LAPAROSCOPIC CHOLECYSTECTOMY WITH MINI INSTRUMENTS (MINISITE CHOLECYSTECTOMY)

Abstract

The advantages and technical details of minisite cholecystectomy (MC) were investigated in this study. The rapid development in the endoscopic industry has recently introduced 2 mm delicate instrument into the laparoscopic field. The main objectives were to have smaller incision, better cosmetic result, less trauma, therefore lower morbidity rote. Twenty two consecutive patients who were admitted for elective laparoscopic Cholecystectomy (LC) were introduced into the study. Following the evaluation of presence of adhesions around the gallb laddder of the beginning of the operation, 18 patients were considered suitable for MC, Operation was successfully completed in 15 patients and conversion to standard LC was required in 3 patients due to bleeding (in 2 cases) and difficulty in defining anatomy (in one case). The mean age was 46. l years (range 23 - 78) and female/male ratio was 13/2. The average operating time was 79.4 minutes (range 45-110). Technique was performed using four punctures with one 10 mm port in the umbilicus and three 2 mm port as in the same position with standard laparoscopic Cholecystectomy (in the right subcostal region). The retraction of the fundus and dissection on hepatoduodenal ligament was performed using mini graspers and miniscissors. Clips were applied to the cystic duct and artery through the umbilical port after changing the 10 mm telescope to 2 mm telescope which was introduced via epigastric port. Gallbladder was delivered from the umbilical port under the direct vision of 2mm scope, All patients were ambulatory 6 hours after the operation. All were discharged at 24 hours. Postoperative analgesic requirement was not different from those who underwent standart LC. At the evaluation of the scar tissue 3 months after the operation 2 mm port sites were barely visible and all patients scored their scar tissue as excellent.