Covert Access Laparoscopic Cholecystectomy: Our Single Center Preliminary Results

Abstract

Introduction: Conventional laparoscopic cholecystectomy involves four trocars incisions on the upper abdomen,which may result in unfavorable cosmetic results. The minimally invasive abdominal surgery has developed toreduce the number of ports, operating with a single incision and natural orifice operation. However, these methodsare still expensive, difficult to implement and with questionable aesthetic results. The suprapubic approach presentsas a simpler and cheaper alternative with good aesthetic results.This study aimed to improve the aesthetic results of laparoscopic cholecystectomy (LC) by using a bikini line portsas an alternative approach to make trocar scars invisible. The feasibility and safety of this technique were evaluated.Patients and methods: This study involved 28 patients with symptomatic cholelithiasis who underwent LCbetween June 2022 and June 2023. The procedure involved inserting a first trocar (10-12 mm, optical trocar) inthe lower abdomen at the bikini line to the left of the midline, insufflation with CO2 and then the other two trocarswere placed at the bikini line to the right and left of the first one.Results: Standard instruments were used to perform the surgery, and the mean operative time was 54.66 ± 14.1min. No intraoperative or postoperative complications occurred, and the median follow-up was 24 weeks. Thecosmetic results were satisfactory for all patients, as the use of only three ports in the bikini line completely hidthe scars from the ports’ incision.Conclusion: Covert Laparoscopic Cholecystectomy: Is a new minimally invasive technique that proved to befeasible and safe, with no significant complications, and satisfactory cosmetic results.