Single access laparoscopic cholecystectomy using conventional laparoscopic instruments

Laparoscopic cholecystectomy is now considered the "gold standard" approach for the treatment of symptomatic gallstones and acute cholecystitis. Single access laparoscopy has been proposed in order to reduce even more surgical trauma and improving the postoperative course and cosmetic results by using one access to the abdominal cavity instead of 3 or 4 trocars. The video describes our personal technique for single access laparoscopic cholecystectomy using conventional laparoscopic instruments.

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Single access laparoscopic cholecystectomy using conventional laparoscopic instruments

Authors

L Boni, M Di Giuseppe, E Colombo, SM Tenconi, G Dionigi

Abstract

Laparoscopic cholecystectomy is now considered the "gold standard" approach for the treatment of symptomatic gallstones and acute cholecystitis. Single access laparoscopy has been proposed in order to reduce even more surgical trauma and improving the postoperative course and cosmetic results by using one access to the abdominal cavity instead of 3 or 4 trocars. The video describes our personal technique for single access laparoscopic cholecystectomy using conventional laparoscopic instruments.

Classification

new techniques, single port

Keywords

Single access laparoscopic cholecystectomy, conventional laparoscopic instruments

Media type

Surgical video

Duration

08'15''

Publication

2009-06

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E-publication

WeBSurg.com, Jun 2009;9(06).
URL: http://www.websurg.com/doi-vd01en2524.htm

Single access laparoscopic cholecystectomy using conventional laparoscopic instruments

1. Trocar and surgeon positioning 00'02''

This video shows our technique for single access cholecystectomy using standard laparoscopic instruments. The patient is placed in supine position. The main surgeon and the assistant stand on the left side. A 2cm sub-umbilical incision is performed and a 10mm trocar inserted using an open technique. Two further 5mm trocars are placed just on the left and the right side of the previous one as shown in the video.

2. Transparietal gallbladder exposure 00'39''

In order to achieve better exposure, a monofilament suture with a straight needle was passed through the skin and then driven superficially through the gallbladder wall at the level of the fundus. The suture is then retracted from outside and fixed. A 5mm disposable articulated grasper is used to retract the gallbladder neck and expose the elements of the triangle of Calot as in a standard cholecystectomy. The use of an articulated device is mandatory in order to reduce the conflict between the instruments.

3. Calot’s triangle dissection 01'56''

Using the hook electrocautery, the peritoneum of both sides of the triangle of Calot is divided. The dissection is carried out until the cystic duct and artery are identified. During this maneuver, crossing of the surgeon’s hands is possible. Once an adequate critical view of safety is achieved, a 5mm clip applier is used to close both the duct and the artery.

4. Cystic duct and artery division 04'03''

Both structures will then be divided using standard scissors. The procedure carries on with the dissection of the gallbladder from the hepatic bed using hook electrocautery. Before completing the detachment of the gallbladder, the surgical field is checked for bleeding.

5. Cholecystectomy and specimen extraction 06'59''

Cholecystectomy is then completed and the gallbladder is placed in a plastic bag and then removed through the umbilicus. The fascia will be closed using a re-absorbable material and this is the final view of the abdomen at the end of the operation.