Mindener Technik der minimalinvasiven Gallenblasenoperation-Operationstechnik mit kaum sichtbaren Narben (Beobachtungs-Studie)

Background: Presently, there is a worldwide attempt to further decrease abdominal trauma and optimize the cosmetic results after laparoscopic cholecystectomy. In a prospective observational study, the combined suprapubic and intraumbiilical cholecystectomy in Minden modification (MI- CHE) was evaluated. Method: The MI- CHE is performed via a 5mm intraumbilical trocar through which a 30° optic is introduced. A 10 mm trocar that is later used as a camera port for the long 45° laparoscopic optic is then instilled in the suprapubic area under visual control, alongside of a long curved grasper. An auxiliary instrument may be punctured into the right abdominal flank without a trocar. Retrieval of the gall bladder is carried out through the suprapubic incision. Patients: Two surgeons within this study operated 30 consecutively selected patients presenting with non-complicated symptomatic cholelithiasis. Clinical data was collected during the perioperative phase and least 3 months after surgery. 6 selected independent judges including 2 independent surgeons, 2 beauticians and 2 patients awaiting surgery due to biliary lithiasis analyzed 18 standardized photos of each patient taken peri- and postoperatively. Results: Between April 2009 and February 2010 two surgeons successfully operated 30 patients, 9 males and 21 females. The average operating time required by both surgeons was 73.06 minutes (65.75 vs. 87.7) minutes. No conversion to 4- trocar laparoscopic or open cholecystectomy was nessesary. No complications were observed. Perioperative data (operation time, pain, mobilization, enteralization, and duration of hospital stay) was within the range found in literature concerning laparoscopic cholecystectomy. Cosmetic results: In all 9 males and 21 females, the scars were barely visible after 3 months. The only visible scar on most patients was the 10 mm incision in the suprapubic area, which was not visible when underwear was normally worn. All the independent judges agreed that the 11 cosmetic results after 3 months were very good with an average of 7.35, 7.92, 8.2, 8.39, 8.45 and 8.98 on the Likert-scale (from 0= “very bad” 10= “very good”). The patient's subjective judgment of the cosmetic results was 9.6 on average (SD 0,76) and 9 in median (range 6-10) on the Likert-scale with an optimum value of 10. All Patients involved admitted they would select this method again. Conclusion: MI- CHE has very good cosmetic results and has shown good acceptance among male and female patients. It seems to be a safe and effective alternative to the traditional laparoscopic cholecystectomy with comparatively good perioperative results. Due to the nature of the observational study, this remains a hypothesis at present.