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Chirurgie 1. Dezember 2011

Technique and outcome of 2 mm needlescopic cholecystectomy*

BACKGROUND: According to the basic idea of minimally invasive surgery, reduction of surgical trauma, the caliber of instruments in needlescopic surgery is reduced to a few millimeters. The reduction in caliber can reduce power transmission to the instruments and impair view and light of the optic, which can cause limitations in its application. This study aimed to analyze the technique and results of needlescopic laparoscopy using the example of cholecystectomy. METHODS: From 2007 to 2010, 124 patients underwent needlescopic and 130 conventional laparoscopic cholecystectomy. The trocar sites were always the same as for conventional laparoscopic cholecystectomy; a 10 mm trocar was introduced transumbilically in open technique and a total of three 2 mm trocars were used on the epigastrium and the right subcostal space. Intraoperative cholangiography was routine as in conventional laparoscopy. RESULTS: All procedures were completed laparoscopically. Three cases (2.4%) required conversion to conventional laparoscopy. In 11 cases (9%), intraoperative cholangiography could not be performed. In 6 patients (5%), there were intraoperative complications such as opening of the gallbladder with spilling of the stones. The bile duct was never injured and there were no re-operations; hemoglobin never fell below 11 g/dl. There was significantly less need for analgesics in the first 3 days than with conventional laparoscopic cholecystectomy. Patient satisfaction was scored as 10 (very good) on a scale from 1–10 by 117 patients (94%). CONCLUSIONS: In contrast to NOTES and single port surgery, minilaparoscopy adheres to the basic principles of laparoscopy. With selected patients, needlescopic technique reduces postoperative pain, and has a better cosmetic result with higher patient satisfaction.

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