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Transumbilical multiple-port laparoscopic cholecystectomy (TUMP-LC): a prospective analysis of 50 initial patients.

OBJECTIVE
The aim of this pilot study was to assess the safety, feasibility, and short-term outcomes of transumbilical multiple-port laparoscopic cholecystectomy (TUMP-LC), using conventional laparoscopic equipment, and to compare it with the currently published studies on single-incision laparoscopic Cholecystectomy.


MATERIALS AND METHODS
During the 4-month study period, data from all consecutive patients referred for cholecystectomy to the General and Minimally Invasive Surgery Unit of our institution who agreed to undergo TUMP-LC were included in a prospective study. Outcome measures included completion rate of attempted TUMP-LC, operative time, conversion rate, length of hospital stay, postoperative pain, and assessment of complications. The data were analyzed and compared with studies obtained from a MEDLINE search on four-port laparoscopic cholecystectomy at its initial period and recently published studies of single-incision laparoscopic cholecystectomy.


RESULTS
Fifty patients completed our protocol. In 47 patients, TUMP-LC was completed successfully without any complications. In 2 patients, the procedure was converted electively to a standard four-incision laparoscopic cholecystectomy without any additional morbidity. In 1 patient, an additional epigastric 5-mm port had to be placed to control bleeding from the gallbladder fossa. One patient had a postoperative biliary leak from an accessory duct in the gallbladder fossa, which was managed by endoscopic retrograde cholangiopancreatography and biliary stenting.


CONCLUSIONS
TUMP-LC is both feasible and safe. It can be performed with standard laparoscopic instruments, and, thus, there is minimal additional challenge to an experienced laparoscopic surgeon. With progressive experience and development in technology, TUMP-LC will probably be performed widely. But, disciplined, evidence-based investigations and randomized studies comparing it to existing techniques must be carried out before the actual place of this procedure in current surgical practice is determined.