Page 12 - Journal of Laparoscopic Surgery

WJOLS

Aswini Misro A 10.5005/jp-journals-10033-1337
ORIGINAL RESEARCH

Two Port Laparoscopic Cholecystectomy—An Initial

Experience of 25 Cases with a New Technique

Aswini Misra A

1
ABSTRACT pain. Many of the 11 mm epigastric wounds land up
Background: In Nepal, it is quite common to find patients with in a dimension of 13 to 14 mm or more at times at the
large stone burden and thick gallbladderwall which often leads completion of the procedure. However, we have used
to incision extension. We have used this extended incision to this wound extension to our advantage by introduc-
our advantage.The present technique of 2 port Laparoscopic ing another 5 mm port through the epigastric wound
cholecystectomy not only helps overcoming thespecimen
extraction difficulties but also contributes to better cosmesis. from the outset. This not only obviates the need for
any additional port insertion but also aids in speci-
Patients and methods: Total of 25 patients were underwent men extraction. This forms the rationale behind two
the surgery in 2008–2010.
port laparoscopic cholecystectomy. With the technique
Results: The mean operating time was 50 minutes. None had described in this article, one will be able to perform
significant procedural blood loss, iatrogenic injury, perforation of
gallbladder, bile spillage, significant gas leak or subcutaneous- laparoscopic cholecystectomy with only two incisions
emphysema at either port site. All patients were comfortable leading to a more cosmetic scar and less postopera-
in the postoperative period and were routinely discharged on tive pain. Last decade has seen many innovations like
2nd postoperative day except for 2 patients who has surgical squamous intraepithelial lesion (SILs), NOTES from
site infection and fever respectively. Although 3 cases were
converted to standard 4 port technique, none required conver- healthcare industries driven by an ever-increasing
sion to open cholecystectomy. Out of 25 patients, 7 cases have demand for cosmesis. However, the cost factor keeps
completed 3 months follow up and did not show any complica- them out of the reach of a common man in developing
tion like port site hernia. countries. This technique certainly adds to cosmesis
Conclusion: The described method of performing 2 port lapa- still fitting to the budget of a common man.
roscopic cholecystectomy is safe,simple and inexpensive yet
cosmetically rewarding.
PATIENTS AND METHODS
Keywords: Cholecystectomy, Laparoscopic.
Twenty-five patients underwent the operation from 2008
How to cite this article: Misra AA. Two Port Laparoscopic to 2010 after the hospital ethical committee approval.
Cholecystectomy—An Initial Experience of 25 Cases with a
New Technique. World J Lap Surg 2018;11(2):64-67. Informed consent was obtained from all the patients.
The same team of surgeons performed all the surgeries.
Source of support: Nil
Every single patient had investigation proven gallstone
Conflict of interest: None or related complications. Operative time, hospital stay
and complications were recorded in each case.
BACKGROUND The patient characteristics are mentioned below. There
In Nepal, it is quite common to find patients with a were 10 male and 15 female patients, and none of the
large stone burden and thick gallbladder wall which patients had any abdominal surgery in the past. The mean
often leads to specimen extraction difficulties. Out of age was 40.5 years (range 27–55 years). All the patients
all the available methods to facilitate the extraction had body mass index (BMI) below 30. Total fourteen
like fascial dilatation, stone crushing, high-speed patients were anesthetic risk assessment (ASA) I and II
ultrasonic rotary, or laser lithotripsy, we prefer to use were ASA II (8 patients were controlled hypertensives
incision extension since it has been described as the and 3 were controlled diabetics).
optimal method and does not aggravate postoperative
Operative Technique
The open technique does a peritoneal entry with the
General Surgeon
insertion of a 10 mm port through the umbilicus. After
Department of Surgery, National Health Service, London, UK creating pneumoperitoneum, a 1-centimeter transverse

Corresponding Author: Aswini Misra, General Surgeon, skin incision is taken in the midline at a level 1 inch
Department of Surgery, National Health Service, London, UK, cephalad to the level of the inferior border of liver for
e-mail: draswini@gmail.com
the epigastric port. A 10 mm port is inserted through the
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