No-visible-scar cholecystectomy

Introduction : Single incision laparoscopic surgery (SILS) is a laparoscopic method providing a good cosmetic effect, but requiring the application of special ports and instruments enabling the surgeon to perform the procedure. We report three-ports cholecystectomy through umbilical and suprapubic incisions performed with typical laparos­copic instruments which calls no-visible-scar cholecystectomy (NVSC).

Material and methods : Twenty patients with symptomatic cholelithiasis were qualified for NVSC. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports of 5 mm were inserted in the maximum external edges of this incision. After cystic duct and cystic artery dissection the right one was exchanged for a port of 11 mm. The second incision for the 11-mm trocar for the laparoscope was done in the suprapubic median line within the hair area.

Results : Cholecystectomies were performed without any conversion to classical laparoscopic cholecystectomy (LCH) or open surgery. They were not technically identical due to the gradual improvement in the access and manipulation of instruments. The time of the intervention ranged from 2 hours during the introduction of the new method to 50 min for the last procedures. No postoperative complications were observed and all patients were discharged not later than after conventional LCH.

Conclusions : NVSC is a three-port laparoscopic intervention performed with typical laparoscopic instruments. It is more convenient for the surgeon than single incision LCH, because the placement of the optic in the suprapubic region gives more space for the instruments. It also provides a very good cosmetic effect of the intervention. The described procedure is easy to learn and in case of technical problems additional ports can be applied (as in typical LCH).