TY - JOUR
T1 - Subcostal trocar approach using four 5-mm with exclusive removal (stauffer)
T2 - An efficient and useful technique for laparoscopic cholecystectomy
AU - Tsamalaidze, Levan
AU - Permenter, Samantha L.
AU - Stauffer, John A.
N1 - Publisher Copyright:
© 2018, Mary Ann Liebert, Inc.
PY - 2018/3
Y1 - 2018/3
N2 - Background: Laparoscopic cholecystectomy (LC) is commonly performed in patients who can pose technical challenges, such as obesity, prior surgery, and subsequent incisional hernias. A new technique, the subcostal trocar approach using four 5-mm with exclusive removal (STAUFFER) LC, was developed to diminish these impediments and is highly advantageous. Methods: A retrospective review was performed of medical records for 389 patients who underwent LC from June 2011 through December 2016. STAUFFER LC involves (1) steep patient positioning, (2) visualized 5-mm trocar entry in the right abdomen, (3) use of three additional right subcostal trocars, and (4) gallbladder extraction from the high right lateral trocar site. Patient characteristics, operative details, and outcomes were analyzed and compared. Results: STAUFFER LC was used in 255 patients (65.6%), and standard four-Trocar LC (SLC) was performed in 134 patients (34.4%). Overall indications for surgery included chronic cholecystitis (71.7%), acute cholecystitis (19.8%), polyp (2.3%), and other (5.9%). No significant differences were detected in comorbidities and American Society of Anesthesiologists classification between the two patient groups. More patients in the STAUFFER LC group had previous midline abdominal surgery (P = .06) and significantly higher body mass index (P = .03), and they required less operative time (P < .001). No patient had an entry site injury. No significant difference was noted in morbidity. One patient required a second laparoscopic operation for bleeding. One patient with Crohn's disease and "hostile abdomen" had an enterocutaneous fistula that closed spontaneously. In the SLC group, trocar site hernia (TSH) developed in 3 patients. Conclusions: STAUFFER LC is widely applicable and effective, saving operative time and reducing the risk of TSH. It is especially advantageous for obese patients who have had previous surgery.
AB - Background: Laparoscopic cholecystectomy (LC) is commonly performed in patients who can pose technical challenges, such as obesity, prior surgery, and subsequent incisional hernias. A new technique, the subcostal trocar approach using four 5-mm with exclusive removal (STAUFFER) LC, was developed to diminish these impediments and is highly advantageous. Methods: A retrospective review was performed of medical records for 389 patients who underwent LC from June 2011 through December 2016. STAUFFER LC involves (1) steep patient positioning, (2) visualized 5-mm trocar entry in the right abdomen, (3) use of three additional right subcostal trocars, and (4) gallbladder extraction from the high right lateral trocar site. Patient characteristics, operative details, and outcomes were analyzed and compared. Results: STAUFFER LC was used in 255 patients (65.6%), and standard four-Trocar LC (SLC) was performed in 134 patients (34.4%). Overall indications for surgery included chronic cholecystitis (71.7%), acute cholecystitis (19.8%), polyp (2.3%), and other (5.9%). No significant differences were detected in comorbidities and American Society of Anesthesiologists classification between the two patient groups. More patients in the STAUFFER LC group had previous midline abdominal surgery (P = .06) and significantly higher body mass index (P = .03), and they required less operative time (P < .001). No patient had an entry site injury. No significant difference was noted in morbidity. One patient required a second laparoscopic operation for bleeding. One patient with Crohn's disease and "hostile abdomen" had an enterocutaneous fistula that closed spontaneously. In the SLC group, trocar site hernia (TSH) developed in 3 patients. Conclusions: STAUFFER LC is widely applicable and effective, saving operative time and reducing the risk of TSH. It is especially advantageous for obese patients who have had previous surgery.
KW - Cholecystectomy
KW - Laparoscopic cholecystectomy
KW - Minimally invasive cholecystectomy
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U2 - 10.1089/lap.2017.0554
DO - 10.1089/lap.2017.0554
M3 - Article
AN - SCOPUS:85045693270
SN - 1092-6429
VL - 28
SP - 311
EP - 319
JO - Journal of Laparoendoscopic and Advanced Surgical Techniques
JF - Journal of Laparoendoscopic and Advanced Surgical Techniques
IS - 3
ER -