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Needlescopic cholecystectomy: prospective study
of 150 patients
ECS Lai, M Fok, ASH Chan
Pedder Medical Partners, M/F Pedder Building, 12 Pedder Street,
Central, Hong Kong
OBJECTIVE. To evaluate the feasibility and safety
of cholecystectomy using miniaturised instruments of 3 mm or less
in diameter.
DESIGN. Prospective study on patients with gallstones,
with or without related complications.
SETTING. Private hospital, Hong Kong.
PATIENTS. From September 1997 to September 2002,
150 of the 180 consecutive patients managed were included in the
present study.
MAIN OUTCOME MEASURES. All patients were operated
on with a standard four-port technique. Mini-laparoscopes of different
sizes were used throughout the study period, which included 2-mm
(n=33) fibre-optic laparoscope, and 2.5-mm (n=61) and 3-mm (n=56)
laparoscopes of Hopkins rod lens system. The cystic duct and artery
were secured either by extracorporeal ties or 10-mm clips passed
through the umbilicus. The time taken from dissection to division
of the cystic duct and artery, and to complete the operation were
documented.
RESULTS. The operation was successfully completed
with needlescopic instruments in 127 (85%) patients, even though
patients with acute cholecystitis and history of common bile duct
stones were included. Use of larger-diameter mini-laparoscopes decreased
the time needed to divide the cystic duct and artery, to detach
the gall bladder from the liver, and to complete the operation.
There were no deaths. One minor bile duct injury developed secondary
to extensive cauterisation of the gall bladder fossa.
CONCLUSION. Needlescopic cholecystectomy with minor
technical modification can be completed within a duration comparable
to standard laparoscopy at no increased risk for the great majority
of patients with gallstones.
Hong Kong Med J 2003;9:238-42
Key words: Cholecystectomy, laparoscopic; Microsurgery/instrumentation;
Pain, postoperative; Surgical instruments
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