Cholecystectomy using mini-instruments

The aim of the present paper is to describe the development of a standardiz ed technique of laparoscopic cholecystectomy using mini-instruments in orde r to demonstrate its feasibility with no increase in the risk to the patien t. For this purpose, the prospective data of the first 60 patients that app eared suitable to undergo laparoscopic cholecystectomy with mini-instrument s were recorded initially, 45 patients were operated on using a 10 mm, 30 d egrees standard laparoscope inserted via the umbilicus, together with two m ini-instruments and a standard instrument inserted under the right costal a rch. The subsequent 15 interventions were performed using, in addition to a 10 mm standard trocar placed in the umbilicus to accommodate the 10 mm lap aroscope, three subcostal employed minitrocars. For the special surgical st eps involved in intraoperative cholangiography, and the clipping of the cys tic duct and cystic artery, a minilaparoscope was introduced through the ep igastric port. Fifty-five of the patients were women, their average age was 47.6 years and the mean BMI 23.5. The sole intraoperative complication see n was bleeding from the liver that made necessary conversion to a 5 mm port to aspirate the coagulum. Conversion to a standard 5 mm instrument was als o required in two cases of broken forceps and in one case with a thickwalle d gallbladder in which the mini grasping forceps proved too weak. The mean operating time was 62.4 min, and no postoperative complications occurred. F or elective laparoscopic cholecystectomy including intraoperative cholangio graphy in slim patients, the use of mini-instruments is not associated with any increased risk of complications, and the operating time is acceptable. However, the general use of mini-instruments cannot as yet be recommended because of the less-than-optimal properties of the mini-instruments and the reduced optical quality of the mini-laparoscopes.