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Single-fulcrum Laparoscopic Cholecystectomy: A Variant Single-Incision and Multiport Technique

Authors
 Sung Hoon Choi  ;  Chang Moo Kang  ;  Ho Kyoung Hwang  ;  Woo Jung Lee 
Citation
 Journal of Laparoendoscopic & Advanced Surgical Techniques. Part B, Videoscopy, Vol.22(1), 2012 
Journal Title
Journal of Laparoendoscopic & Advanced Surgical Techniques. Part B, Videoscopy
Issue Date
2012
Keywords
Gallbladder
Abstract
Background: Single-port laparoscopic surgery using a natural wound, the umbilicus, has been developed based on accumulated laparoscopic experiences and technique. Because working instruments need different fulcrum points in a narrow incision (umblicus), various types of specialized instruments are generally necessary for performing single-port surgery.1–8

Methods: This technique is a kind of single-incision and multiport technique. However, by using two main working instruments in a single fulcrum point, we can perform single-incision laparoscopic cholecystectomy more effectively without expensive and specialized equipments. After making an incision on the umbilicus, a 10-mm port for the laparoscope was introduced through the upper portion of the wound. A commercialized miniature 5-mm port was inserted through the lower part of incision, and the usual 2-mm port was inserted just below the 5-mm trocar insertion site (these two working ports use the same fulcrum point). Upward and lateral traction of gallbladder was done by applying 2-0 monofilament suture to the fundus percutaneously. With right lateral traction of the gallbladder by a 2-mm grasper, the anterior aspect of Calot's triangle was dissected. After changing the vector of the working port at the single fulcrum, gallbladder was retracted to the left lateral portion to expose the posterior part of Calot's triangle. After isolating and dividing both cystic artery and cystic duct, cholecystectomy was done.

Results: From March 2009 to May 2010, seventy patients underwent this single-fulcrum laparoscopic cholecystectomy. The general characteristics and perioperative outcomes of the patients were summarized. There was no conversion case to conventional laparoscopic cholecystectomy or open surgery. There was no case of drain insertion, complication, or death, even though about 16% of bile spillage was occurred. Cosmetic effect of this single-fulcrum laparoscopic cholecystectomy was similar to the usual one-port technique.

Conclusion: This single-fulcrum laparoscopic cholecystectomy is regarded feasible, safe, and cost effective. Further comparative study between current single-fulcrum laparoscopic cholecystectomy and conventional technique will address the potential benefits of this technique.

The authors would like to express special thanks to Dong-Su Jang (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the figures and to Anthony Thomas Milliken (English Editor, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for comprehensive narration of this multimedia article.
Full Text
http://online.liebertpub.com/doi/abs/10.1089/vor.2011.0041
DOI
10.1089/vor.2011.0041
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Surgery (외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Chang Moo(강창무) ORCID logo https://orcid.org/0000-0002-5382-4658
Jang, Ji Young(장지영)
Choi, Sung Hoon(최성훈)
Hwang, Ho Kyoung(황호경) ORCID logo https://orcid.org/0000-0003-4064-7776
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/95331
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