Transumbilical single access laparoscopic Toupet fundoplication
Epublication WebSurg.com, Jan 2013;13(01). URL: http://websurg.com/doi/vd01en3846
Background: Different procedures have been reported to be feasible and safe through single access laparoscopy (SAL). A transumbilical SAL Toupet fundoplication is demonstrated here. Video: A young lady sought care for gastroesophageal reflux disease associated with grade B esophagitis, hiatal hernia and esophageal dyskinesia. The SAL procedure was performed by the opening of the umbilicus through Hasson’s technique. An 11mm reusable trocar was inserted for a 10mm, 30-degree angled, non-flexible, and standard length scope. Curved reusable instruments according to Dapri (Karl Storz Endoskope) were introduced through the same scar without trocars. The gastroesophageal junction was exposed thanks to the insertion of a 2mm wire under the xiphoid access. Crura repair and fundoplication were performed using intracorporeal knots, with a curved needle-holder. The umbilicus was finally closed in layers. Results: No extra-umbilical trocar was necessary, and no intraoperative complications were registered. Operative time was 172 minutes and the final umbilical scar was 15mm. Postoperative pain was kept minimal, and the patient was discharged on the third postoperative day after a satisfying gastrograffin swallow. Conclusions: Transumbilical SAL Toupet fundoplication is feasible. Use of curved and reusable instruments permits to avoid the conflict between the instruments’ tips intracorporeally or between the surgeons’ hands externally. Thanks to this technique, the cost of SAL is similar to multi-trocar laparoscopy.