Uploaded: 12-10-2011 18:44:47
Single Incision Laparoscopic Cholecystectomy
Very clean and critical view well demonstrated!
I wish my practice included gallbladders as pristine as this one! Acceptable operation, but please eliminate the music and add narration, trocar placement, patient history, etc. For truth in advertising, should we call this, "1 very big trocar site plus 2 needle hole surgery"? Less sexy than "single incision" but more accurate.
All the videos in this forum should have a narration and should be educational. Is very hard for me to watch a music video when Im looking for an educational one.
First: Making bile comes outside the gallbladder again?. Letīs better use a laparoscopic vascular clam introduced by the main trocar, with a suture and a needle passing through the wall if you want, then you not only could retract, but also and mainly you could change the position of the clamp as you wish. Second: My fellow insists..."itīs obvious this surgeon is using conventional trocars umbilically, but...why the surgeons dont show how they do the initial access??" and I agree with her...that is as challenging as the way to retract the gallblader. Comercial ports or convencional trocars as Curcillo?
The surgeon has used one retracting forceps, one retracting suture and one operating instrument. We generally use two retracting sutures(one at fundus and one at infundibulum), and two operating instruments. The first operating instrument(grasper) is used to have an anterior or posterior view by retracting the gall bladder laterally or medially. The second operating is used for dissection or cautery as required. The problem with using a single operating instrument(as shown in the video) is that in difficult cases(moderate to severe adhesions, large stone impacted in Hartmann's pouch,mucocele etc ), it would be difficult to have a critical view of safety.
We use the suture to retract the fundus and use the left hand to manipulate the neck of the gall bladder.
This video demonstrated a standard single incision laparoscopic cholecystectomy without cholecystitis. If there were severe inflammations, I add one more forceps that directly punctured besides the umbilical port inside the incision to control gallbladder adequately. Needle puncture may not be required if you use holding forceps more active.