Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2015; 21(45): 12857-12864
Published online Dec 7, 2015. doi: 10.3748/wjg.v21.i45.12857
Innovative technique of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration: A comparative study
Say-June Kim, Kee-Hwan Kim, Chang-Hyeok An, Jeong-Soo Kim
Say-June Kim, Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon 301-723, South Korea
Kee-Hwan Kim, Chang-Hyeok An, Jeong-Soo Kim, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu-shi 480-717, Gyeonggi-do, South Korea.
Author contributions: Kim KH designed the study and approved the final version for publication; Kim SJ, An CH and Kim JS contributed equally to acquiring and analyzing the data; Kim SJ and Kim KH interpreted the data; Kim SJ wrote the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee at Uijeongbu St. Mary’s Hospital (IRB code: UC15RISI0027).
Informed consent statement: The IRB has approved the informed consent procedures would appropriately be waived for all subject due to the nature of this study (retrospective analysis).
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at keehwan@catholic.ac.kr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kee-Hwan Kim, MD, PhD, Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, #271, Cheonbo-ro, Uijeongbu-shi 480-717, Gyeonggi-do, South Korea. keehwan@catholic.ac.kr
Telephone: +82-31-8203562 Fax: +82-31-8472717
Received: March 26, 2015
Peer-review started: March 30, 2015
First decision: May 18, 2015
Revised: May 22, 2015
Accepted: September 2, 2015
Article in press: September 2, 2015
Published online: December 7, 2015
Processing time: 255 Days and 3.8 Hours
Abstract

AIM: To investigate the safety and feasibility of needlescopic grasper-assisted single-incision laparoscopic common bile duct exploration (nSIL-CBDE) by comparing the surgical outcomes of this technique with those of conventional laparoscopic CBDE (CL-CBDE).

METHODS: We retrospectively analyzed the clinical data of patients who underwent CL-CBDE or nSIL-CBDE for the treatment of common bile duct (CBD) stones between January 2000 and December 2014. For performing nSIL-CBDE, a needlescopic grasper was also inserted through a direct puncture below the right subcostal line after introducing a single-port through the umbilicus. The needlescopic grasper helped obtain the critical view of safety by retracting the gallbladder laterally and by preventing crossing or conflict between laparoscopic instruments. The gallbladder was then partially dissected from the liver bed and used for retraction. CBD stones were usually extracted through a longitudinal supraduodenal choledochotomy, mostly using flushing a copious amount of normal saline through a ureteral catheter. Afterward, for the certification of CBD clearance, CBDE was performed mostly using a flexible choledochoscope. The choledochotomy site was primarily closed without using a T-tube, and simultaneous cholecystectomies were performed.

RESULTS: During the study period, 40 patients underwent laparoscopic CBDE. Of these patients, 20 underwent CL-CBDE and 20 underwent nSIL-CBDE. The operative time for nSIL-CBDE was significantly longer than that for CL-CBDE (238 ± 76 min vs 192 ± 39 min, P = 0.007). The stone clearance rate was 100% (40/40) in both groups. Postoperatively, the nSIL-CBDE group required less intravenous analgesic (pethidine) (46.5 ± 63.5 mg/kg vs 92.5 ± 120.1 mg/kg, P = 0.010) and had a shorter hospital stay than the CL-CBDE group (3.8 ± 2.0 d vs 5.1 ± 1.7 d, P = 0.010). There was no significant difference in the incidence of postoperative complications between the two groups.

CONCLUSION: The results of this study suggest that nSIL-CBDE could be safe and feasible while improving cosmetic outcomes when performed by surgeons trained in conventional laparoscopic techniques.

Keywords: Choledocholithiasis; Choledochotomy; Common bile duct exploration; Laparoscopy; Single-incision laparoscopic surgery

Core tip: Though single-incision laparoscopic surgery has been applied in various fields worldwide, the reports on the single-incision laparoscopic common bile duct exploration (SIL-CBDE) are very limited, possibly due to technical difficulties. In this study, we were intended to overcome these difficulties by using additional 2-mm needlscopic grasper. This grasper is separately entered into the right abdomen by a puncture, and helps to form a stable trangulation with the transumbilically placed instruments. Our SIL-CBDE resulted in comparable surgical outcomes as conventional laparoscopic CBDE, indicating that the nSIL-CBDE is not only cosmetically acceptable but also provides both operative safety and feasibility.