Downes Ross O, McFarlane Michael, Diggiss Charles, Iferenta James
Doctors Hospital, Nassau, Bahamas.
University Hospital of the West Indies, Mona, Kingston, Jamaica.
Int J Surg Case Rep. 2015;11:104-109. doi: 10.1016/j.ijscr.2015.04.034. Epub 2015 May 1.
Scarless/single-incision laparoscopic cholecystectomy (SILC) is a new procedure. It affords a superior cosmetic outcome when compared to conventional laparoscopic cholecystectomy. We examine the application of this technique using LigaSure via a clipless method. The present study looks at the experience of a single surgeon using this method with initial evaluation of the safety, feasibility, affordability, and benefits of this procedure.
Twenty-eight patients underwent transumbilical SILC at Doctors Hospital from January to December, 2014. The cohort included both emergency and elective patients. There was no difference in the preoperative work-up as indicated. To perform the operation, a 2-2.5-cm linear incision was made through the umbilicus and the single port platform utilized. A 10mm 30-degree laparoscope, a 5mm LigaSure and straight instruments were used to perform the laparoscopic cholecystectomy procedure.
All patients except two were operated on successfully. Conversion was considered the placement of an additional epigastric/Right upper quadrant (RUQ) port. The conversion rate to standard LC was 7%. No patient was converted to open cholecystectomy. In the 28 successfully completed patients, the median duration of the operation was 38.5min and estimated operative blood loss was 24ml. Patients were commenced on liquid diet immediately on being fully conscious and after return to the ward with an estimated time of 6h. The mean postoperative hospital stay was 1.4 days. Follow-up visits were conducted for all patients at 2-weeks intervals and continued for 6 weeks after surgery where possible. Two patients developed wound infections. All patients were satisfied with the good cosmetic effect of the surgery. The total satisfaction rate was 100%.
SILC is a safe and feasible technique for operating with scarless outcomes and reducing perioperative discomfort at the same time. The GelPOINTTM is a safe and feasible platform to be used. The procedure can be accomplished using regular instruments and laparoscope. Curved instruments and a bariatric length laparoscope may make the procedure easier and result in greater time saving. The addition of LigaSure™ decreases the complexity of the operation, decreases operative time and blood loss. The technique is economical in a resource-limited environment.
无痕/单切口腹腔镜胆囊切除术（SILC）是一种新的手术方法。与传统腹腔镜胆囊切除术相比，它具有更好的美容效果。我们研究了使用LigaSure通过无夹法应用该技术的情况。本研究观察了一位外科医生使用该方法的经验，并对该手术的安全性、可行性、可承受性和益处进行了初步评估。
2014年1月至12月，28例患者在多科医院接受了经脐单切口腹腔镜胆囊切除术。该队列包括急诊和择期患者。术前检查如所述无差异。为进行手术，经脐做一个2 - 2.5厘米的线性切口，并使用单孔平台。使用10毫米30度腹腔镜、5毫米LigaSure和直器械进行腹腔镜胆囊切除手术。
除两名患者外，所有患者手术均成功。中转是指额外放置一个上腹部/右上腹（RUQ）端口。标准腹腔镜胆囊切除术的中转率为7%。没有患者转为开腹胆囊切除术。在28例成功完成手术的患者中，手术中位持续时间为38.5分钟，估计术中失血量为24毫升。患者完全清醒并返回病房后立即开始流食，估计时间为6小时。术后平均住院时间为1.4天。所有患者每2周进行一次随访，并在术后尽可能持续6周。两名患者发生伤口感染。所有患者对手术良好的美容效果均满意。总满意率为100%。
单切口腹腔镜胆囊切除术是一种安全可行的技术，可实现无痕手术效果，同时减少围手术期不适。GelPOINTTM是一个安全可行的平台。该手术可以使用常规器械和腹腔镜完成。弯曲器械和肥胖专用长度的腹腔镜可能会使手术更容易并节省更多时间。增加LigaSure™可降低手术复杂性，减少手术时间和失血量。在资源有限的环境中，该技术经济实惠。
