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PERSONAL VIEWPOINT
Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 271-273
 

Twenty years of mini-laparoscopy in Brazil: What we have learned so far


1 Health and Biologic Sciences Center, Catholic University of Pernambuco, Recife, Pernambuco, Brazil
2 Department of General Surgery, University of Pernambuco, University Hospital Oswaldo Cruz, Recife, Pernambuco, Brazil
3 Medical Student, School of Medicine, Pernambuco Health College, Recife, Pernambuco, Brazil

Date of Submission23-Jul-2019
Date of Decision26-Aug-2019
Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Diego Laurentino Lima
Desembargador Joao Paes Street, Number 421, Apartment 1101, Recife, Pernambuco
Brazil
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmas.JMAS_179_19

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 ¤ Abstract 

The mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho, and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy. We discuss the development of mini-laparoscopy in Brazil for the past 20 years.


Keywords: Cholecystectomy, hernia, laparoscopy, minimally invasive surgical procedures


How to cite this article:
Lima DL, Carvalho GL, Cordeiro RN. Twenty years of mini-laparoscopy in Brazil: What we have learned so far. J Min Access Surg 2021;17:271-3

How to cite this URL:
Lima DL, Carvalho GL, Cordeiro RN. Twenty years of mini-laparoscopy in Brazil: What we have learned so far. J Min Access Surg [serial online] 2021 [cited 2021 Apr 10];17:271-3. Available from: https://www.journalofmas.com/text.asp?2021/17/2/271/277077


Laparoscopic cholecystectomy has become the standard procedure for the treatment of gallbladder diseases, since this technique allows the possibility of smaller incisions, reduced hospital stay, less post-operative pain, and better cosmetic results.[1],[2],[3],[4],[5],[6],[7],[8] Using a minimally invasive technological advancement, the mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy (CLC).[1],[2],[4],[9],[10] Different terms were used to describe this technique: mini-laparoscopy, needlescopic surgery and microlaparoscopy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho et al., and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy (3.2%).[11] In <24 h after the procedure, 96% of the patients were discharged from the hospital. In 2008, Cabral et al. performed a prospective study with 60 patients, comparing MLC to the conventional 5-mm laparoscopic procedure. He concluded that both techniques were safe, with similar operative durations. However, the patients submitted to MLC presented a better aesthetic outcome and less pain until the postoperatory day 4.[12]

For many years, surgeons discussed the advantages of mini-laparoscopic procedures, such as aesthetic improvements and less pain? Several studies tried to find answers to these questions. Bisgaard et al.[13] showed that the cosmetic results were expressively superior in the 3.5-mm trocar group. Cheah et al.[14] showed that the MLC scars were 32% smaller than those of CLC. Kimura et al.[15] demonstrated that the scars become significantly smaller than the trocar diameters right after the surgery and after a 6-month follow-up. Besides, the pigmentation attenuates while the scar reduces.

In 2009, another publication by our team showed the results after 1000 cases in Brazil. One important finding was that the use of knots instead of clips significantly reduced the cost of the procedures.[3]

However, mini-laparoscopy has proven to provide more than just better aesthetic results. Other advantages of its use have been confirmed; they include better visualisation of the surgical field and allows the surgeon to perform more precise movements.[16] We conducted a study comparing the abilities of surgeons, residents and students performing different tasks with conventional 5-mm instruments and 3-mm minilaparoscopic instruments. When comparing CLC to MLC, medical students and residents took less time to perform more precise tasks (such as tying a knot, passing a suture through metal rings, and creating a necklace) when using mini-laparoscopic instruments.[16]

The most traditional use of mini-laparoscopic instruments is while performing cholecystectomies. However, these instruments can also be used in hernia procedures and more complex surgeries.[17],[18],[19],[20] It has become very popular in inguinal hernia repairs. When working in a limited space, such as in totally extraperitoneal (TEP) repair, smaller instruments have helped surgeons perform more precise movements and have a better visualisation of the surgical field.[20],[21]

Carvalho et al. showed a combined totally transabdominal pre-peritoneal and a TEP technique) for inguinal hernia repair. With a successful description of 22 cases, this technique proved to be safe and simple and with reduced costs. There was no use of balloon dissection or mesh fixation.[21]

Malcher et al. showed that mini-laparoscopic TEP (TEP inguinal hernia procedure) can benefit patients and surgeons due to the reduction in early post-operative pain and reduced operative time when compared to the conventional laparoscopic TEP procedure. He also described the reduced costs due to not using a dissection balloon or mesh fixation.[20]

The mini-laparoscopic technique, over the years, has proved to be a very reliable and important option for Brazilian surgeons. It cannot be declared as being better or worse than other consecrated techniques. However, surgeons ought to be aware of this technique while preparing this strategy for the next surgery. It is been 20 years of mini-laparoscopy in Brazil, and even with the rising popularity of the robotic surgery, mini-laparoscopy is far from becoming obsolete.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
 ¤ References Top

1.
Franklin ME Jr., Jaramillo EJ, Glass JL, Treviño JM, Berghoff KR. Needlescopic cholecystectomy: Lessons learned in 10 years of experience. JSLS 2006;10:43-6.  Back to cited text no. 1
    
