Procedure Profile - Needlescopic Cholecystectomy

Minimally Invasive Surgery Program

At California Pacific Medical Center we are committed to bringing new and advanced diagnostic tools, medical treatments and surgical options to the physicians we serve and the patients they care for. Through this procedure profile, our physicians illustrate actual medical situations that provide you with a window into their practice of diagnosis, treatment and patient follow-up—changing the lives of patients just like yours.

For patient referrals: 888-637–2762
www.cpmc.org/lapsurg

Printer Friendly PDF of Procedure Profile - Needlescopic Cholecystectomy (63KB)

What is Needlescopic cholecystectomy?

This procedure involves removal of the gallbladder using 4 small incisions. Needlescopic refers to the use of incisions and instruments that are so small there is virtually no scarring and very little pain.

Why choose needlescopic over laparoscopic cholecystectomy?

Needlescopic surgical technology takes patient care a step beyond laparoscopy. Typically, laparoscopic cholecystectomy incisions are approximately 10 millimeters in length and cause very little scarring and substantially less pain than traditional or open procedures. However, needlescopic procedures are even less invasive. These procedures are performed through needle size incisions, less than 3 millimeters in diameter, so small there is virtually no visible scarring within one month after surgery. The pain is extremely minimal and can usually be relieved with only one or two narcotic pain relievers or an over-thecounter analgesic such as Tylenol or Motrin. Studies have shown that patients use 80% less pain medication and return to their normal daily activities sooner after needlescopic cholecystectomy procedures.

How is Needlescopic cholecystectomy done?

Needlescopic surgery is performed by inserting narrow guide tubes into small incisions, then passing tiny instruments through the tubes while using a small television camera for guidance. This procedure requires a 1 cm incision at the belly button to remove the gallbladder and 3 mm incisions along the right lower rib (see back). The slender instruments are used to separate the gallbladder from its blood supply and its connections to the liver. The gallbladder is then removed through the belly button.

What are the risks of the procedure?

The risks include bleeding, infection, bile duct injury and conversion to open. These complications are all quite rare and can be easily treated. Patients should be aware that if difficulties are encountered during surgery which cannot be safely managed laparoscopically, for their safety, conversion to an open procedure may be required.

What is the recovery time?

About 50% of patients feel well enough to go home the same day, the others need to stay in the hospital overnight. Most patients use only 1 or 2 narcotic pain pills and then switch over to Tylenol. Generally, patients can walk and start a liquid diet a few hours after surgery.

Case Study

Symptomatic Cholelithiasis

Overview

C.M. is a 44-year-old woman who has experienced upper abdominal pain and nausea for 2 years. Over the last 6 months she has had 3 attacks of pain lasting up to 4 hours each. Shortly after her most recent attack, her primary care physician recommended an abdominal ultrasound which confirmed his suspicion of gallstones and sludge.

Treatment

Because of the increasing frequency of her symptoms and the risk of developing gallstone-related complications, surgery was recommended. A needlescopic cholecystectomy and cholangiogram were performed on 06/08/01 and the patient went home the same day.

Outcome

Two days later the patient was taking over-the-counter Tylenol for pain relief and eating a regular diet. She returned to work full-time one week after her surgery.

Patient referral and insurance coverage

Patients will need a referral from their primary care provider or physician specialist prior to scheduling their needlescopic cholecystectomy surgical evaluation. Many pre-evaluation laboratory and radiological results can be forwarded to Dr. Jossart’s office prior to consultation. These include abdominal ultrasound and the patient’s most recent lab result.
Needlescopic cholecystectomy is a surgical option covered by Medicare, Medi-Cal and most private insurance companies. In order to avoid unexpected medical expenses, it is always best for your patients to contact their insurance company prior to treatment to confirm coverage for this service and obtain prior authorization.

For More Information

Please call our referral coordinators at 888-637-2762.
DVD of procedure available.

Sponsored in part by a grant from the Joseph H. Friend Laparoscopy Education Center.