Journal of Minimally Invasive Surgery 2021; 24(3): 152-157  https://doi.org/10.7602/jmis.2021.24.3.152
Gasless single-port laparoscopic cholecystectomy
Masashi Ishikawa, Michihito Asanoma, Yoshihiko Tashiro, Hirokazu Takechi, Kazuo Matsuyama, Takayuki Miyauchi
Department of Surgery, Shikoku Central Hospital, Shikokuchuo, Japan
Correspondence to: Masashi Ishikawa
Department of Surgery, Shikoku Central Hospital, 2233 Kawanoecho, Shikokuchuo, Ehime 799-0193, Japan
Tel: +81-896-58-3515
Fax: +81-896-58-3464
E-mail: masaishi1122@gmail.com
ORCID:
https://orcid.org/0000-0001-5434-6443
Received: May 17, 2021; Revised: July 13, 2021; Accepted: August 9, 2021; Published online: September 15, 2021.
© The Korean Society of Endoscopic and Laparoscopic Surgeons.

cc This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Purpose: Single-port laparoscopic surgery is anticipated to become the future of minimally invasive surgery. We have devised an alternative approach for laparoscopic cholecystectomy by inserting a single port at the umbilicus and using the abdominal wall-lifting method, without establishing pneumoperitoneum.
Methods: Retrospective analysis of 130 patients undergoing laparoscopic cholecystectomy was done to compare the conventional laparoscopic cholecystectomy (CLC) (n = 69) and the novel single-port laparoscopic cholecystectomy (SLC) using the abdominal wall-lifting method (n = 61). The surgical procedures were as follows. A 2- to 3-cm transumbilical incision was made, and a wound retractor was inserted into the abdomen without difficulty. Abdominal distension was obtained using a fan-shaped retractor without the use of carbon dioxide insufflations. A 5-mm flexible scope and modified curved graspers and dissectors were used to give the feeling of triangulation during dissection.
Results: The SLC group consisted of 25 males and 36 females with a mean age of 58.1 ± 7.2 years and a mean body mass index of 23.1 ± 3.2 kg/m2. The two groups were comparable for mean age, sex, disease, American Society of Anesthesiologists physical status classification, and comorbidity. Likewise, the duration of operation, postoperative hospital stays, complications, the number of use of analgesics, and conversion rate to open technique were not significantly different in the two groups.
Conclusion: The impaired view in single-port laparoscopic surgery can be improved by using articulating instruments that can be rotated out of the field of view. This novel gasless method is cost-effective and produces minimal postoperative discomfort with no additional scars.
Keywords: Laparoscopic cholecystectomy, Single-incision, Pain


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