title: Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: A comparative study.
abstract: OBJECTIVE
  To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE).
  
  
  METHODS
  We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using ﬂushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a ﬂexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.
  
  
  RESULTS
  During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.
  
  
  CONCLUSIONS
  The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.
authors.affiliation: Say-June Kim, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Say-June
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Say-June Kim, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Kee-Hwan
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Say-June Kim, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Chang-Hyeok
authors.initials: CH
authors.lastname: An
authors.affiliation: Say-June Kim, Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Jeong-Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation; D003135:Common Bile Duct / Q000601:surgery*; D019723:Endoscopes; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D042882:Gallstones / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome
keywords: Choledocholithiasis; Choledochotomy; Common bile duct exploration; Laparoscopy; Single-incision laparoscopic surgery