The “lap-loop” as a substitute for the fourth trocar in laparoscopic cholecystectomy

Ng, W. T.; Kong, C. K.; Yeung, H.C.; Böök, Kim; Yuen, K. S.

doi:10.1007/s004640080080

Cited by 5 publications

(4 citation statements)

References 2 publications

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“…Excessive lateral traction may also avulse the duct or artery, and therefore one should be careful not to apply too much traction. Other studies conducted in the past have confirmed the safety of the procedure [ 12 , 20 - 21 ]. Our study was a prospective observational study with a sample size of 102, but to further establish the safety and feasibility of three-port laparoscopic cholecystectomy, a comparative study with a larger sample size is required.…”

Section: Discussionmentioning

confidence: 64%

Three-Port Laparoscopic Cholecystectomy as a Safe and Feasible Alternative to the Conventional Four-Port Laparoscopic Cholecystectomy

Chatterjee,

Kumar,

Chattoraj

2024

Cureus

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Aims A prospective observational study was performed to assess the feasibility and safety of three-port laparoscopic cholecystectomy. Parameters comprising age, sex, number of cases in which intra-operative difficulty were encountered, and outcomes such as number of cases that required conversion to four-port laparoscopic cholecystectomy, postoperative pain on the visual analog scale (VAS), and postoperative hospital stay were assessed. We also documented difficult cases that were operated successfully with three ports, and the number of cases that needed conversion to four ports along with the reason for the conversion. Material and methods The patients were operated upon in the supine position in all cases. A pre-emptive analgesia with 1% lignocaine was administered in all cases prior to making the incision. The first port was 10-mm supraumbilical and inserted by the open technique. After insertion of the umbilical port, pneumoperitoneum was created by maintaining a maximum pressure of 12 mmHg and a flow rate of 8 L/minute. A camera head with a 30° telescope was introduced in the peritoneal cavity, and diagnostic laparoscopy was performed. A 10-mm subxiphoid port and a 5-mm subcostal port were placed under vision, with the latter placed more lateral and inferior to the conventional port position for better triangulation and ergonomics. The outcomes measured were operative time, the number of cases requiring a fourth port, postoperative pain (VAS), and postoperative hospital stay (number of days patients stayed in the hospital post-surgery until discharge). Data were collected using MS Excel, and an analysis was performed using SPSS Version 21.0. Results Data of 102 patients were analyzed prospectively. The mean age of the patients was 50.98 years, with an SD of 16.88, and the gender ratio was 73:29 (female: male). The mean operative time was 52.68 ± 20.84 minutes, with an SD of 20.84. Difficulty was encountered in 18.6% of cases in the form of pericholecystic adhesions, aberrant Calot’s anatomy, empyema or mucocele of the gallbladder, or bleeding from the liver bed or cystic artery stump. Postoperative pain was less in our study due to the reduced number of ports and the use of a pre-emptive analgesia, with a mean VAS score of 1.22 and an SD of 0.56. The mean postoperative hospital stay was 1.08 days, with an SD of 0.31. We needed to convert to a four-port procedure for safety in 2.9% cases. The operative time and postoperative hospital stay in our study were similar to those of other studies, but our average pain score was less due to the use of the pre-emptive analgesia. Only three cases required conversion to four ports, and 99 cases were successfully managed with three ports without compromising safety. No bile duct injury occurred in any of our 102 cases. Conclusion From this study, we conclude that three-port cholecystectomy is feasible, and it can be performed even in difficult cases without compromising safety. The surgic...

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Section: Discussionmentioning

confidence: 64%

Three-Port Laparoscopic Cholecystectomy as a Safe and Feasible Alternative to the Conventional Four-Port Laparoscopic Cholecystectomy

Chatterjee,

Kumar,

Chattoraj

2024

Cureus

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“…However, the special device is not readily available. We first described in 2001 the use of the ubiquitous intravenous cannula for the same purpose through a 16‐G cannula that had punctured the abdominal wall, a long thread was inserted into the peritoneal cavity where its end was grasped and exteriorized through the epigastric port; a sliding loop was fashioned, returned to the peritoneal cavity and used to encircle the fundus of the gall badder 4 . Since 2003, we have evolved the following simpler and more expedient modification.…”

mentioning

confidence: 99%

Simple and Effective Suspension Technique for Laparoscopic Cholecystectomy

Ng¹,

Cheng²

2006

ANZ Journal of Surgery

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Many surgeons elect to dispense with the lateral retraction port during laparoscopic cholecystectomy using the American four-port technique; however, this may not be easy and safe. To retain the superior ergonomical and observation advantages, suspension techniques that leave virtually no scars have been developed to substitute for the lateral retraction port. All published techniques for suspending the gall bladder fundus were reviewed and an attempt was made to evolve a technique that is expedient, safe and cost-effective. In our setting, the optimal technique is to pass a folded thread down a 14-G intravenous cannula that has punctured the abdominal wall to form a snare loop to entrap and hold the gall bladder fundus. The anchorage is maintained by a two-haemostat technique heretofore undescribed. In some of the cases where better exposure of the undersurface of the liver is needed, the cannula can be directed to puncture the thoracic cage at or below the seventh intercostal space to provide cephalad retraction and to rotate the liver superiorly. Postoperative chest radiographs did not show any pneumothorax. The simple suspension technique emulates the four-port technique's advantages in terms of favourable ergonomics and exposure (and hence safety). It is suitable for selected patients and due caution should be exercised.

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“…The endoloop is used to ensnare and stabilize the appendix during dissection of the mesoappendix. It also can be used to ligate the appendiceal stump [6].…”

mentioning

confidence: 99%

Transabdominal suspension sutures for laparoscopic cholecystectomy

Wt¹

2003

Surgical Endoscopy

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The “lap-loop” as a substitute for the fourth trocar in laparoscopic cholecystectomy

Cited by 5 publications

References 2 publications

Three-Port Laparoscopic Cholecystectomy as a Safe and Feasible Alternative to the Conventional Four-Port Laparoscopic Cholecystectomy

Three-Port Laparoscopic Cholecystectomy as a Safe and Feasible Alternative to the Conventional Four-Port Laparoscopic Cholecystectomy

Simple and Effective Suspension Technique for Laparoscopic Cholecystectomy

Transabdominal suspension sutures for laparoscopic cholecystectomy

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