-Report on Experiments and Clinical Cases-

Single-incision Laparoscopic Cholecystectomy with an Additional Needle Grasper: A Novel Technique

Osamu Komine¹, Hideyuki Suzuki¹, Masanori Watanabe¹, Satoshi Nomura¹, Satoshi Mizutani¹, Masanori Yoshino¹, Naoto Chihara¹, Keisuke Mishima¹, Rina Oyama¹ and Eiji Uchida²

¹Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital
²Department of Surgery, Nippon Medical School

Background: Single-incision laparoscopic surgery has gained increasing attention due to its potential to improve the benefits of laparoscopic surgery. However, the technique remains technically challenging for most surgeons. We developed a new technique utilizing a needle grasper held in the surgeon's left hand as an alternative to conventional single-incision laparoscopic cholecystectomy (SILC).
Patients and Methods: From August 2011 through May 2013, 29 patients at Nippon Medical School Musashi Kosugi Hospital, with gallbladder stones or polyps underwent single-incision laparoscopic cholecystectomy (SILC) with an additional needle grasper that was held in the surgeon's left hand (SILCAN) and introduced in the right subcostal region without a trocar. We analyzed intraoperative and postoperative outcomes of 29 patients for whom SILCAN was performed and retrospectively compared these outcomes to those of 32 patients who underwent conventional 4-port laparoscopic cholecystectomy (CLC) from January 2011 through May 2013.
Results: No differences in patient characteristics or intraoperative/postoperative outcomes were observed between the groups. None of the patients in either group required conversion to an open procedure or additional ports. In the SILCAN group, no patients had complications within the first 4 weeks after surgery, with the exception of 1 patient with severe chronic cholecystitis in whom bile duct stenosis developed due to inadvertent clipping of the common hepatic duct. The frequency of postoperative analgesic use was similar in both groups, although none of the patients in the SILCAN group received analgesics for pain from the small, inconspicuous wound in the right subcostal region.
Conclusions: SILCAN is a safe and feasible alternative to SILC which does not compromise the qualities of CLC. It is less technically challenging, and postoperative pain and cosmesis are comparable to those of conventional SILC.

J Nippon Med Sch 2015; 82: 43-49

Keywords
single incision, laparoscopic surgery, cholecystectomy, needle surgery, reduced port surgery

Correspondence to
Osamu Komine, Institute of Gastroenterology, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-cho, Nakahara-ku, Kawasaki, Kanagawa 211-8533, Japan
ANA62519@nifty.com

Received, July 25, 2014
Accepted, January 8, 2015