Use of a peripheral venous catheter in single-incision laparoscopic surgery

Abstract

Getting the critical view in performing single-incision laparoscopic surgery (SILS) is challenging. In addition, visibility may be impaired by lens fogging and smoke accumulation in the abdomen produced by electrocautery or ultrasonic devices. In 12 patients undergoing single-incision laparoscopic cholecystectomy, a peripheral venous catheter (PVC) was introduced in the right upper quadrant under direct vision, and a three-way stopcock was screwed onto the catheter to allow controlled smoke evacuation. Cholangiography was attempted in all cases, four times by introducing a (CH5) feeding tube via PVC. The described technique allowed controlled smoke evacuation via the PVC during SILS while reducing lens fogging and contamination by a constant air flow toward the venous catheter. Cholangiography was possible using a conventional cholangiography forceps (in 7 of 12 cases) or a feeding tube introduced via PVC (in 4 of 12 cases). Once, bleeding from an adjuvant vessel after incision of the cystic duct had to be controlled with clips, and no cholangiogram was achieved (in 1 of 12 cases). No procedure-related complications were observed. There was no conversion to conventional laparoscopic or open surgery. No visible scar was seen at the site of PVC introduction 5weeks postoperatively. Visibility can be improved in SILS using a PVC without leaving apparent scars. Cholangiography via PVC is technically feasible and allows complete assessment of the biliary tract.