Prophylaxis and correction of complications while performance of a monoport laparoscopic cholecystectomy for chronic calculous cholecystectomy

Objective. To analyze the causes and rates of perioprative complications and to estimate the methods of their correction while performance of a monoport laparoscopic cholecystectomy (LCH) for chronic calculous cholecystitis (CHCH). Маterials and methods. In the period of 2015 - 2017 yrs in 102 patients a monoport LCH for CHCH was performed. Results. In all the patients a standard monoport cholecystectomy was performed, using laparoscopic transumbilical access. In 12 patients a necessity for additional 5-mm trocar have occurred, in 2 - a necessity for conversion (pass towards the four-port access in cholecystectomy). In 11 patients the abdominal cavity drainage via additional (5 mm) access was done, in 3 the liquid accumulations were revealed in zone of the gallbladder vesicle bed. In 1 a drainage tube was inserted and endoscopic papillosphincterotomy was performed. Conclusion. A monoport access for performance of cholecystectomy may be applied in patients with uncomplicated course of CHCH. Possible complications, occurring while application of a monoport access, may be predicted and addressed by prophylactic measures.

Minilaparoscopy-assisted transumbilical laparoscopic cholecystectomy

ABSTRACT The role of laparoscopy in the modern surgery era is well established. With the prospect of being able to improve the already privileged current situation, new alternatives have been proposed, such as natural orifice endoscopic surgery (NOTES), the method for single transumbilical access (LESS - Laparo-endoscopic single-site surgery) and minilaparoscopy (MINI). The technique proposed by the authors uses a laparoscope with an operative channel like the flexible endoscope used in NOTES. All operative times are carried out through the umbilical trocar as in LESS, and assisted by a minilaparoscopy grasper. This new technic combines, and results from, the rationalization of technical particularities and synergy of these three approaches, seeking to join their advantages and minimize their disadvantages.

Laparoendoscopic Single-Site Surgery for the Treatment of Benign Adnexal Disease: A Prospective Trial

Background. To validate feasibility, efficacy, and safeness of laparoscopic treatment of benign adnexal diseases through a single transumbilical access (LESS) in a prospective series of patients. Methods. A prospective clinical trial including 30 women has been conducted at the Division of Gynecology of Catholic University of Sacred Hearth of Rome. Patients underwent different laparoscopic procedures by LESS utilizing a multiport trocar and conventional straight laparoscopic instrumentation. Intra and perioperative outcome has been reported. Results. Ten mono/bilateral adnexectomies and 20 cystectomies have been performed by LESS approach. Laparoscopic procedures were completed through a single access in 28 cases (93.4%). No major intra- or postoperative complications were observed. Mean hospital stay was 1.3 days. Conclusions. LESS approach is feasible to treat benign adnexal disease with a very low conversion rate and no early or late complications. More clinical data are needed to confirm these advantages compared to standard laparoscopic technique.