SINGLE HOLE GALL BLADDER SURGERY

Sun, 07 Aug 2005 19:40:10 +0200

AIM: To achieve a minimally invasive surgery safer than laparoscopic cholecystectomy (LC). “Single hole cholecystectomy” has evolved with lesser chances of bile duct injury (BDI), it also does not have problems of indirect vision, hand eye coordination, pneumoperitoneum, trocar injuries and other complications unique to LC. METHODS: Microlap cholecystectomy is performed through a small rectus splitting incision (3 – 3.5 cms) in right hypochondrium. Intraoperative ultrasound is done using 6.5 MHz end firing sector probe to avoid BDI. Cystic duct is hooked with suture while intraoperative ultrasound is used to see that bile duct is secure and not kinked. 0º, 30º & 45º endoscopes or sinuscopes are used to assist in surgery if and when needed. RESULTS: 2700 single hole cholecystectomies have been done from November 1991 to December 2004. Of these 2160 were from May 1996 to December 2004 using intraoperative ultrasound routinely & endoscopes when needed in later phase of study. Hemostasis is convenient due to direct 3D view enabling quick suction, precise pressure and cautery. After May 1996 only 10 (0.4%) were converted to laparotomy due to bleeding or adhesions. Other 2150 (99.6%) patients were discharged 6 to 24 hours after surgery. 0% suffered bile duct or other injury compared to 0.2 to 1.4% incidence quoted in LC along with an equal number of other injuries. CONCLUSION: Single hole cholecystectomy done this way is called “Laparoscopic assisted-intraoperative ultrasound guided-single hole cholecystectomy (LAIOUSC)”. It is a safe, minimally invasive surgery with advantages of being gas-less as well as having direct 3D and laparoscopic view.

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GALL BLADDER STONE

SINGLE HOLE GALL BLADDER SURGERY