title: Novel hybrid (magnet plus curve grasper) technique during transumbilical cholecystectomy: initial experience of a promising approach.
abstract: OBJECTIVE
  The use of magnets in transumbilical cholecystectomy (TUC) improves triangulation and achieves an optimal critical view. Nonetheless, the tendency of the magnets to collide hinders the process. In order to simplify the surgical technique, we developed a hybrid model with a single magnet and a curved grasper.
  
  
  METHODS
  All TUCs performed with a hybrid strategy in our pediatric population between September 2009 and July 2012 were retrospectively reviewed. Of 260 surgical procedures in which at least one magnet was used, 87 were TUCs. Of those, 62 were hybrid: 33 in adults and 29 in pediatric patients. The technique combines a magnet and a curved grasper. Through a transumbilical incision, we placed a 12-mm trocar and another flexible 5-mm trocar. The laparoscope with the working channel used the 12-mm trocar. The magnetic grasper was introduced to the abdominal cavity using the working channel to provide cephalic retraction of the gallbladder fundus. Across the flexible trocar, the assistant manipulated the curved grasper to mobilize the infundibulum. The surgeon operated through the working channel of the laparoscope.
  
  
  RESULTS
  In this pediatric population, the mean age was 14 years (range, 4-17 years), and mean weight was 50 kg (range, 18-90 kg); 65% were girls. Mean operative time was 62 minutes. All procedures achieved a critical view of safety with no instrumental collision. There were no intraoperative or postoperative complications. The hospital stay was 1.4±0.6 days, and the median follow-up was 201 days.
  
  
  CONCLUSIONS
  A hybrid technique, combining magnets and a curved grasper, simplifies transumbilical surgery. It seems feasible and safe for TUC and potentially reproducible.
authors.affiliation: Hospital Foundation, Private Children's Hospital , Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina .
authors.forename: Carolina
authors.initials: C
authors.lastname: Millan
authors.forename: Horacion
authors.initials: H
authors.lastname: Bignon
authors.forename: Gaston
authors.initials: G
authors.lastname: Bellia
authors.forename: Enrique
authors.initials: E
authors.lastname: Buela
authors.forename: Fernando
authors.initials: F
authors.lastname: Rabinovich
authors.forename: Mariano
authors.initials: M
authors.lastname: Albertal
authors.forename: Marcelo
authors.initials: M
authors.lastname: Martinez Ferro
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005705:Gallbladder Diseases / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D059346:Magnets; D008297:Male; D057605:Natural Orifice Endoscopic Surgery / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014472:Umbilicus; D055815:Young Adult