H. Bonatti1, N. Kubicki2, S. Kavic2 1Shore Regional,Surgical Care,Easton, MD, USA 2Medical Center,General Surgery,Baltimore, MD, USA
Introduction: The majority of surgeons use four ports for laparoscopic cholecystectomy (LC). We propose a three port technique with access from the left upper quadrant (LUQ).
Methods: Ninety-one LCs performed from 6/2013 – 12/2016, were analyzed. Trocars are placed in the LUQ (5mm), umbilicus (5 or 10-12mm), and between the two (5mm). The third troacar was replaced by a Teleflex minigrasper in 29 cases. After the gallbladder (GB) serosa is incised on both sides, a window is created behind the GB midportion and widened towards fundus and infundibulum. Cystic artery and duct are dissected out obtaining the critical view and after the last fundus adhesion is cut, they are secured with clips or endoloop.
Results: Median age of 60 women and 31 men was 57.2 (range 16.5-89.6 ) years. LC was done for acute cholecystitis (n=12), chronic cholecystitis (n=70), other (n=9). In 79 cases (87%), the procedure could be completed with three instruments, in five cases an additional instrument was inserted for second procedures (paraesophageal hernia repair, cystgastrostomy, appendectomy, extensive lysis of adhesions (n=2)). In seven cases an additional 5mm port was placed for GB retraction; a Keith needle was used for GB suspension in four patients. Ten cases were done with two five mm ports and a minigrasper and in 53 cases the modified dome down technique was completed (remaining cases were done in traditional dome down technique). There were no vascular or bile duct injuries in this series. 39% of cases were done as outpatient procedures, 35% of patients required 23hours observation and 26% were hospitalized.
Conclusion: Three instrument modified dome down technique with trocar placement in LUQ is feasible and safe in easy and difficult cases.