Subcostal trocar approach using four 5-mm with exclusive removal (stauffer): An efficient and useful technique for laparoscopic cholecystectomy

Levan Tsamalaidze, Samantha L. Permenter, John A. Stauffer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)311-319
Number of pages9
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques
Volume28
Issue number3
DOIs
StatePublished - Mar 1 2018

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Laparoscopic Cholecystectomy
Surgical Instruments
Operative Time
Hernia
Abdomen
Intestinal Fistula
Patient Positioning
Acute Cholecystitis
Cholecystitis
Polyps
Gallbladder
Crohn Disease
Medical Records
Comorbidity
Body Mass Index
Obesity
Hemorrhage

Keywords

  • Cholecystectomy
  • Laparoscopic cholecystectomy
  • Minimally invasive cholecystectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Subcostal trocar approach using four 5-mm with exclusive removal (stauffer) : An efficient and useful technique for laparoscopic cholecystectomy. / Tsamalaidze, Levan; Permenter, Samantha L.; Stauffer, John A.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques, Vol. 28, No. 3, 01.03.2018, p. 311-319.

Research output: Contribution to journalArticle

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abstract = "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.",
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