[Laparoscopic cholecystectomy with mini-instruments. Technique and initial experiences].

The aim of the present paper is to describe the development of a standardized technique of laparoscopic cholecystectomy using mini-instruments in order to demonstrate its feasibility with no increase in the risk of the patient. For this purpose, the prospective data of the first 60 patients that appeared suitable to undergo laparoscopic cholecystectomy with mini-instruments were recorded initially, 45 patients were operated on using a 10 mm, 30 degrees standard laparoscope inserted via the umbilicus, together with two mini-instruments and a standard instrument inserted under the right costal arch. The subsequent 15 interventions were performed using, in addition to a 10 mm standard trocar placed in the umbilicus to accommodate the 10 mm laparoscope, three subcostal employed mini-trocars. For the special surgical steps involved in intraoperative cholangiography, and the clipping of the cystic duct and cystic artery, a minilaparoscope was introduced through the epigastric port. Fifty-five of the patients were women, their average age was 47.6 years and the mean BMI 23.5. The sole intraoperative complication seen was bleeding from the liver that made necessary conversion to a 5 mm port to aspirate the coagulum. Conversion to a standard 5 mm instrument was also required in two cases of broken forceps and in one case with a thick-walled gallbladder in which the mini grasping forceps proved too weak. The mean operating time was 62.4 min, and no postoperative complications occurred. For elective laparoscopic cholecystectomy including intraoperative cholangiography in slim patients, the use of mini-instruments is not associated with any increased risk of complications, and the operating time is acceptable. However, the general use of mini-instruments cannot as yet be recommended because of the less-than-optimal properties of the mini-instruments and the reduced optical quality of the mini-laparoscopes.