Two Port Laparoscopic Cholecystectomy with a Technical Modification of Using Port Closure Needle (The Chalkoo Modification)

Abstract

Background: Laparoscopy has revolutionised the gall bladder surgery since inception. There have been more than 30 different ways of performing Laparoscopic cholecystectomy mentioned in the literature. The standard 4 port Laparoscopic cholecystectomy has been modified to 3 port, 2 port, single port, SILS, NOTES cholecystectomy. Two port Laparoscopic cholecystectomy has also been modified in many ways using sutures for the traction of fundus and the infundibulum (puppet technique) and using alligator forceps. We became interested to modify two port lap chole by using port closure needle as a rescue instrument. Objective: To assess the technical ease, safety and feasibility of using a new instrument (port closure needle) in performing two port laparoscopic cholecystectomy. Materials and Methods: To assess the safety and technical feasibility of 2 port laparoscopic cholecystectomy using port closure needle as a rescue instrument. We selected a group of 50 patients for a prospective study at Govt. Medical College Srinagar, Kashmir India between January 2016 to January 2018. Our modification of 2 port lap chole resulted in no scar for the port closure needle and avoided the time consuming puppet sutures for traction of fundus and infundibulum. The cases were performed by a single surgeon in the unit. The selection criteria for laparoscopic cholecystectomy with 2 port taking assistance with port closure needle were done purely on clinical and Sonographic findings. Results: The study was performed with a sample size of 50 patients selected purely on radiological findings. Two port laparoscopic cholecystectomy with assistance from port closure needle, offering the benefit of availability of left hand at the operative site was performed in a span of two year. 28 cases were females and 22 cases were males. The age range was between 12 to 50 years with a median age of 25 years. The mean body mass index was 30 (range 25-35). Mean operative time was 20 minutes (range 15-35 minutes) and a follow up period ranged from 6 to 9 months. No cases were converted to open though 4 cases required an additional port which was placed in the umbilicus at its 8 o’clock position. Conclusion: Laparoscopic two port cholecystectomy taking help from port closure needle gives the benefit of left hand being available to the surgeon, yet avoiding a port and its subsequent scar. It is more convenient, rapid technique over 2 port puppet techniques and 2 port alligator technique. We were satisfied with its good results and patients satisfaction. However, a word of caution is that the port closure needle being a sharp and traumatic instrument needs to be handled carefully even by the expert surgeon.