2.
Lee PC, Lai IR, Yu SC. Minilaparoscopic (needlescopic) cholecystectomy: A study of 1,011 cases. Surg Endosc 2004;18:1480-4.  Back to cited text no. 2
    
3.
Carvalho GL, Silva FW, Silva JS, de Albuquerque PP, Coelho Rde M, Vilaça TG, et al. Needlescopic clipless cholecystectomy as an efficient, safe, and cost-effective alternative with diminutive scars: The first 1000 cases. Surg Laparosc Endosc Percutan Tech 2009;19:368-72.  Back to cited text no. 3
    
4.
Carvalho GL, Cavazzola LT, Rao P. Minilaparoscopic surgery-not just a pretty face! What can be found beyond the esthetics reasons? J Laparoendosc Adv Surg Tech A 2013;23:710-3.  Back to cited text no. 4
    
5.
Suo G, Xu A. Clipless minilaparoscopic cholecystectomy: A study of 1,096 cases. J Laparoendosc Adv Surg Tech A 2013;23:849-54.  Back to cited text no. 5
    
6.
Risquez F, Pennehouat G, Fernandez R, Confino E, Rodriguez O. Microlaparoscopy: A preliminary report. Hum Reprod 1993;8:1701-2.  Back to cited text no. 6
    
7.
Ros A, Gustafsson L, Krook H, Nordgren CE, Thorell A, Wallin G, et al. Laparoscopic cholecystectomy versus mini-laparotomy cholecystectomy: A prospective, randomized, single-blind study. Ann Surg 2001;234:741-9.  Back to cited text no. 7
    
8.
Sarli L, Costi R, Sansebastiano G. Mini-laparoscopic cholecystectomy vs. laparoscopic cholecystectomy. Surg Endosc 2001;15:614-8.  Back to cited text no. 8
    
9.
Gagner M, Garcia-Ruiz A. Technical aspects of minimally invasive abdominal surgery performed with needlescopic instruments. Surg Laparosc Endosc 1998;8:171-9.  Back to cited text no. 9
    
10.
Cheah WK, Goh P, Gagner M, So J. Needlescopic retrograde cholecystectomy. Surg Laparosc Endosc 1998;8:237-8.  Back to cited text no. 10
    
11.
Carvalho GL, Silva FW, Ramos, CH, Albuquerque PPC, Araújo DG, Vilaça TG, et al. Clipless minilaparoscopic cholecystectomy: Technique and results of 719 cases. Rev Bras Videocir 2007;1:5-11.  Back to cited text no. 11
    
12.
Cabral PH, Silva IT, Melo JV, Gimenez FS, Cabral CR, Lima AP. Needlescopic versus laparoscopic cholecystectomy. A prospective study of 60 patients. Acta Cir Bras 2008;23:543-50.  Back to cited text no. 12
    
13.
Bisgaard T, Klarskov B, Trap R, Kehlet H, Rosenberg J. Microlaparoscopic vs. conventional laparoscopic cholecystectomy: A prospective randomized double-blind trial. Surg Endosc 2002;16:458-64.  Back to cited text no. 13
    
14.
Cheah WK, Lenzi JE, So JB, Kum CK, Goh PM. Randomized trial of needlescopic versus laparoscopic cholecystectomy. Br J Surg 2001;88:45-7.  Back to cited text no. 14
    
15.
Kimura T, Sakuramachi S, Yoshida M, Kobayashi T, Takeuchi Y. Laparoscopic cholecystectomy using fine-caliber instruments. Surg Endosc 1998;12:283-6.  Back to cited text no. 15
    
16.
Firme WA, Carvalho GL, Lima DL, Lopes VG, Montandon ID, Santos Filho F. Low-friction minilaparoscopy outperforms regular 5-mm and 3-mm instruments for precise tasks. JSLS 2015;19. pii: e2015.00067.  Back to cited text no. 16
    
17.
Carvalho GL, Góes GH, Cordeiro RN, Lima DL, Amorim LL, Furtado RH. A new hybrid mini-laparoscopic technique for spigelian hernia. J Minim Access Surg 2019;15:253-5.  Back to cited text no. 17
    
18.
Carvalho GL, Lima DL, Silva FW, Belarmino de Goes GH. Giant nonparasitic spleen cyst treated by minilaparoscopy. CRSLS e201700030. Available from: http://crsls.sls.org/2017-00030/. [Last accessed on 2019 Jul 17].  Back to cited text no. 18
    
19.
Carvalho GL, Silva de Abreu GF, Lima DL, Belarmino de Goes GH. Type IV Mirizzi syndrome treated by hepaticoduodenostomy by minilaparoscopy. CRSLS e201600057. Available from: http://crsls.sls.org/2016-00057/. [Last accessed on 2019 Jul 17].  Back to cited text no. 19
    
20.
Malcher F, Cavazzola LT, Carvalho GL, Araujo GD, Silva JA, Rao P, et al. Minilaparoscopy for inguinal hernia repair. JSLS 2016;20. pii: e2016.00066.  Back to cited text no. 20
    
21.
Carvalho GL, Loureiro MP, Bonin EA, Claus CP, Silva FW, Cury AM, et al. Minilaparoscopic technique for inguinal hernia repair combining transabdominal pre-peritoneal and totally extraperitoneal approaches. JSLS 2012;16:569-75.  Back to cited text no. 21
    




 

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