J Minim Invasive Surg.  2015 Mar;18(1):7-13. 10.7602/jmis.2015.18.1.7.

The Feasibility of Fundal Retraction of the Gallbladder in the Single Port Laparoscopic Cholecystectomy: Comparison between a 4-instrument Fundal Retraction Group and a 3-instrument Group

• Kim JS
• Han HJ
• Song TJ
• Choi SB
• Kim WB
• Choi SY
• Suh SO

• KMID: 1895240
• DOI: http://doi.org/10.7602/jmis.2015.18.1.7

Abstract

PURPOSE
Owing to the accumulation of surgical experience, the indications of single port laparoscopic cholecystectomy (SLC) have increased. To overcome the difficulties and limitations of SLC, we included an additional instrument for use in retracting the gallbladder fundus. The aim of this study was to investigate the feasibility of 4-instrument fundal retraction SLC.
METHODS
We retrospectively analyzed 134 patients who had undergone SLC for benign gallbladder disease. We compared the clinical outcome between patients who had undergone SLC without fundal retraction (3-instrument SLC, n=102) and those who had undergone SLC with fundal retraction (4-instrument fundal retraction SLC, n=32).
RESULTS
Of 134 patients, 47 were male and 87 were female. A significantly higher proportion of patients in the 4-instrument fundal retraction group had gallbladder distention and wall thickening than patients in the 3-instrument SLC group. No statistically significant difference in the incidence of pericholecystic inflammation, adhesion, and gallbladder perforation; duration of operation, the incidence of complications, and duration of postoperative hospital stay was observed between the two groups. In univariate analysis to perform 4-instrument fundal retraction SLC, higher BMI, the presence of gallbladder distension, and wall thickening were significant factors. In multivariate analysis, gallbladder distention and the presence of concurrent operation during SLC were independently significant factors for performing 4-instrument fundal retraction SLC.
CONCLUSION
Four-instrument fundal retraction SLC is a feasible and safe surgical procedure, particularly in patients with a high BMI, gallbladder distention, wall thickening, inflammation, or adhesions. If difficulties are encountered during 3-instrument SLC, simple fundal retraction using an additional instrument may be the preferred option prior to converting the operation to conventional laparoscopic cholecystectomy.

Keyword

Gallbladder/surgery; Cholecystectomy; Laparoscopic/methods; Cholecystitis, Acute/surgery; Inflammation/surgery

MeSH Terms

Cholecystectomy
Cholecystectomy, Laparoscopic*
Female
Gallbladder Diseases
Gallbladder*
Humans
Incidence
Inflammation
Length of Stay
Male
Multivariate Analysis
Retrospective Studies