Culdolaparoscopy cholecystectomies with percutaneous needle assistance.

Culdolaparoscopy cholecystectomies with percutaneous needle assistance

Martha R. Dvila MD. Hospital Dr. Manuel Gea Gonzlez, DF, Mxico .Daniel A. Tsin MD. New European Surgical Academy.Fausto Dvila MD. Hospital Regional Sesver, Poza Rica, Veracruz,Mxico.Gloria Gonzlez MD. Hospital Isstecali, Tijuana, Baja California, Mxico.Andrea Tinelli MD. Hospital Vito Fazzi , Lecce , Italy.

Presented at the:

Society of Laparoendoscopic SurgeonsAnnual Meeting & Endo ExpoSept 2-5 2015New York, New York

Abstract:Objective: To present the feasibility and advantages of percutaneous needle assistance in hybrid and pure natural orifice transvaginal endoscopic cholecystectomies.

Material and Methods: We used Laparoscopy Reins and Hook Needles. The hybrid transvaginal cholecystectomy is based on the original description of Culdolaparoscopy that consists of the use of a long transvaginal laparoscope with minilaparoscopy assistance. We replaced the ancillary minilaparoscopy ports with percutaneous needles. For the pure transvaginal cholecystectomy, we evolved by eliminating the umbilical port and limiting it to a single 16 mm in diameter vaginal port for the parallel introduction of a gastroscope and long laparoscopy instruments.Results: The laparoscopy rein offers good traction, retraction and exposure, while the hook needle offers assistance in mobilization and exposure of the Calot triangle.

Conclusions: There is an increased interest in the use of percutaneous needles in port reducing ,single incision laparoscopy and robotics. This presentation shows percutaneous needles assistance in natural orifice surgery using the laparoscopy rein and the hook needle as a feasible cost contained technique that allows for completion of hybrid and pure transvaginal cholecystectomies without ancillary ports

The term CULDOLAPAROSCOPY first appeared in:Tsin DA.J Am Assoc Gynecol Laparosc. 2000 Aug;7(3):440; author reply 441-2. No abstract available.PMID: 11041659Visit: www.culdoscopy.comSection: ProfessionalsLetter to the Editor of the Journal of the American Association of Gynecologists Laparoscopists published before Natural Orifice Transluminal Endoscopic Surgery.

JSLS. 2001 Jan-Mar; 5(1): 6971.PMCID: PMC3015410Culdolaparoscopy: A Preliminary ReportDaniel A. Tsin(described a unique transvaginal approach of peritoneoscopy)

The Culdolaparoscope:We performed our first transvaginal cholecystectomy Minilaparoscopy Assisted Natural Orifice Surgery (MANOS) using a custom made 46 cm long laparoscope with a 30 degree angle view. The edges of the custom made laparoscope at the lens end were specifically manufactured with blunt, round, smooth edges that allow it to slide over the bowel serosa without producing any tears. We call this scope the Culdolaparoscope", it was used alternating with rigid transvaginal instruments and with minimal abdominal assistance for a hybrid form of natural orifice transvaginal endoscopic surgery, at the Mount Sinai Hospital of Queens located in Long Island City New York on August, 20 1999.

In 2008, Dr. Tsin and Dr. Fausto Davila, began a project replacing the culdolaparoscopy minilaparoscopy instruments with percutaneous needles, based on Dr. Davilas Single Port experience, dated from 1997.

minilaparoscopy instruments with parcutaneous needle based on Dr. Davila Single Port experience dated from 1997.

Here are some of our tools. In the center, is the rein which consists of a Keith needle with a 75 cm length, 2-0 Nylon suture with a silastic stoppage.

We also used a hook needle with a sharp end and a stabilizer to secure and manipulate as needed.

le is bent to make a hook and also to make it straight for removal..

Once inside the abdomen, the needle is bent to make a hook, and also to make it straight for removal.

CULDOLAPAROSCOPE , RIGID INSTRUMENTS 2.8-5 mm

The first level of conversion shows a transvaginal culdolaparoscope with a 2.8 or 5 mm instrument in the umbilicus, and the use of the percutaneous needles.

GASTROSCOPE , RIGID INSTRUMENTS 2.8-5 mmThe second level of conversion, we used a transvaginal gastroscope, and 2.8 or 5 mm instruments in the umbilicus and percutaneous needle assistance.

CULDOLAPAROSCOPY : CONVERSION LEVEL 2Here we see a gastroscope in the vaginal port , and the view of the rein at the fundus and the hook isused for exposing the Calot triangle.

GASTROSCOPE , PARALLEL RIGID INSTRUMENTS 5 mmThe third level of conversion, a pure procedure yet limited to the reins and hook and using a larger and longer vaginal port that we showed earlier to place the gastroscope and 5 mm instruments in a parallel fashion.

The specimen is extracted with no abdominal scars

VIDEOThis edited video shows the placing of the first rein at the fundus, viewed from a transvaginal gastroscope.

Between the first and second rein we used a needle to aspirate the gall bladder to limit biliary leakage.

The second rein is placed at the infundibulus.

The video shows the introduction of the needle and the use of the needle bender to form the hook and expose the Calot tringle.

The specimen is then extracted together with the vaginal port.

There are now new more narrow and stronger instruments, and a renewed interest in Minilaparoscopy, not limited to cholecystectomy.

Minilaparoscopy Assisted Natural Orifice Surgery, specifically Culdolaparoscopy, could offer solutions to the limitations of Minilaparoscopy with respect to insufflation, visualization, operation, and extraction of specimens.

Thank You for your attentionwww.culdoscopy.com

Find us on Twitter @sinhuella