Dhillon Kanwarjit Singh, Awasthi Divya, Dhillon Arshbir Singh
Department of Minimally Invasive and Bariatric Surgery, Max Super Speciality Hospital, Mohali, Punjab, India.
Department of Advanced Gynaecologic Laparoscopy and Hysteroscopy, Max Super Speciality Hospital, Mohali, Punjab, India.
J Minim Access Surg. 2017 Jul-Sep;13(3):176-181. doi: 10.4103/0972-9941.207838.
This study presents a novel technique to perform cholecystectomy and assess its outcome and feasibility.
This study presents the novel Dhillon technique and experience of hybrid natural orifice transluminal endoscopic surgery (NOTES) technique, that is, laparoscopic-assisted transvaginal cholecystectomy. We have evaluated the outcomes in terms of cosmesis, post-operative recovery and analgesic requirement. The study included 257 patients who underwent hybrid NOTES cholecystectomy at single tertiary hospital. The biographical data, surgical time, pain score on day 1 and 2, need of analgesia, intra- and post-operative complication and aesthetic assessment on day 7 were recorded.
Out of a total of 1100 cases of laparoscopic cholecystectomy 257 had hybrid NOTES cholecystectomy. Only two of these cases were converted to standard laparoscopic cholecystectomy. The mean operative time was 31.5 ± 5.1 (25-40) min. None of the patients had any complication or biliary leakage. The mean pain score on day 1 and 2 was 3.6 ± 0.4 (3-4) and 1.0 ± 0.06 (1-2), respectively. The mean paracetamol (analgesic) dose requirement was 6.1 ± 0.6 (4-6.9) g. The aesthetic score was excellent in all the cases.
Using the present technique of hybrid NOTES is beneficial in terms of cosmetic results, lesser need of analgesic and shorter hospital stay.
本研究提出了一种进行胆囊切除术的新技术，并评估其结果和可行性。
本研究介绍了新颖的迪隆技术以及混合式自然腔道内镜手术（NOTES）技术，即腹腔镜辅助经阴道胆囊切除术的经验。我们从美容效果、术后恢复和镇痛需求方面评估了结果。该研究纳入了在一家三级医院接受混合式NOTES胆囊切除术的257例患者。记录了患者的传记资料、手术时间、第1天和第2天的疼痛评分、镇痛需求、术中和术后并发症以及第7天的美学评估。
在总共1100例腹腔镜胆囊切除术中，有257例接受了混合式NOTES胆囊切除术。其中仅有2例转为标准腹腔镜胆囊切除术。平均手术时间为31.5±5.1（25 - 40）分钟。所有患者均无任何并发症或胆漏。第1天和第2天的平均疼痛评分分别为3.6±0.4（3 - 4）和1.0±0.06（1 - 2）。对乙酰氨基酚（镇痛药）的平均剂量需求为6.1±0.6（4 - 6.9）克。所有病例的美学评分均为优秀。
采用当前的混合式NOTES技术在美容效果、较少的镇痛需求和较短的住院时间方面是有益的。
