Single-incision laparoscopic cholecystectomy using flexible endoscopy: saline infiltration gallbladder fossa dissection technique.
BACKGROUND
The introduction of natural orifice translumenal endoscopic surgery has led to the development of new techniques to accomplish minimally invasive procedures using flexible endoscopic instruments. This study evaluated a technique used in endoscopic mucosal resection and applied it to dissection of the gallbladder from the liver bed.


METHODS
Eight patients underwent an elective transumbilical single-incision cholecystectomy using a flexible endoscope at the authors' institution from August 2007 to February 2008. An endoscopic injection needle was used to inject 20 ml of saline strategically into the gallbladder fossa. After infiltration, dissection of the gallbladder and hilum was performed with endoscopic instruments, whereas the cystic duct and artery were clipped using laparoscopic instruments.


RESULTS
None of the eight patients had inadvertent perforation of the gallbladder during dissection. The technique of infiltrating the potential space between the gallbladder and the liver bed leads to a significantly improved visualization of the plane between them.


CONCLUSIONS
The injection of saline to develop surgical planes is an effective tool in performing a cholecystectomy using flexible endoscopic instrumentation. The enhancement of this potential space improved visualization in all patients. This technique has great potential value for dissections and requires further evaluation of its effectiveness in other applications.
Afthinos
John N
JN
Department of Surgery, St. Luke's Roosevelt Hospital Center, 1000 10th Avenue, Suite 2B, New York, NY 10019, USA. Afthinos@gmail.com
Forrester
Glenn J
GJ
Binenbaum
Steven J
SJ
Harvey
E John
EJ
Kim
Grace J
GJ
Teixeira
Julio A
JA
D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D004210:Dissection / Q000379:methods; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015552:Injections, Intralesional; D020706:Laparoscopes; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000517:prevention & control; D018570:Risk Assessment; D012965:Sodium Chloride / Q000494:pharmacology*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014472:Umbilicus / Q000601:surgery; D055815:Young Adult
D012965:Sodium Chloride