Background: The introduction of natural orifice translumenal endoscopic surgery (NOTES) has demanded the creation of new techniques to accomplish minimally invasive procedures using flexible endoscopic instruments. We evaluated a technique similar to that employed in endoscopic mucosal resection and applied it to the dissection of the gallbladder from the liver bed.
Methods: Eight patients underwent an elective, transumbilical single incision cholecystectomy using a flexible endoscope in our institution from August to October of 2007. Approximately 15 mL of saline were strategically injected into the gallbladder fossa with an endoscopic injection needle. After infiltration of this potential space, dissection of the gallbladder and hilum was carried out with endoscopic instruments and the cystic duct and artery were clipped with standard instruments.
Results: One of the eight patients had inadvertent perforation of the gallbladder during dissection. The technique of infiltrating the potential space between the gallbladder and the liver bed leads to a significantly improved visualization of the plane between the gallbladder and the liver bed.
Conclusions: The technique of saline injection to develop surgical planes is an invaluable tool in performing a cholecystectomy using flexible endoscopic instrumentation. The enhancement of the potential space between the gallbladder and the liver bed improved visualization in all of our patients. This technique can prove valuable in dissections and requires further experimentation to evaluate its effectiveness in other applications.