Transumbilical multiple-port laparoscopic cholecystectomy using standard laparoscopic instruments.
BACKGROUND
As a complement to standard laparoscopy, single incision laparoscopic cholecystectomy (SILS) is gaining popularity. We report our technique and our initial experience with transumbilical multi-port laparoscopic cholecystectomy (TUMP-LC) without an access device, with standard laparoscopic instruments, and report the clinical outcomes.


METHODS
Twenty-five (23 F: 2 M) consecutive patients with symptomatic cholelithiasis were included. The surgical outcomes such as length of stay, complications and perioperative morbidity were analyzed. For evaluation of surgical stress preoperative and postoperative C-reactive protein (CRP) values at 6 h and 24 h were measured. Postoperative pain was evaluated using a standard 10-point visual analogue scale (VAS).


RESULTS
The mean duration of the surgery was 44.56 minutes (range, 18-110). Additional trocars were needed in two (8%) cases. Mean pain scores post-operatively at 4 h, 12 h and 24 h were 4 ± 1.19, 3.64 ± 1.03 and 2.24 ± 0.96, respectively (p < 0.0001). Plasma CRP values increased at 6 h and started to decrease at 24 h (p < 0.0001). None of the cases were converted to open surgery and no major complications occurred.


CONCLUSIONS
TUMP-LC using standard laparoscopic instrumentation without an access device is an effective alternative to standard four-incision laparoscopic cholecystectomy. Our technique maintains the principles of the conventional procedure and the instrumentation, but also improves the access.
Kocaeli Derince Teaching and Research Hospital, Department of General Surgery, Kocaeli, Turkey. mtoruc@yahoo.com
M Tahir
MT
Oruc
M Umit
MU
Ugurlu
Zehra
Z
Boyacioglu
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002769:Cholelithiasis / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology*; D013997:Time Factors; D016896:Treatment Outcome; D014472:Umbilicus; D055815:Young Adult
D002097:C-Reactive Protein