Authors: Sinan Ersin Ozgur Firat Murat Sozbilen
Publish Date: 2011/05/10
Volume: 25, Issue: 10, Pages: 3476-
Abstract
We thank Dr Ianelli et al 1 for their interest in our article and gladly accept the opportunity to answer their comments Placing the suspending suture to the abdominal wall theoretically seems more reasonable however in some patients particularly those with slender body shapes a considerable part of the abdominal wall is constituted by the lower ribs We believe that careful pinning through lower intercostal spaces whilst obeying the rules of chest tube insertion will not cause significant bleeding pneumothorax or lung injury This is not just a subjective opinion because the surface projections of the pleura and the lungs are clearly defined 2 In all cases we preferred the mid clavicular line below the eighth rib for pinning where the limits for the lung and costal pleura end at the levels of the sixth and eighth ribs respectively 2 Also the patients’ being under positive pressure will not be a serious issue because the rate of mechanical ventilation can be arranged as requested in any case We recently exceeded a hundred cases considering these points and did not face any problem as wellWe do not agree with the second issue that the authors have mentioned In our opinion routine use of intraoperative cholangiography is not recommended and this has not been a matter of debate for more than one decade 3 Additionally because we did not face any suspicious cases in our first 20 cases we did not comment on this issue in our article However in our recent series intraoperative cholangiography was necessitated in only one patient’s operation and was successfully performed within the SILS techniqueFinally Dr Ianelli and his colleagues have criticized the durations of the operations Actually the article cited in the letter which Dr Ianelli has contributed to personally clearly replies to this commentary as “Naturally operation times do improve with experience Safety should always come first and never be sacrificed to do the procedure ‘quickly’” 4 We completely agree with this statement but nevertheless could not infer against the conflict of the commentary As the authors have suggested with our improved experience our recent operations usually last less than 1 h
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