Abstract
Laparoscopy has rapidly emerged as the preferred surgical approach in a number of different diseases because it ensures correct diagnoses and appropriate treatment. The use of mini-instruments (5 mm or less in diameter) and, when possible, the reduction of the number of trocars used might be its natural evolution. Laparoscopic cholecystectomy is a gold standard technique. The aim of the present work is to illustrate the results of the prospective experience of minilaparoscopic cholecystectomy (5 mm MLC) performed at our institution. Between August 2005 and July 2010 a total of 932 patients (mean age 45 years) underwent a laparoscopic cholecystectomy. Amongst them, 887 (95.1%) were operated on with a 5 mm-three trocar approach and in the remaining 45 cases (4.8%) a 3 mm trocar was used. The primary endpoint was the feasibility rate of the techniques. Secondary endpoints were safety and the impact of the techniques on duration of laparoscopy. In two cases conversion to laparotomy was necessary. We needed to add a fourth—5 mm trocar in the 10.7% of the cases (95 patients) in the 5 mm MLC. There were two cases of redo-laparoscopy in this group due to bile leakage from the cystic duct in one case, and to bleeding from the gallbladder bed in the other. Minor occurrence ranged as high as 2.1% in the 5 mm-MLC group, while it was nil in the 3 mm-MLC patients. The present experience shows that the 5 mm-three trocars MLC is a safe, easy, effective and reproducible approach to gallbladder diseases. Such features make the technique a challenging alternative to conventional laparoscopy both in the acute and the scheduled setting. We consider the 3 mm-MLC approach suitable only in selected cases, young and thin patients, due to the fragility of the smaller instruments.
Similar content being viewed by others
References
Bedin N, Agresta F (2010) Colorectal surgery in a community hospital setting: have attitudes changed because of laparoscopy? A general surgeons’ last 5 years experience review. Surg Laparosc Endosc Percutan Tech 20(1):30–35
Agresta F, Mazzarolo G, Bedin N (2009) Inguinal hernia in a community hospital setting: have attitudes changed because of laparoscopy? A review of a general surgeons’ experience over the last 5 years. Surg Laparosc Endosc Percutan Tech 19(3):267–271
Agresta F, Mazzarolo G, Ciardo LF, Bedin N (2008) The laparoscopic approach in abdominal emergencies: has the attitude changed? A single-center review of a 15-year experience. Surg Endosc 22(5):1255–1262
Berci G, Rozga J (1999) Miniature laparoscopy. Quo vadis? The basic parameters of image relay and display systems. Surg Endosc 13:211–217
Ciardo L, Agresta F, Michelet I, Bedin N (2003) Minilaparoscopic appendectomy: which indications? Chir Ital 55(5):699–705
El-Dhuwaib Y, Hamade A, Issa ME, Balbisi B, Abid G, Ammori B (2004) An “all 5-mm ports” selective approach to laparoscopic cholecystectomy, appendectomy and anti-reflux surgery. Surg Laparosc Endosc Percutan Tech 14:141–144
Gagner M, Garcia-Ruiz A (1998) Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 8(3):171–179
Manazza J, Sclachta CM, Seshadri PA, Cadeddu MO, Poulin EC (2001) Needlescopic surgery. Surg Endosc 15:1208–1212
Ng WT, Kong CK, Tse S et al (2002) Needlescopic appendectomy as a routine procedure: “Just because you can?” or “Just because you cannot?”. Surg Laparosc Endosc 12(4):301–306
Santoro E, Agresta F, Aloisi P, Caravani A, Mancini R, Mulieri G, Ciardo LF, Bedin N, Mulieri M (2005) Is minilaparoscopic inguinal hernia repair feasible? A preliminary experience. J Laparoendosc Adv Surg Tech 15:290–293
Santoro E, Agresta F, Veltri S, Mulieri G, Bedin N, Mulieri M (2008) Minilaparoscopic colorectal resection: a preliminary experience and an outcomes comparison with classical laparoscopic colon procedures. Surg Endosc 22(5):1248–1254
McCloy R, Randall D, Schung SA, Kehlet H, Simanski C, Bonnet F, Camu F, Fisher B, Joshi G, Rawal N, Neugebauer EAM (2008) Is smaller necessarily better? A systemic review comparing the effects of minilaparoscopic and conventional laparoscopic cholecystectomy on patients outcomes. Surg Endosc 25:2541–2553
Blinman T (2010) Incisions do not simply sum. Surg Endosc 24:1746–1751
Agresta F, Trentin G, Ciardo LF, Michelet I, Mazzarolo G, Bedin N (2005) Laparoscopic cholecystectomy with a three-trocar 5-mm instrument approach. Chir Ital 59(3):371–377
Nio D, Bemelman A, Bursch ORC, Vrouenraets BC, Gouma DJ (2004) Robot-assisted laparoscopic cholecystectomy vs conventional laparoscopic cholecystectomy. A comparative study. Surg Endosc 18:379–383
Perez A, Zinner MJ, Ashley SW, Brooks DC, Whang EE (2003) What is the real value of telerobotic technology in gastrointestinal surgery? Surg Endosc 17:811–813
