Laparoscopic cholecystectomy has become the standard treatment for symptomatic cholelithiasis in patients with situs inversus totalis (SIT). In an effort to reduce morbidity and improve the cosmesis single-port laparoscopic cholecystectomy has recently emerged, where the surgery is done through a single port, typically the patient's navel. This improves the cosmesis, lessens post-operative pain and ensures virtually a “scar less” surgery. We report a case of successful single-port laparoscopic cholecystectomy for a patient with SIT, and describe its technical advantages and review of literature.
Laparoscopic surgery has come to replace many conventional abdominal surgeries because of its outstanding advantages, including a better cosmetic result, faster recovery, and lesser postoperative pain. We present a case of laparoscopic-assisted total excision of Todani type I(B) choledochal cyst and biliary reconstruction in a 24-yearold female patient. Dissection of the cyst was done laparoscopically using the monopolar diathermy energy source. An end-to-side hepaticojejunostomy was created intracorporeally using 3-0 Vicryl suture, and end-to-side enteroenterostomy was completed outside the abdominal cavity using the E.K. glove port as wound protector. A new pair of gloves was then used to construct the glove port that served as the optical port. Additional instruments for retraction and suturing were deployed through the port whenever necessary. The use of the glove port also eliminated the need to suture the umbilical port before the completion of surgery. No intraoperative complications or technical problems were encountered using this technique. The use of the E.K. glove port makes it more a convenient and cost-effective procedure in a country like India.
The technique of laparoscopic cholecystectomy continues to evolve with a trend towards decreasing use of working ports. One of the emerging concepts of 21st century is single-port surgery. It has further minimized the minimally invasive surgery. However, the main drawbacks of this technique are the lack of “triangulation” to which the laparoscopic surgeons have grown accustomed to, the clustering of instruments, and the costly multichannel ports, which are very costly and, in fact, are not affordable by the majority of the population in a developing country like India.
From September 2009 to December 2011, 210 patients identified as having biliary colic, chronic cholecystitis, and previous biliary pancreatitis or obstructive jaundice due to stones (managed by ERCP) underwent single-port laparoscopic cholecystectomy using the E. K. glove port. The operating time was reasonable and can be lessened with experience. Excellent exposure of the critical view was obtained in all cases. This technique is safe, feasible, reproducible, cheap, and easy to learn. It may be an alternative to the currently available single-port access system, especially in a developing country like India. If required, placement of the remaining two to three ports for a more conventional laparoscopic cholecystectomy can be done.
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