Use of Percutaneous Needles in the Feasibility of Single-port Laparoscopic Cholecystectomy

IntroductionThe usefulness of percutaneous needles (PN) to replace traditional assistance ports in mini-invasive techniques with a single port is analyzed and their feasibility for conducting a single port laparoscopic cholecystectomy (SPLC) is demonstrated.Material and methodsA retrospective, linear and descriptive study covering 2431 patients with a diagnosis of acute and non-acute gallbladder disease has been conducted. The patients underwent a single port laparoscopic cholecystectomy using some type of PNs, replacing the assisting ports used in traditional laparoscopic cholecystectomy (TLC). Based on the progressive use of PNs–reins (R), hooked needles (HN) and passing suture needles (PSN)–to carry out the SPLC technique, 3 groups have been established: A, B and C. The results were compared using a Student t test, odds ratio and CI and were analyzed by means of the SPSS software v. 13.0.ResultsThe use of PNs showed an increased feasibility for the laparoscopic procedure, as they were included in the surgical technique. The R were useful when carrying out the SPLC in 78% of the cases and when the HK were added, the results increased to 88%. When using the 3 types (R, HN and PSN), the results increased by 96%. Statistical significance was obtained with these values: chi 2=67.13 and P<.001; odds ratio and 95% CI became significant when comparing the B/C, A/C, and A–B/C groups.ConclusionsThe PNs, replacing the assisting ports in laparoscopy, make it possible to attain a feasibility of the process in 96% of the cases. This percentage was similar to what is achieved with the TLC, which places the one port laparoscopy surgery technique as an advantageous and economic alternative. This application of the PNs could be made extensive to other single-port techniques, with a multi-valve platform and natural orifice surgery.

ResumenIntroducciónSe analiza la utilidad de agujas percutáneas (AP) sustituyendo puertos de asistencia tradicionales en técnicas miniinvasivas de puerto único, mostrando su factibilidad al realizar colecistectomía laparoscópica con un puerto (CL1P).Material y métodosEstudio retrospectivo, lineal y descriptivo de 2.431 pacientes intervenidos de CL1P, por enfermedad vesicular aguda y no aguda utilizando algún tipo de AP, sustituyendo los puertos asistenciales usados en colecistectomía laparoscópica tradicional (CLT).Basado en el uso progresivo de AP: riendas (R), aguja-gancho (AG) y aguja pasa hilos (APH) al desarrollar la técnica CL1P, dividimos 3 grupos: A, B y C. Se compararon resultados utilizando T de student, odds ratio e IC, analizándolos mediante SPSS 13.0.ResultadosEl uso de las AP mostró incremento en la factibilidad del procedimiento laparoscópico, conforme se integraron en la técnica quirúrgica. Las R tuvieron factibilidad de realizar CL1P en 78% de los casos, integrando AG aumentó a 88% y utilizando R, AG y APH en 96%. Hubo significación estadística con valores: Ji2 de 67,13 y p < 0,001; odds ratio e IC (95%) obtuvieron significación comparando grupos B/C, A/C y A-B/C.ConclusionesLas AP, sustituyendo puertos asistenciales, permiten alcanzar factibilidad del procedimiento en el 96% de los casos, semejante al que se logra con la CLT, lo cual coloca a la técnica CL1P como una alternativa ventajosa y económica. Esta aplicación de las AP podría ser extensiva a otras técnicas de puerto único, con plataforma multivalvular, y a la cirugía por orificios naturales.