[Video-laparoscopic cholecystectomy with suprapubic approach. Technical note]

The authors describe a personal variant of the videolaparoscopic technique of cholecystectomy. This is characterised by the use of an open access to the abdominal cavity following the execution of pneumoperitoneum through an incision in a non-umbilical but suprapubic site, and the use of only three incisions and therefore only three operating trocars. Twenty-nine cholecystectomies have been performed using this personal technique of which only 2 had to be converted to open surgery. The reasons were not attributable to the technique and no complications were observed. The authors also performed a total of 99 laparoscopic cholecystectomies between February 1993 and September 1994 with a total of 4 reconversions and 1 complication (choleperitoneum). Concomitant lithiasis of the choledochus was present in 4 cases and treated with operative ERCP prior to laparoscopic cholecystectomy. Throughout this period only 4 cholecystectomies were performed using a laparotomic access roule owing to concomitant choledochal lithiasis and non-cannulatable papilla during ERCP. The reasons that led the authors to prefer the suprapubic access route were both aesthetic and technical owing to the reduced interference of the videocamera with other instruments, whereas the use of only 3 trocars was also based on the need to economise as well as on aesthetic grounds.