Carvalho Gustavo L, Silva Frederico W, Silva José Sérgio N, de Albuquerque Pedro Paulo C, Coelho Raphael de Macedo C, Vilaça Thiago G, Lacerda Cláudio M
Clínica Cirúrgica, Videolaparoscópica Gustavo Carvalho, Department of Surgery, Faculdade de Ciências Médicas (FCM), Member of SAGES, SOBRACIL, ELSA and Brazilian College of Surgeons (CBC), Universidade de Pernambuco (UPE), Recife, Brazil.
Surg Laparosc Endosc Percutan Tech. 2009 Oct;19(5):368-72. doi: 10.1097/SLE.0b013e3181b7d3c7.
The advent of natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), surgery without skin scarring, is now challenging every surgeon to improve the esthetic results for patients. Minilaparoscopic cholecystectomy (MLC) represents a refinement in laparoscopic surgery, potentially as cosmetically effective as NOTES. Nevertheless, because of the increased cost and difficulty in managing the equipment, it has not been widely accepted among surgeons.
To report modifications of the minilaparoscopic technique that make it possible to conduct needlescopic procedures safely and effectively, thereby, considerably reducing costs and promoting the dissemination of this operation.
One thousand consecutive patients who underwent MLC were analyzed, from January 2000 to May 2009 (78.7% women; average age 45.9 y).
after performing the pneumoperitoneum at the umbilical site, 4 trocars were inserted; 2 of 2 mm, 1 of 3 mm, and 1 of 10 mm in diameter, through which a laparoscope was inserted. Neither the 3-mm laparoscope, nor clips, nor manufactured endobags were used. The cystic artery was safely sealed by electrocautery near the gallbladder neck and the cystic duct was sealed with surgical knots. Removal of the gallbladder was carried out, in an adapted bag made with a glove wrist, through the 10-mm umbilical site.
The operative time was 43 minutes. The average hospital stay was 16 hours. There was no conversion to open surgery; 2.8% of patients underwent conversion to standard (5 mm) laparoscopic cholecystectomy because of difficulties with the procedure; there were 1.9% minor umbilical site infections and 1.0% umbilical herniations. There was no mortality; no bowel injury, no bile duct injury, and no postoperative hemorrhage, only 1 patient with Luschka's duct bile leakage needed a reoperation.
The MLC technique shows no differences in risks as compared with other laparoscopic cholecystectomy procedures. It also entails a considerable reduction in cost, and, as it does not use the 3-mm laparoscope or disposable materials, it is possible to perform MLC on a larger number of patients. Owing to the near invisibility of scars, MLC may also be considered as cosmetically effective as NOTES and SILS.
自然腔道内镜手术（NOTES）和单切口腹腔镜手术（SILS）的出现，即无皮肤瘢痕的手术，正在促使每位外科医生为患者改善美观效果。迷你腹腔镜胆囊切除术（MLC）是腹腔镜手术的一种改进，其美容效果可能与NOTES相当。然而，由于设备管理成本增加和难度加大，它尚未被外科医生广泛接受。
报告迷你腹腔镜技术的改进方法，使其能够安全有效地进行针式腹腔镜手术，从而大幅降低成本并促进该手术的推广。
分析了2000年1月至2009年5月连续接受MLC的1000例患者（女性占78.7%；平均年龄45.9岁）。
在脐部进行气腹后，插入4个套管针；直径分别为2个2mm、1个3mm和1个10mm，通过这些套管针插入腹腔镜。未使用3mm腹腔镜、夹子或成品内镜袋。胆囊动脉在胆囊颈部附近用电灼安全封闭，胆囊管用手术结封闭。用手套腕部制成的适配袋通过10mm脐部切口取出胆囊。
手术时间为43分钟。平均住院时间为16小时。无转为开腹手术的情况；2.8%的患者因手术困难转为标准（5mm）腹腔镜胆囊切除术；有1.9%的患者脐部切口轻微感染，1.0%的患者发生脐疝。无死亡病例；无肠道损伤、胆管损伤和术后出血，仅1例胆囊管副肝管胆汁漏患者需要再次手术。
与其他腹腔镜胆囊切除术相比，MLC技术在风险方面无差异。它还能大幅降低成本，并且由于不使用3mm腹腔镜或一次性材料，可以为更多患者进行MLC手术。由于瘢痕几乎不可见，MLC在美容效果上也可被认为与NOTES和SILS相当。
