title: Suprapubic laparoscopic cholecystectomy: technique and preliminary results.
abstract: BACKGROUND
  The minimally invasive abdominal surgery has evolved to reduce portals, culminating with a single incision and natural orifice operation. However, these methods are still expensive, difficult to implement and with questionable aesthetic results.
  
  
  OBJECTIVE
  To present the standardization and preliminary results of a technique for performing laparoscopic suprapubic access by the principle which was called the Supra Pubic Endoscopic Surgery for cholecystectomy.
  
  
  METHODS
  The average body mass index of patients, the mean operative time, clinical data of the postoperative complications and quality of life were prospectively studied. The operation incisions consisted of: A) umbilical for instrumental dissection and clipping; B) in the right groin for handling and gallbladder gripping; C) suprapubic for the camera. With the patient in reverse Trendelenburg and left lateral decubitus, the operation flew by the camera trocar in C, proceeding with dissection and isolation of the biliary pedicle, identification of cystic duct and artery, with usual instrumentation. Transcystic intraoperative cholangiography was performed in all cases in which there were indications. The procedure was completed with clipping and sectioning of the cystic duct and artery, retrograde resection of the gallbladder and extracting it by the umbilical trocar incision under direct vision.
  
  
  RESULTS
  Thirty patients undergone this surgical procedure between March and June 2012 and were evaluated. The mean age was 40.7 years and the indications were typical biliary colic in 18 cases (60 %), cholecystitis in five cases (16.6 %), biliary pancreatitis in one case (3.3%); polyp in three cases (10%) and obstructive jaundice at three cases (10%). The average body mass index was 27.8 (23.1-35.1) and surgical time ranged between 24 and 70 minutes.
  
  
  CONCLUSIONS
  The technique proved to be feasible and safe , with no significant complications, and satisfactory cosmetic results.
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Leonardo Adolpho S
authors.initials: LA
authors.lastname: Sales
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: João Odilo G
authors.initials: JO
authors.lastname: Pinto
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Carlos Eduardo F
authors.initials: CE
authors.lastname: Queiroz
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Castro
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Paulo Henrique F
authors.initials: PH
authors.lastname: Dourado
authors.affiliation: Walter Cantidio University Hospital, Federal University of Ceara, Fortaleza, CE, Brazil.
authors.forename: Fernando Antonio S
authors.initials: FA
authors.lastname: Pinheiro
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011630:Pubic Bone; D016896:Treatment Outcome; D055815:Young Adult