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Rafael Abaid has completed his PhD at Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, USP, Brazil and is Professor in Medicine School, University of Santa Cruz do Sul, UNISC, Brazil
About 20% of the population has cholelithiasis and this is the main abdominal cause of hospitalization in developed countries. Considering that only in the United States about 700,000 cholecystectomies are done each year, it is possible to estimate the importance of the problem for public health.
For a century, since Carl Langenbuch removed the first gallbladder, cholecystectomy was only performed through laparotomies. In the 1980s, laparoscopic cholecystectomy (LC) appeared. The technique was improved and spread rapidly in the 1990s. It is one of the most frequently performed procedures today and is still considered gold standard technique in the treatment of symptomatic cholelithiasis. Although large and traumatic incisions have been replaced by four small 5-mm and 10-mm incisions, many surgeons continue to search for even less invasive techniques. The reduction of surgical trauma has potential benefit of causing less postoperative pain, reducing convalescence time and generating better aesthetic results. Several techniques have been described with these objectives. As LC is a relatively inexpensive and easy-to-perform technique, the greatest challenges are to maintain safety without increasing technical difficulty or cost.
In accordance with safety standards and with the intention of reducing scars, it was proposed to perform two incisions simplified laparoscopic cholecystectomy using a hybrid technique with an incision inside the umbilicus and another in the epigastrium to operate similarly to standard LC.