Q) Regarding minimal access cholecystectomy all are true except?

a) NOTES can be done transvaginally and transgastrically

b) Transgastric route is preferred

c) SILS is done through single port with multiple instruments avoiding multiple ports

d) SILS has difficulty with triangulation and retraction

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Answer is B

Natural  orifice  transluminal  endoscopic  surgery (NOTES),  which  uses  natural  orifices  (transgastric, colonic,  urethral,  vagina)  to  introduce  an  endoscope,  has been  reported  since  early  2000  as  a  less  invasive  approach to  laparoscopy.  The  first  human  NOTES  transvaginal  cholecystectomy  was  reported  in  2007,  and  later  the  report  of a  hybrid  combination  of  flexible  scope  by  a  transvaginal approach  in  combination  with  an  umbilical  needle  or port  for  laparoscopic  instruments  for  retraction,  dissection,  or  clips  application.  This  hybrid  technique  allowed for  a  quicker  and  safer  procedure;  the  present  deficiency is  in  the  proper  endoscopic  instrumentation. For  the  trans vaginal  approach,  a  Foley  catheter is  placed,  a  dissection  is  performed  in  the  posterior vaginal  cul-de-sac  to  allow  a  port  placement,  and  when the  case  is  over,  the  closure  is  easier  than  a  transgastric or  transcolonic  approach,  which  continues  to  be  an  issue.



Q.    Regarding percutaneous cholecystostomy A/E

a.       Technical success in 90 – 98 % of cases

b.      Indicated in Grade II cholecystitis with significant pericholecystic inflammation & GOO

c.       Indicated in Gr III cholecystitis with significant comorbidity

d.      In Grade III cholecystitis with biliary peritonitis, PCC results in significant improvement


Cholelithiasis with Choledocholithiasis

Q.  Patients with gallstones and choledocholithiasis in a centre with endoscopy, interventional radiology and tertiary care centre

a.       Single setting lap chole + CBDE better than endoscopy followed by lap chole

b.      In choledocholithiasis endoscopic clearance alone without lap chole can be done without any long term complication

c.       For impacted ampullary stones with CBD dilatation that requires biliary enteric drainage is performed with a preferred open approach