Use of Mini-Laparoscopic Percutaneous Graspers During Laparoscopic Cholecystectomy

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
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Author: Nova Szoka
Published:
Specialties: General Surgery
Schools: Duke University, West Virginia University
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Basic Info

Contributors: Jin Yoo

Percutaneous instrumentation is a new area of development within minimally invasive surgery. This video demonstrates the use of 2.3mm low profile percutaneous graspers during an elective laparoscopic cholecystectomy.

Advanced

Procedure

Laparoscopic Cholecystectomy using Mini-Laparoscopic Percutaneous Graspers

Indications

For use in laparoscopic cholecystectomy. Indications are similar to those for laparoscopic cholecystectomy.

Contraindications

The use of percutaneous laparoscopic instrumentation follows the same principles of traditional laparoscopic instrumentation. Namely, patients who have a contraindication to laparoscopic surgery are also not candidates for percutaneous laparoscopic surgery.

In the video shown above, the patient did not have any contraindication to laparoscopic or percutaneous laparoscopic surgery.

Instrumentation

Setup

Percutaneous instruments are low profile tools measuring 2.3mm in diameter. These instruments are inserted directly though the skin, thus achieving percutaneous entry into the peritoneal cavity. No trocar is needed. Due to the small diameter size of the instruments, surgical closure of the entry site is not necessary.

Preoperative Workup

The patient presented with symptoms of biliary colic and was worked up in the standard fashion. An elective laparoscopic cholecystectomy was planned. Informed consent was obtained.

Anatomy and Landmarks

An elective laparoscopic cholecystectomy was performed. Two percutaneous graspers were used in lieu of the standard 5mm trocars in the right lateral subcostal and right epigastric positions. The dissection was carried out in the usual fashion. The critical view of safety was obtained.

Advantages/Disadvantages

The gallbladder was successfully removed without complication. The use of percutaneous graspers in lieu of standard instruments did not hinder the operation. The incision sites from the percutaneous instruments were significantly smaller than standard 5mm incisions. Percutaneous instruments can be safely used to perform laparoscopic cholecystectomy in select patients. Benefits of percutaneous instruments include decreased incision size which may lead to decreased postoperative pain and improved cosmesis.

Complications/Risks

The complications are similar to that of standard laparoscopic cholecystectomy, namely: bleeding, infection, damage to surrounding structures (CBD), bile leak, anesthesia risks, DVT, PE, heart attack, stroke, death.

Disclosure of Conflicts

The complications are similar to that of standard laparoscopic cholecystectomy, namely: bleeding, infection, damage to surrounding structures (CBD), bile leak, anesthesia risks, DVT, PE, heart attack, stroke, death.

Acknowledgements

none

References

1.Carvalho GL, Paquentin EM, Redan JA, Shadduck PP. The Science Behind Mini-Laparoscopic Cholecystectomy. Surg Technol Int. 2016 Oct 26;XXIX:93-98. PubMed PMID: 27466870.
2.Dorian ED, DeAsis FJ, Lapin B, Amesbury R, Tanaka R, Ujiki MB. A Comparative Assessment of Novel Mini-Laparoscopic Tools. Surg Innov. 2017 Feb;24(1):35-41. PubMed PMID: 27591753.
3.http://www.teleflex.com/en/usa/productAreas/surgical/product-details/minilap/

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