BackgroundThe minimally invasive abdominal surgery has evolved to reduce portals,
culminating with a single incision and natural orifice operation. However, these
methods are still expensive, difficult to implement and with questionable
aesthetic results.AimTo present the standardization and preliminary results of a technique for
performing laparoscopic suprapubic access by the principle which was called the
Supra Pubic Endoscopic Surgery for cholecystectomy.MethodThe average body mass index of patients, the mean operative time, clinical data of
the postoperative complications and quality of life were prospectively studied.
The operation incisions consisted of: A) umbilical for instrumental dissection and
clipping; B) in the right groin for handling and gallbladder gripping; C)
suprapubic for the camera. With the patient in reverse Trendelenburg and left
lateral decubitus, the operation flew by the camera trocar in C, proceeding with
dissection and isolation of the biliary pedicle, identification of cystic duct and
artery, with usual instrumentation. Transcystic intraoperative cholangiography was
performed in all cases in which there were indications. The procedure was
completed with clipping and sectioning of the cystic duct and artery, retrograde
resection of the gallbladder and extracting it by the umbilical trocar incision
under direct vision.ResultsThirty patients undergone this surgical procedure between March and June 2012 and
were evaluated. The mean age was 40.7 years and the indications were typical
biliary colic in 18 cases (60 %), cholecystitis in five cases (16.6 %), biliary
pancreatitis in one case (3.3%); polyp in three cases (10%) and obstructive
jaundice at three cases (10%). The average body mass index was 27.8 (23.1-35.1)
and surgical time ranged between 24 and 70 minutes.ConclusionThe technique proved to be feasible and safe , with no significant complications,
and satisfactory cosmetic results.