Single-port endoscopic cholecystectomy: a bridge between laparoscopic and translumenal endoscopic surgery.
OBJECTIVE
The intentional puncture of the normal viscera is likely the most important issue limiting the widespread use of natural orifice translumenal endoscopic surgery (NOTES). We developed a new procedure for cholecystectomy using a flexible endoscope via a single port placed in the abdominal wall without visceral puncture (single-port endoscopic cholecystectomy; SPEC) as a bridge between laparoscopic surgery and NOTES. This study aimed to evaluate the technical feasibility of SPEC.


METHODS
Five pigs were subjected to SPEC. An endoscope was inserted through a 12-mm port placed in the right upper abdomen. After grasping and retracting the gallbladder using a 2-mm retractor that was directly introduced into the peritoneal cavity, gallbladder excision with ligation of the cystic artery and duct using endoclips was carried out.


RESULTS
A complete gallbladder excision was carried out easily and safely in all cases. No major adverse events occurred. The mean operating time was 67 min (range 52-84 min).


CONCLUSIONS
SPEC is a technically feasible procedure. It is simpler, easier, and safer than NOTES cholecystectomy. SPEC could be a less invasive alternative to the conventional four-port laparoscopic cholecystectomy.
Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan. abenbtg@kyorin-u.ac.jp
Nobutsugu
N
Abe
Hirohisa
H
Takeuchi
Hisayo
H
Ueki
Osamu
O
Yanagida
Tadahiko
T
Masaki
Toshiyuki
T
Mori
Masanori
M
Sugiyama
Yutaka
Y
Atomi
D034861:Abdominal Wall; D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D004195:Disease Models, Animal; D004724:Endoscopy / Q000379:methods*; D016145:Endoscopy, Digestive System / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000503:physiopathology; D011897:Random Allocation; D018570:Risk Assessment; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome