LAPAROSCOPC HAND-PORT ASSISTED CHOLECYSTECTOMY: AN ALTERNATIVE APPROACH IN CONVERTING MINIMALLY INVASIVE SURGERY FOR COMPLICATED GALLBLADDER DISEASES
Oluwatosin Fawibe*2,3, James H. Avruch4, Sara Halizadeh Barfjani2,3, Elliott G. Smith2,3, Massimo Arcerito4,1
1Surgery, Riverside Medical Clinic INc, Temescal Valley , CA; 2Riverside Community Hospital, Riverside, CA; 3University of California Riverside, Riverside, CA; 4University of Maryland Medical System, Baltimore, MD
Introduction: Minimally Invasive cholecystectomy (laparoscopic or robotic) is the gold standard in treating symptomatic cholelithiasis and more complex gallbladder diseases. When there is a need for conversion, a right subcostal incision is universally used. Objective: To assess the role of laparoscopic hand-port assisted cholecystectomy, as an alternative approach to the right subcostal incision in converting complicated cholecystitis. Material and Methods: Between August 2013 and July 2022, 712 patients underwent minimally invasive cholecystectomy (645 laparoscopic, 67 robotic). Of those, 85 patients (47 M, 38 F) with mean age of 60 years old (20-95) were converted using laparoscopic hand-port technique. They represent our prospective review. Emergent surgery, reason for conversion, hospital course, peri- and post-operative complication and pain medication use represent the main outcome measures. Results: Eighty-two patients were treated in acute care surgery setting, while 3 patients were scheduled for suspected gallbladder malignancy. Conversion was secondary to the following: chronic cholecystitis (32), porcelain gallbladder (3), gangrenous cholecystitis (28), Mirizzi's syndrome (5), gallstone pancreatitis (5), gallbladder mass (3), remnant gallbladder (3), xanthogranulomatous cholecystitis (1), obesity (5). A patient had type-A biliary duct injury due to Luschka's duct, and he was treated endoscopically with biliary stent placement and sphincterotomy. Mean hospital stay was 32 hours (18-48), and regular diet was resumed within 24 hours. Postoperatively, 2 patients had urinary retention, 2 patients developed wound infection and 1 obese patient developed a ventral hernia 6 months after surgery. He was treated with robotic bariatric surgery and ventral hernia repair with non-absorbable mesh. Our patients's postoperative pain was controlled with scheduled anti-inflammatory drugs and all were discharged home on the same PO regimen. All patients resumed regular activity within 2 weeks from surgery. Conclusions: Laparoscopic hand-port assisted cholecystectomy should be considered a valid alternative in converting complicated gallbladder pathologies to the current traditional right subcostal incision. Comparison in quality of life and long term clinical outcome between the two techniques are warranted.
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