Super minimally invasive laparoscopic cholecystectomy: Report of three cases

Abstract

The latest development in laparoscopic surgery has been the introduction of ultra-thin instruments. These newly developed surgical instruments are inserted through guide tubes that are 2-3 mm in diameter. In August 1996, three patients (two female, one male; aged 50, 42 and 43 years, respectively) were selected for super minimally invasive laparoscopic cholecystectomy (SMILC). After insertion of umbilical (10 mm) and right flank (5 mm) trocars, a quick evaluation of the thickness of the gallbladder wall and the adhesions was made. The patients included in this study had thin-walled gallbladders without adhesions. Another two 2- and 3-mm trocars were placed in the right subchondral region. Following dissection in Calot's triangle using a 2-mm electrocautery probe, the cystic duct and artery were defined and clipped via the 5-mm right flank port. The gallbladder was mobilized from its bed using electrocautery. The 10-mm laparoscope was then changed for a 2-mm one inserted through the epigastric port. The gallbladder was delivered via the umbilical port. At postoperative day 14, the 2- and 3-mm scar tissues were barely visible. In conclusion, SMILC is undoubtedly cosmetically superior. The initial evaluation showed that it is a promising modification that has the potential for even less morbidity than the standard laparoscopic cholecystectomy.