Feasibility of laparoscopic cholecystectomy with miniaturized instrumentation in 50 consecutive cases.
A new technique utilizing miniaturized (2 mm) instrumentation to perform laparoscopic cholecystectomy (LC) is introduced. The safety and efficacy of this mini-LC were assessed. Fifty consecutive mini-LCs were performed using one 10-mm port and three 2-mm ports (cumulative port size 16 mm). A 2-mm fiberoptic video-laparoscope was placed in the mid-epigastrium through a 2-mm port. A 10-mm umbilical port was then placed under direct visualization, allowing access for standard laparoscopic instruments. Two additional 2-mm ports were placed in the right upper quadrant allowing insertion of grasping instruments. Parameters reviewed included total operative time (OT), postoperative length of stay (LOS), anatomic pathology, complications, and rate of conversion to conventional LC and open cholecystectomy. Results were compared to those of 50 consecutive conventional LCs using two 10-mm and two 5-mm ports (cumulative port size 30 mm). The OT for the mini-LC and conventional LC were 88 +/- 5.9 and 78 +/- 5 minutes (mean +/- SD), respectively, (p = NS), and postoperative LOS for the mini-LC and conventional LC were 1.5 +/- 0. 2 and 1.8 +/- 0.4 days (mean +/- SD), respectively, (p = NS). Of the 50 mini-LC cases, 5 required conversion to conventional LC. One cystic duct leak was detected and successfully treated conservatively; no common bile duct injuries occurred; and no patients required conversion to open cholecystectomy. This study demonstrates the safety and efficacy of minilaparoscopic instruments for the performance of cholecystectomy. The data reveal that this new technique is comparable to conventional LC.
Reardon
P R
PR
Department of Surgery, Baylor College of Medicine, 6550 Fannin, Smith Tower, Suite 2435, Houston, Texas 77030, USA.
Kamelgard
J I
JI
Applebaum
B
B
Rossman
L
L
Brunicardi
F C
FC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery; D002769:Cholelithiasis / Q000473:pathology / Q000601:surgery; D003135:Common Bile Duct / Q000293:injuries; D003549:Cystic Duct / Q000601:surgery; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D012449:Safety; D013997:Time Factors; D014743:Videotape Recording / Q000295:instrumentation