Page 3 - Journal of Laparoscopic Surgery

WJOLS
10.5005/jp-journals-10007-1129
ORIGINAL RESEARCH Scarless Cholecystectomy with Standard Laparoscopic Instruments in Selected Patients

Scarless Cholecystectomy with Standard

Laparoscopic Instruments in Selected Patients

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1
1 Ali Aminian, RK Mishra, Rasoul Mirsharifi
1 Department of General Surgery, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
2 Chairman and Director, World Laparoscopic Hospital Pvt Ltd, DLF Cyber City, Gurgaon, Haryana, India

ABSTRACT
Laparoscopic cholecystectomy is a gold standard for treatment of gallstone-related diseases. We have now modified this technique and
introduced scarless cholecystectomy with standard laparoscopic instruments. Patients with normal body mass index and with no
previous history of acute cholecystitis are suitable candidates for scarless cholecystectomy. Operation is performed through two
10 mm ports placed just above and below the umbilicus. Surgical exposure is created by applying two traction sutures, one placed in
fundus and another in infundibulum of gallbladder. The ends of these sutures are pulled out the abdomen by means of percutaneously
inserted suture passer. Applying different traction to these stitches, enable appropriate exposure of the Calot’s triangle and gallbladder
bed for dissection. We have concluded that scarless cholecystectomy is technically feasible and safe. Further validation of this
approach, however, awaits randomized clinical trials and accurate comparison with outcomes of more conventional approaches.
Keywords: Laparoscopic cholecystectomy, Minimally invasive, Scarless cholecystectomy, Two-port laparoscopic cholecystectomy,
Pain, Gallbladder.

INTRODUCTION sutures through the abdominal wall. Even cholangiography was
4,5
Laparoscopic cholecystectomy (LC) is a gold standard for performed in some cases. Piskun et al used the same concept
treatment of gallstone-related diseases. This procedure is of multiple trocars deployed through a single umbilical incision
usually performed with four-or three-ports of entry into the in 1999, but used two 5 mm ports. These authors also used
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abdomen around the world. Recent developments in LC have traction sutures to retract the gallbladder. Bresadola et al
been directed toward reducing the size or number of ports to compared similar technique with standard LC and showed lower
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achieve the goal of minimal invasive surgery. Less abdominal pain scores in the single-port group. Recently, Cuesta et al
wall trauma and subsequent postoperative pain and early describe a procedure that uses two transumbilical 5 mm ports
recovery are major goals in order to achieve better patient care and a 1 mm Kirschner wire instead of sutures for gallbladder
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and cost-effectiveness. Several studies demonstrated that less traction. Poon et al and Bucher et al published the result of
postoperative pain was associated with reduction in either size single transumbilical access LC using modified laparoscope
1,3
or number of ports. Poon et al published the result of first with extra working channel. Romanelli et al reported a single-
randomized clinical trial comparing two-port versus four-port port cholecystectomy using the TriPort and AirSeal port. 4,9
LC in 120 patients. They concluded that two-port LC resulted in Most of these single access procedures need special devices
fewer surgical scars, less individual port-site pain and similar and instruments. Several types of access devices, such as
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clinical outcomes compared with four-port LC. Additionally, TriPort (Advanced Surgical Concepts, Wicklow, Ireland), AirSeal
cosmetic issue is important for patients. In recent surveys, it (SurgiQuest, Orange, CT, USA), SILS port (Covidien, Inc,
has been shown that patients would largely favor NOTES Norwalk, CT, USA), different type of articulating instruments
(natural orifice translumenal endoscopic surgery) and modified telescope with operating channels have been
cholecystectomy compared with standard LC, unless the risks innovated for this purpose. Two other advances in recent years
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of NOTES cholecystectomy drastically exceeded those of in the field of less invasive cholecystectomy are NOTES
conventional LC. This shows the importance of cosmesis and cholecystectomy and needlescopic cholecystectomy. However,
should warrant surgeons to look for less invasive surgical the two important drawbacks with application of these
procedures. 2,3 instruments and innovations are the cost and need for learning
The first brief report about single incision LC was published of technically demanding procedures. 1,3
in 1997, when Navarra et al described a series of 30 cases Herein, we report our experience of scarless LC using a
performed with two 10 mm ports placed via a single umbilical simple technique with standard laparoscopic instruments. This
incision. The gallbladder was retracted using three traction represent a safety concern, as use of standard laparoscopic
instruments enables to conform to surgical principles of standard
cholecystectomy, which have been used for years. Surgeons
This article was presented at International College of Surgeons (ICS)
2009 Beijing Conference, China. are familiar with application of standard instruments. The use

World Journal of Laparoscopic Surgery, September-December 2011;4(3):129-131 129