OGBN P08 Novel technique of Zooming Inside Narrow Orifice (ZINO) could reduce the need for subtotal cholecystectomy and enables intraoperative cholangiography

Abstract Background The complete removal of a difficult gallbladder has regularly been an encumbrance for the work surgeons. A common approach to circumvent hazardous dissection and biliary injury performing subtotal cholecystectomy (SC). Reduced exposure trainees open total cholecystectomy, inflamed, fibrotic hepatocystic triangle might contribute growing tendency perform as bail out procedure. However, significant post-operative morbidity leads high incidence recurrent symptoms. This abstract aims describe novel technique – Zooming Inside Narrow Orifice (ZINO) dissect in safe plane whilst keeping vital structures protected. reduces need less desirable enables intraoperative cholangiography. Methods Data from laparoscopic performed by single surgeon between 01/07/2020–25/05/2022 prospectively collected evaluated. starts with circular marking peritoneum 1–3 cm on Hartmann's pouch. is deepened until reaching mucosa, without penetrating it. Following this, carried submucosal towards neck gallbladder. As this out, may be able zoom inside narrow orifice made wall outside mucosa. mainly using blunt hydro-dissection progresses or cystic duct identified. Once identified, carry cholangiography visualize integrity system make sure no stones are left behind. Results 205 cholecystectomies were during study period. was necessary 9 cases (4.39%). Five patients males four females. Based Nassar difficulty grading, eight these grade IV one case III. By ZINO technique, not only possible all cases, but also completed 8 cases. Cholangiography abandoned due necrotic, fragile patient who admitted acute cholecystitis 17 days underwent ERCP treat sepsis clear duct. No complications readmissions have recorded. Subtotal any patients. Conclusions Discussion:Dissection will prevent damage important within Thus, every structure encountered expendable anatomical definition it should related Adherence protect they other side funnel. It note that diathermy used avoid collateral thermal through Conclusion 4.39% - number similar rate major centres. cholangiography, avoiding neglect unidentified bile Our data suggests reduce their subsequent morbidity.