TRANSCYLINDRICAL CHOLECYSTECTOMY - NEW TECHNIQUE FOR MINIMALLY INVASIVE CHOLECYSTECTOMY

Minilaparotomy cholecystectomy presents exposition difficulties, and l aparoscopy requires expensive equipment and additional training. Lapar otomy is more painful, causes trauma to the abdominal wall, and requir es a longer convalescence; it is also less aesthetic, We present a new technique for minilaparotomy cholecystectomy, transcylindrical cholec ystectomy (TC), based on the introduction of a 3.8- or 5.0-cm diameter cylinder (10.0 cm long). The cylinder serves the purpose of separatin g and isolating the hepatocystic triangle from the surrounding structu res, thereby providing a stable surgical field and adequate vision of the hepatocystic triangle so the technique can be performed safely. Pa tients who have been diagnosed with symptomatic cholelithiasis, who ar e convalescent from biliary pancreatitis, or who have acute cholecysti tis have been treated consecutively by TC. We have carried but the pro cedure on 116 occasions, 94 using the 3.8-cm cylinder and 28 with the 5.0-cm cylinder; both cylinders were used in 6 cases, The indications for using the 5.0-cm cylinder were mainly cholecystitis, pancreatitis, choledocholithiasis, and difficulty with the 3.8-cm cylinder, The res ult is a 4.5- or 7.0-cm incision. We had difficulty recognizing the an atomy in 11 dissections so we had to enlarge the incision, We have not had accidents related to placement of the cylinder, hemorrhage, or bi le duct injuries. The median operating time was 43 minutes, and the me an postoperative stay was 1.8 days, Postoperative FVC and FEV1 reducti ons were 21.7% and 27.4%, respectively. The technique has proved fast, safe, and practicable using conventional material. The cost of TC is $701 (US).