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Four-channel single incision laparoscopic cholecystectomy using a snake retractor: comparison between 3- and 4-channel SILC 4-channel single incision cholecystectomy.

Sung NS, Choi IS, Moon JI, Ra YM, Lee SE, Choi WJ - Ann Surg Treat Res (2014)

Bottom Line: The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709).In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043).There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Single incision laparoscopic cholecystectomy (SILC) is a widely used method of performing cholecystectomy. A common technique used in SILC is a 3-channel method. However, exposure of Calot's triangle is limited in conventional 3-channel SILC. Therefore, we herein report the adequacy and feasibility of 4-channel SILC using a snake retractor.

Methods: Four hundred and fifteen SILC cases were performed between April 2010 and February 2013. We performed 326 SILC cases between April 2010 and September 2012 using the 3-channel method. We introduced a snake retractor for liver traction in October 2012, and 89 cases of 4-channel SILC using snake retractor have been performed since.

Results: Thirty patients (9.2%) in the 3-channel SILC group, and 23 patients (25.8%) in the 4-channel SILC group, were treated with percutaneous transhepatic gallbladder drainage insertion because of acute inflammation of the gallbladder (GB) before operation (P < 0.001). The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709). In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043). There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

Conclusion: Benign diseases of the GB can be operated on using SILC with the 4-channel method using a snake retractor.

No MeSH data available.


Related in: MedlinePlus

The handmade port and instruments.
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Figure 1: The handmade port and instruments.

Mentions: The handmade port consisted of a 10-mm size ALEXIS wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) and size 7 sterile glove in which three 5-mm ports and one 10-mm port (Laport, Sejong Medical, Paju, Korea) were prepared on the 1st, 2nd, 3rd, 5th tip of fingers to create a 4-working channel for the laparoscopic instruments (Fig. 1). The wound retractor was introduced through 2.5-cm transumbilical incision. The surgical glove was fixed to the outer ring of the wound retractor and then the CO2 pipe was connected to 10-mm port to create pneumoperitoneum. We used a 10-mm flexible telescope (Olympus Co., Tokyo, Japan), a 5-mm snake liver retractor for liver traction (Diamond-Flex Triangular Retractors, CareFusion, Waukegan, IL, USA), a long articulated Endo-Roticulator (Coviden, Mansfield, MA, USA) for traction and dissection of GB, and a suction-hook bovie (Endopath Probe Plus II Pistol Grip Handle, Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) for irrigation and coagulation. We ligated cystic duct and artery using 5-, 10-mm Hem-O-Lok clip (Weck Closure Systems, a division of Teleflex Inc., Wayne, PA, USA).


Four-channel single incision laparoscopic cholecystectomy using a snake retractor: comparison between 3- and 4-channel SILC 4-channel single incision cholecystectomy.

Sung NS, Choi IS, Moon JI, Ra YM, Lee SE, Choi WJ - Ann Surg Treat Res (2014)

The handmade port and instruments.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127901&req=5

Figure 1: The handmade port and instruments.
Mentions: The handmade port consisted of a 10-mm size ALEXIS wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA) and size 7 sterile glove in which three 5-mm ports and one 10-mm port (Laport, Sejong Medical, Paju, Korea) were prepared on the 1st, 2nd, 3rd, 5th tip of fingers to create a 4-working channel for the laparoscopic instruments (Fig. 1). The wound retractor was introduced through 2.5-cm transumbilical incision. The surgical glove was fixed to the outer ring of the wound retractor and then the CO2 pipe was connected to 10-mm port to create pneumoperitoneum. We used a 10-mm flexible telescope (Olympus Co., Tokyo, Japan), a 5-mm snake liver retractor for liver traction (Diamond-Flex Triangular Retractors, CareFusion, Waukegan, IL, USA), a long articulated Endo-Roticulator (Coviden, Mansfield, MA, USA) for traction and dissection of GB, and a suction-hook bovie (Endopath Probe Plus II Pistol Grip Handle, Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) for irrigation and coagulation. We ligated cystic duct and artery using 5-, 10-mm Hem-O-Lok clip (Weck Closure Systems, a division of Teleflex Inc., Wayne, PA, USA).

Bottom Line: The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709).In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043).There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Single incision laparoscopic cholecystectomy (SILC) is a widely used method of performing cholecystectomy. A common technique used in SILC is a 3-channel method. However, exposure of Calot's triangle is limited in conventional 3-channel SILC. Therefore, we herein report the adequacy and feasibility of 4-channel SILC using a snake retractor.

Methods: Four hundred and fifteen SILC cases were performed between April 2010 and February 2013. We performed 326 SILC cases between April 2010 and September 2012 using the 3-channel method. We introduced a snake retractor for liver traction in October 2012, and 89 cases of 4-channel SILC using snake retractor have been performed since.

Results: Thirty patients (9.2%) in the 3-channel SILC group, and 23 patients (25.8%) in the 4-channel SILC group, were treated with percutaneous transhepatic gallbladder drainage insertion because of acute inflammation of the gallbladder (GB) before operation (P < 0.001). The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709). In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043). There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

Conclusion: Benign diseases of the GB can be operated on using SILC with the 4-channel method using a snake retractor.

No MeSH data available.


Related in: MedlinePlus