title: Gasless laparoendoscopic single-site surgery with abdominal wall lift in general surgery: initial experience.
abstract: BACKGROUND
  Laparoendoscopic single-site surgery (LESS) was motivated by the desire to make minimally invasive surgery even more "minimal." We performed gasless laparoendoscopic single-site surgery (GLESS) with abdominal wall lift (AWL) for cholecystectomy and fenestration of liver cyst. This study aims to assess the safety and feasibility of the techniques.
  
  
  METHODS
  From June to December 2009, 18 cases of gasless laparoendoscopic single-site cholecystectomy (GLESC) and 4 cases of fenestration of liver cyst (GLESF) were performed in Qilu Hospital of Shandong University, Shandong, China. Subcutaneous abdominal wall lifting system, LAP protector, flexible laparoscopes, and bent and articulating instruments were used during the procedures. Clinical data regarding patient demographics, operating time, blood loss, complications, and postoperative hospital stay were collected and analyzed retrospectively in the study.
  
  
  RESULTS
  17 cases of GLESC and 4 cases of GLESF were performed successfully, and 1 case of GLESC was converted to laparoendoscopic single-site cholecystectomy using AWL combined with low-pressure pneumoperitoneum. Mean body mass index was 23.7 ± 3.1 kg/m(2) for GLESC and 22.9 ± 1.5 kg/m(2) for GLESF. Mean operating time was 64 ± 17 min for GLESC and 101 ± 10 min for GLESF. Mean blood loss was 8 ± 3 ml for GLESC and 24 ± 11 ml for GLESF. Despite minor wound complication, no postoperative complications were observed during mean follow-up of 118 and 95 days for GLESC and GLESF, respectively.
  
  
  CONCLUSIONS
  GLESS with AWL is safe and feasible for cholecystectomy and fenestration of liver cyst. The techniques provide satisfactory operative field exposure and an easier access method for LESS. Instrument collisions are greatly ameliorated both extra- and intracorporeally through use of flexible laparoscopes and bent and articulating instruments. This may prove to be a better approach for LESS techniques.
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, People's Republic of China.
authors.forename: Guangyong
authors.initials: G
authors.lastname: Zhang
authors.forename: Shaozhuang
authors.initials: S
authors.lastname: Liu
authors.forename: Wenbin
authors.initials: W
authors.lastname: Yu
authors.forename: Lei
authors.initials: L
authors.lastname: Wang
authors.forename: Nan
authors.initials: N
authors.lastname: Liu
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Sanyuan
authors.initials: S
authors.lastname: Hu
mesh_terms: D034861:Abdominal Wall; D000328:Adult; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D002769:Cholelithiasis / Q000601:surgery; D003560:Cysts / Q000601:surgery; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000601:surgery; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011127:Polyps / Q000601:surgery; D013523:Surgical Equipment; D016896:Treatment Outcome