Hidden laparoscopic access (HiLA) cholecystectomy – first results
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : G. F. Federmann, Ch. Hessler
- چاپ و سال / کشور: 2010
Description
Background: The introduction of the NOTES concept led to several new approaches to laparoscopic or endoscopic cholecystectomy, e.g. transvaginal, SILS/ LESS, or transgastral. Many of them require additional equipment or highly trained endoscopic surgeons, or are limited to females. Hidden laparoscopic access (HiLA) cholecystectomy via umbilical and suprapubic trocars leads to hidden scars. We started this to reveal its practicability in laparoscopic cholecystectomy. Methods: HiLA-cholecystectomy starts with an umbilical access. After diagnostic laparoscopy a 10-mm trocar is placed in a midline suprapubic positions, then 1 or 2 additional 5mmtrocars in the right lower abdomen, and the cholecystectomy is performed. Forty-nine patients were treated this way. Highly acute cholecystitis, massive adipositas and adhesions were excluded. Results: In 49 patients (BMI 21–42.8) HiLA-cholecystectomy was performed. There was no conversion, in 1 of these patients a further 10-mm trocar was needed. 46/ 49 operations were done with standard instruments and optics. Mean operation time was 53.3 min. There were no intraoperative complications, 1 postoperative hematoma was observed, 1 postoperative gastric ulcer was seen. There were no major differences compared to own standard laparoscopic cholecystectomies 2009 (n¼126) or to those (n¼17013) in BQS Lower Saxony 2009. Conclusions: HiLA-cholecystectomy via umbilical and suprapubic accesses is a suitable procedure to perform laparoscopic cholecystectomy leaving hidden (“invisible”) scars. It can be done with standard instruments and optics in patients of either gender.
Eur Surg (2011) 43/1: 34–38 DOI 10.1007/s10353-010-0575-5 Received July 31, 2010; accepted after revision November 5, 2010
