Needlescopic cholecystectomy: prospective study of 150 patients.
OBJECTIVE
To evaluate the feasibility and safety of cholecystectomy using miniaturised instruments of 3 mm or less in diameter.


METHODS
Prospective study on patients with gallstones, with or without related complications.


METHODS
Private hospital, Hong Kong.


METHODS
From September 1997 to September 2002, 150 of the 180 consecutive patients managed were included in the present study.


METHODS
All patients were operated on with a standard four-port technique. Mini-laparoscopes of different sizes were used throughout the study period, which included 2-mm (n=33) fibre-optic laparoscope, and 2.5-mm (n=61) and 3-mm (n=56) laparoscopes of Hopkins rod lens system. The cystic duct and artery were secured either by extracorporeal ties or 10-mm clips passed through the umbilicus. The time taken from dissection to division of the cystic duct and artery, and to complete the operation were documented.


RESULTS
The operation was successfully completed with needlescopic instruments in 127 (85%) patients, even though patients with acute cholecystitis and history of common bile duct stones were included. Use of larger-diameter mini-laparoscopes decreased the time needed to divide the cystic duct and artery, to detach the gall bladder from the liver, and to complete the operation. There were no deaths. One minor bile duct injury developed secondary to extensive cauterisation of the gall bladder fossa.


CONCLUSIONS
Needlescopic cholecystectomy with minor technical modification can be completed within a duration comparable to standard laparoscopy at no increased risk for the great majority of patients with gallstones.
Lai
E C S
EC
Pedder Medical Partners, M/F Pedder Building, 12 Pedder Street, Central, Hong Kong. ecslai@hku.hk
Fok
M
M
Chan
A S H
AS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods; D002769:Cholelithiasis / Q000601:surgery; D005260:Female; D005336:Fiber Optic Technology / Q000295:instrumentation; D006723:Hong Kong; D006769:Hospitals, General; D006801:Humans; D020706:Laparoscopes; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D009339:Needles; D011446:Prospective Studies; D013997:Time Factors