Single-access transumbilical laparoscopic nissen fundoplication performed with new curved reusable instruments.
BACKGROUND
The authors report a single-access laparoscopic Nissen fundoplication (SALN) performed with new curved reusable instruments.


METHODS
A 21-year-old woman sought care for symptomatic grade B esophagitis and hiatal hernia. A reusable 11-mm trocar was inserted in the umbilicus and a 10-mm, 30° angled, nonflexible, standard length scope was used. Curved reusable instruments (Karl Storz-Endoskope) were transumbilically introduced without trocars. The left hepatic lobe was retracted thanks to the distal curve of the grasper. The cruraplasty and wrap were performed using curved needle holder and intracorporeal sutures.


RESULTS
No extraumbilical trocar was necessary. Laparoscopic time was 108 minutes, and umbilical scar length was 16 mm. Discharge was allowed after 48 hours.


CONCLUSIONS
SALN is feasible to be performed with curved reusable instruments, which avoid the conflict between the instruments' tips inside the abdomen or between the surgeon's hands outside. Cost of the procedure remains similar to standard laparoscopy because only reusable material is used.
Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Saint-Pierre University Hospital, Brussels, Belgium. giovanni@dapri.net.
Giovanni
G
Dapri
Jean
J
Bruyns
Jacques
J
Himpens
Guy Bernard
GB
Cadière
D004867:Equipment Design; D005260:Female; D018662:Fundoplication / Q000295:instrumentation*; D006551:Hernia, Hiatal / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation*; D055815:Young Adult