Single-incision laparoscopic cholecystectomy using flexible endoscopy: saline infiltration gallbladder fossa dissection technique

• Published in: Surgical endoscopy Vol. 23; no. 11; pp. 2610 - 2614
• Main Authors: Afthinos, John N., Forrester, Glenn J., Binenbaum, Steven J., Harvey, E. John, Kim, Grace J., Teixeira, Julio A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.11.2009; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Biological and medical sciences; Cholecystectomy; Cholecystectomy, Laparoscopic - methods; Cholelithiasis - diagnostic imaging; Cholelithiasis - surgery; Cohort Studies; Consent; Digestive system. Abdomen; Dissection; Dissection - methods; Electrocoagulation - methods; Endoscopy; Female; Follow-Up Studies; Gallbladder; Gastroenterology; General anesthesia; General aspects; Gynecology; Hepatology; Humans; Injections, Intralesional; Investigative techniques, diagnostic techniques (general aspects); Laparoscopes; Laparoscopy; Length of Stay; Liver; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - methods; Postoperative Complications - prevention & control; Proctology; Review boards; Risk Assessment; Sodium Chloride - pharmacology; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Technique; Time Factors; Treatment Outcome; Ultrasonography; Umbilicus - surgery; Young Adult; United States > US; Cholecystectomy; Hydrodissection; Single incision; Laparoscopy; Flexible endoscopy; Medicine; Endoscopic surgery; Treatment; Gallbladder; Endoscopy; Technique
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-009-0415-5

Background The introduction of natural orifice translumenal endoscopic surgery has led to the development of new techniques to accomplish minimally invasive procedures using flexible endoscopic instruments. This study evaluated a technique used in endoscopic mucosal resection and applied it to dissection of the gallbladder from the liver bed. Methods Eight patients underwent an elective transumbilical single-incision cholecystectomy using a flexible endoscope at the authors’ institution from August 2007 to February 2008. An endoscopic injection needle was used to inject 20 ml of saline strategically into the gallbladder fossa. After infiltration, dissection of the gallbladder and hilum was performed with endoscopic instruments, whereas the cystic duct and artery were clipped using laparoscopic instruments. Results None of the eight patients had inadvertent perforation of the gallbladder during dissection. The technique of infiltrating the potential space between the gallbladder and the liver bed leads to a significantly improved visualization of the plane between them. Conclusion The injection of saline to develop surgical planes is an effective tool in performing a cholecystectomy using flexible endoscopic instrumentation. The enhancement of this potential space improved visualization in all patients. This technique has great potential value for dissections and requires further evaluation of its effectiveness in other applications.