Okada K, Araki
of gallbladder and take preventive steps to avoid intra- K, Kuwano H. Laparoscopic cholecystectomy using a novel
operative spillage and hence do not use sutures for two-port technique for surgical residency training. Int Surg
8,9
traction. However, the present technique requires no 2009 Apr-Jun;94(2):149-153.
special instrument or complex technique. 3. Poon CM, Chan KW, Lee DWH, Chan KC, Ko CW, Cheung
Although, the present technique is safe, there are HY, Lee KW. Two-port vs four-port laparascopic cholecys-
some inherent limitations. This should not be used for tectomy: a prospective randomized controlled trial. Surg
Endosc 2003;17:1624-1627.
cases where technical difficulty is anticipated or encoun- 4. Hougård K, Bergenfeldt M, Ugeskr Laeger. Abdominal
tered for example in acute cholecystitis, empyema, fistula 7 years after laparoscopic cholecystectomy 2008 Sep
dense adhesions in Calot’s triangle, intrahepatic gall- 1;170(36):2803.
bladder, anatomic abnormality in the hepatobiliary system, 5. Arishi AR, Rabie ME, Khan MS, Sumaili H, Shaabi H,
Mirrizzi’s syndrome, cirrhosis of liver, etc. Drain inser- Michael NT, Shekhawat BS. Spilled gallstones: the source of
an enigma. JSLS 2008 Jul-Sep;12(3):321-325.
tion in the subcostal region nullifies all the purported 6. Bhati CS, Tamijmarane A, Bramhall SR. A tale of three spilled
advantages of the procedure. Hence, it is better to gall stones: one liver mass and two abscesses. Dig Surg 2006;
perform a feasibility assessment before attempting this 23(3):198-200.
two port technique and difficult cases should routinely 7. Patterson EJ, Nagy AG. Do not cry over spilled stones?
be done in four port fashion. If there is bleeding during Complications of gallstones spilled during laparoscopic
cholecystectomy: case report and literature review. Can J
the procedure, low threshold should be maintained to Surg 1997 Aug;40(4):300-304.
convert to the standard four port technique. Meticulous 8. Waqar SH, Shah SF, Khan IA, Ch TS, Abdullah MT, Malik
dissection and gentle handling of instruments are sine ZI, Zahid MA. Two-port laparoscopic cholecystectomy: a
qua non for safe and successful completion of the pro- new technique. J Ayub Med Coll Abbottabad 2008 Oct-Dec;
cedure. One should not expect the freedom of a 4 port 20(4):167-168.
9. Sathesh-Kumar T, Saklani A, Vinayagam R, Blackett R. Spilled
technique in this method. With careful case selection gall stones during laparoscopic cholecystectomy: a review of
coupled with precise technique and patience, one can the literature. Postgrad Med J 2004 Feb;80(940): 77-79.

106