Alponat A, Cubukcu Anil, Gonullu N, Canturk Z, Ozbay O (2002) Is minisite cholecystectomy less traumatica? Prospective randomized study comparing minisite and conventional laparoscopic cholecystectomy. World J Surg 26:1437–1440
Ainsle WG, Catton JA, Davides D, Dexter S, Gibson J, Larvin M, McMahon MJ, Moore M, Smith S, Vezakis A (2003) Micropuncture cholecystectomy vs conventional laparoscopic cholecystectomy. A randomized controlled study. Surg Endosc 17:766–772
Berci G (1998) Laparoscopic cholecystectomy using fine-caliber instruments. Smaller is not necessarily better. Surg Endosc 12:197
Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosemberg J (2002) Microlaparoscopic vs conventional laparoscopic cholecystectomy. Surg Endosc 16:458–464
Cheah WK, Lenzi JE, So JBY, Kum CK, Goh PMY (2001) Randomized trial of needlescopic versus laparoscopic cholecystectomy. Br J Surg 88:45–47
Dieter RA (2005) Three port vs standard laparoscopic cholecystectomy. Surg Endosc 19:153
Endo S, Souda S, Nezu R, Yoshikawa Y, Hashimoto J, Mori T, Uchikoshi F (2001) A new method of laparoscopic cholecystectomy using three trocars combined with suture retraction of gallbladder. J Laparoendosc Adv Surg Tech 11:85–88
Lau H, Brooks DC (2002) Transitions in laparoscopic cholecystectomy. Surg Endosc 16:323–326
Leggett PL, Bissell CD, Churchman-Winn R, Ahn C (2001) Three-port microlaparoscopic cholecystectomy in 159 patients. Surg Endosc 15:293–296
Lomanto D, De Angelis L, Ceci V, Dalsasso G, So J, Frattaroli FM, Muthiah R, Speranza V (2001) Two-trocar laparoscopic cholecystectomy: a reproducible technique. Surg Laparosc Endosc Percutan Tech 11:248–251
Look M, Chew SP, Tan YC, Liew SE, Cheong DM, Tan JC, Wee SB, Teh CH, Low CH (2001) Post-operative pain in needlescopic versus conventional laparoscopic cholecystectomy: a prospective randomized trial. J R Coll Surg Edinb 46:138–142
Mori T, Ikeda K, Sakata K, Ideguchi K, Nakagawa K, Yasumitsu T (2002) A new technique for two-trocar laparoscopic cholecystectomy. Surg Endosc 16:589–591
Poon CM, Chan KW, Lee DWH, Chan KC, Ko CW, Cheung HY, Lee KW (2003) Two-port vs four-port laparoscopic cholecystectomy. A prospective randomized controlled trial. Surg Endosc 17:1624–1627
Sarli L, Iusco D, Gobbi S, Porrini S, Ferro M, Roncoroni L (2003) Randomized clinical trial of laparoscopic cholecystectomy performed with mini-instruments. Br J Surg 90:1345–1348
Schwenk W, Neudecker J, Mall J, Bohm B, Muller JM (2000) Prospective randomized blinded trial of pulmonary function, pain, and cosmetic results after laparoscopic vs microlaparoscopic cholecystectomy. Surg Endosc 14:345–348
Trichak S (2003) Three-port standard four-port laparoscopic cholecystectomy. A prospective randomized study. Surg Endosc 17:1434–1436
Lee KW, Poon CM, Leung KF, Lee DWH, Ko CW (2005) Two-port needlescopic cholecystectomy: a prospective study of 100 cases. Hong Kong Med J 11:30–35
Hosono S, Osaka H (2007) Minilaparoscopic versus conventional laparoscopic cholecystectomy: a meta-analysis of randomised controlled trials. J Laparoendosc Adv Surg Tech 17:191–199
Cabral PHO, da Costa e Silva IT, Melo JV, Gimenez FS, Cabral CRB, de Lioma APC (2008) Needlescopic versus laparoscopic cholecystectomy. A prospective study of 60 patients. Acta Chir Bras 23(6):543–550
Novitsky YW, Kercher KW, Czerniach DR, Kaban GK, Khera S, Gallagher-Dorval KA, Callery MP, Litwin DEM, Kelly JJ (2005) Advantages of mini-laparoscopic vs conventional laparoscopic cholecystectomy. Arch Surg 140:1178–1183
Roberts KE, Solomon D, Duffy AJ, Bell RL (2010) Single-incision laparoscopic cholecystectomy: a surgeon’s initial experience with 56 consecutive cases and a review of the literature. J Gastrointest Surg 14:506–510
Curcillo PG II, Wu AS, Podolsky ER, Graybeal C, Katkhouda N, Saenz A, Dunham R, Fendley S, Neff M, Copper C, Bessler M, Gumbs AA, Norton M, Iannelli A, Mason R, Moazzez A, Cohen L, Mouhlas A, Poor A (2010) Single-port-access (SPA™) cholecystectomy: a multi-institutional report of the first 297 cases. Surg Endosc 24:1854–1860
Tsimoyiannis E, Tsimogiannis KE, Pappas-Gogos G, Farantos C, Benetatos N, Mavridou P, Manataki A (2010) Different pain scores in single transumbilical incision laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 24:1842–1848
de Carvalho GP, Cavazzola Lt (2010) Can mathematic formulas help us with our patients? Surg Endosc 25:336–337
Acknowledgments
The authors want to thank Mrs Jannet Hanney for the linguistic review of the manuscript.
Conflict of interest
Doctors Ferdinando Agresta and Natalino Bedin have no conflict of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agresta, F., Bedin, N. Is there still any role for minilaparoscopic-cholecystectomy? A general surgeons’ last five years experience over 932 cases. Updates Surg 64, 31–36 (2012). https://doi.org/10.1007/s13304-011-0123-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-011-0123-2