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Comparative Study
, 21 (45), 12857-64

Innovative Technique of Needlescopic Grasper-Assisted Single-Incision Laparoscopic Common Bile Duct Exploration: A Comparative Study

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Comparative Study

Innovative Technique of Needlescopic Grasper-Assisted Single-Incision Laparoscopic Common Bile Duct Exploration: A Comparative Study

Say-June Kim et al. World J Gastroenterol.

Abstract

Aim: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE).

Methods: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.

Results: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.

Conclusion: The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.

Keywords: Choledocholithiasis; Choledochotomy; Common bile duct exploration; Laparoscopy; Single-incision laparoscopic surgery.

Figures

Figure 1
Figure 1
External view of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration. The needlescopic grasper (black arrow) was used for traction through a direct puncture on the right abdomen along the right anterior axillary line. The snake liver retractor (white arrow) was used for cephalad traction of the liver to obtain better visualization.
Figure 2
Figure 2
Operative illustrations of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration. The needlescopic grasper helped with obtaining a critical view of safety by retracting the gallbladder laterally (A). After ligation and transection of the cystic artery and duct, the common bile duct (CBD) was opened longitudinally using an endoknife (B) The CBD stones were extracted through various methods including direct extraction (C) or the use of a stone basket (D). After extraction of the CBD stones, completion choledochoscopy was performed to check for the presence of remnant stone(s) (E). After CBD clearance, the choledochotomy was primarily closed using either interrupted (F) or running sutures. Black arrows indicates lateral retraction of the gallbladder by the needlescopic grasper. A white and a red arrows indicate the snake retractor and Endograb, respectively.

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