BACKGROUND
Lost intraperitoneal gallstones have caused abscess formation, inflammation, fibrosis, adhesions, cutaneous sinuses, ileus and septicaemia.1,2 Few reports describe uncomplicated techniques to remove ‘spilled’ gallstones.3 Use of a laparoscopic grasper to collect each spilled stone is technically flawed as: (i) gallstones frequently fragment; (ii) a grasper holding the stone cannot pass through the port; and (iii) removal of port causes loss of the pneumoperitoneum.
We present an simple technique for removal of spilled gallstones. The technique relies upon suction, all instruments are in routine use, and the pneumoperitoneum and continued camera vision is maintained.
TECHNIQUE
A standard 10-mm port is used as a suction device by connection to the standard low-intensity theatre suction. The ‘female’ end of plain suction-tubing is removed and briefly inserted into the 10-mm port positioned over the spilled intraperitoneal gallstones. The suction-tubing is briefly passed to just past the port-valve mechanism causing the port to deliver suction to the stones without loss of the pneumoperitoneum (Fig. 1).
Figure 1.
The movement of the suction tubing back and forth through the 10-mm port-valve mechanism during manoeuvring of port ‘end’ controls suction applied.
For peripherally positioned stones, the suction-tubing is ‘clamped off’ using Spencer-Wells forceps (to maintain pneumoperitoneum) and inserted through the port to reach the gallstones under camera vision (Fig. 2). Suction is controlled by release of clamping.
Figure 2.
A Spencer-Wells clamp applied to tubing during manoeuvring of suction tubing controls suction for removal of gallstone.
DISCUSSION
This new technique facilitates safe and efficient removal of spilled gallstones and friable fragments without additional cost and is especially useful for: (i) rapid and simple removal of intraperitoneal gallstones and friable gallstone debris with continued camera vision and pneumoperitoneum; and (ii) removal of large stones piece-meal.
References
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