Single-Access Transumbilical Laparoscopic Nissen Fundoplication Performed With New Curved Reusable Instruments

Dapri, Giovanni; Bruyns, Jean; Himpens, Jacques; Cadière, Guy Bernard
March 2011
Surgical Innovation;Mar2011, Vol. 18 Issue 1, p61
Academic Journal
Introduction: The authors report a single-access laparoscopic Nissen fundoplication (SALN) performed with new curved reusable instruments. Case report: A 21-year-old woman sought care for symptomatic grade B esophagitis and hiatal hernia. A reusable 11-mm trocar was inserted in the umbilicus and a 10-mm, 30° angled, nonflexible, standard length scope was used. Curved reusable instruments (Karl Storz-Endoskope) were transumbilically introduced without trocars. The left hepatic lobe was retracted thanks to the distal curve of the grasper. The cruraplasty and wrap were performed using curved needle holder and intracorporeal sutures. Results: No extraumbilical trocar was necessary. Laparoscopic time was 108 minutes, and umbilical scar length was 16 mm. Discharge was allowed after 48 hours. Conclusions: SALN is feasible to be performed with curved reusable instruments, which avoid the conflict between the instruments’ tips inside the abdomen or between the surgeon’s hands outside. Cost of the procedure remains similar to standard laparoscopy because only reusable material is used.


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