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                                  Two Port Laparoscopic Cholecystectomy—An Initial Experience of 25 Cases with a New Technique
          need of additional ports. However, traction sutures on  REFERENCES
          gallbladder may end up in tearing of the organ leading     1.  Bordelon BM, Hobday KA, Hunter JG. Incision extension
          to stone spillage and associated consequences like an   is the optimal method of difficult gallbladder extraction at
          abscess, fistula formation and other septic complications   laparoscopic cholecystectomy. Surg Endosc. 1992 Sep-Oct;
                 4-7
          later on.  This possibility further increases in patients   6(5):225-227.
          with a high stone burden. So, we aim at the gentle han-    2.  Shimura T, Suehiro T, Suzuki H, Mochida Y, Okada K, Araki
          dling of the gallbladder and take preventive steps to avoid   K, Kuwano H. Laparoscopic cholecystectomy using a novel
          intra-operative spillage and hence do not use sutures for   two-port technique for surgical residency training. Int Surg.
                                                                  2009 Apr-Jun;94(2):149-153.
                 8,9
          traction.  However, the present technique requires no     3.  Poon CM, Chan KW, Lee DW, Chan KC, Ko CW, Cheung
          special instrument or complex technique.                HY, et al. Two-port versus four-port laparoscopic chole-
             Although the present technique is safe, there are some   cystectomy. Surgical Endoscopy and Other Interventional
          inherent limitations. This should not be used for cases   Techniques. 2003 Oct 1;17(10):1624-1627.
          where technical difficulty is anticipated or encountered     4.  Hougård K, Bergenfeldt M. Abdominal fistula 7 years after
          for example in acute cholecystitis, empyema, dense      laparoscopic cholecystectomy. Ugeskrift for laeger. 2008
                                                                  Sep;170(36):2803.
          adhesions in Calot’s triangle, intrahepatic gallbladder,     5.  Arishi AR, Rabie ME, Khan MS, Sumaili H, Shaabi H, Michael
          anatomic abnormality in the hepato-biliary system, Mir-  NT, et al. Spilled gallstones: the source of an enigma. JSLS:
          rizzi’s syndrome, cirrhosis of the liver, etc. Drain inser-  Journal of the Society of Laparoendoscopic Surgeons. 2008
          tion in the subcostal region nullifies all the purported   Jul;12(3):321-325.
          advantages of the procedure. Hence, it is better to perform     6.  Bhati CS, Tamijmarane A, Bramhall SR. A tale of three spilled
          a feasibility assessment before attempting this two port   gall stones: one liver mass and two abscesses. Dig Surg.
                                                                  2006;23(3):198-200.
          technique, and difficult cases should routinely be done in     7.  Patterson EJ, Nagy AG. Don’t cry over spilled stones? Com-
          four port fashion. If there is bleeding during the proce-  plications of gallstones spilled during laparoscopic cholecys-
          dure, a low threshold should be maintained to convert to   tectomy: case report and literature review. Can J Surg. 1997
          the standard four-port technique. Meticulous dissection   Aug;40(4):300-304.
          and gentle handling of instruments are a sine qua non     8.  Waqar SH, Shah SF, Khan IA, Ch TS, Abdullah MT, Malik
          for safe and successful completion of the procedure. One   ZI, et al. Two-port laparoscopic cholecystectomy–a new tech-
          should not expect the freedom of a four-port technique   nique. J Ayub Med Coll Abbottabad. 2008 Oct- Dec;20(4):167-
                                                                  168.
          in this method. With careful case selection coupled with     9.  Sathesh-Kumar T, Saklani AP, Vinayagam R, Blackett RL.
          precise technique and patience, one can make this two-  Spilled gall stones during laparoscopic cholecystectomy: a
          port laparoscopic cholecystectomy an amazing reality in   review of the literature. Postgraduate medical journal. 2004
          one’s surgical practice.                                Feb 1;80(940):77-79.





































          World Journal of Laparoscopic Surgery, May-August 2018;11(2):64-67                                67
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