Dávila ÁF, Gutiérrez RL, Dávila ÁU, Montero PJJ, Lemus AJ, Torres MJ, Dávila ÁMR, Gutiérrez VDE

Language: Spanish
References: 21
Page: 205-212
PDF size: 129.60 Kb.

ABSTRACT

Background: Clinical application of natural orifice transluminal endoscopic surgery is under investigation. The clinical experience in humans has been developed through transvaginal access. The technique and initial results of hybrid transgastric cholecystectomy are now reported in this article. Methods: Three patients aged 20-55 years (two with no acute cholelithiasis and one with acute cholelithiasis) underwent transgastric cholecystectomy with transumbilical assistance (hybrid technique) in a prospective study. The gastrotomy was created under laparoscopic guidance through a 11 mm umbilical trocar, for the use of a laparoscopy with a 6 mm working channel that allows to use 5 x 43 cm length instruments to put leashes in gallbladder, dissect and clip the cystic pedicle. The gastrotomy was performed using an endoscope helped by an sphincterotome. The endoscope permits the procedure guidance and the gallbladder extraction through the stomach. Results: The procedure was successful in all patients with a median operating time of 165 (range 145-185) min. Transumbilical assistance allows the using of percutaneous neddles that facilitates the gallbladder traction, the dissection and clip of cystic structures, and the secure close of stomach. There were no intraoperative or postoperative complications. There was not a visible scar in abdomen. Conclusions: Until technical issues have been not resolved, a transumbilical assistance is necessary in a transgastric cholecystectomy for a safety and efficient procedure.

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