Alexander S Rosemurgy, MD, Larry Glazerman, MD, Harold Paul, BS, Kenneth Luberice, BS, Edward Choung, MD, Sharona B Ross, MD. University of South Florida & Tampa General Medical Group
This video is of a combined Laparo-Endoscopic Single Site (LESS) cholecystectomy, for symptomatic cholelithiasis, and supracervical hysterectomy, for menorrhagia and uterine fibroids. LESS surgery, undertaken through only a single incision at the umbilicus, avoids multiple incisions on the abdomen wall, lends itself to the use of epidural anesthesia as an alternative to general anesthesia.
After administration of epidural anesthesia, 10ml of bupivacaine was injected at the umbilicus. A single multi-trocar port was placed through a 12mm vertical incision at the umbilicus, while preserving the umbilical ring. Visualization was provided by a 5mm deflectable tip laparoscope. Retraction of the gallbladder was achieved with two graspers. The cystic duct and artery were dissected, providing the necessary “critical view”. Both structures were each clipped twice proximally and distally, and then divided. The gallbladder was dissected off the liver bed. Prior to disengaging the gallbladder from the liver, hemostasis was ensured.
The patient was then placed in Trendelenburg position and attention was directed to the pelvis. A 5mm bipolar energy device was utilized to divide the fallopian tubes, ovarian ligaments, round ligaments, and broad ligament bilaterally, as well as uterine vessels. The bladder flap was developed and a LiNA Loop® was utilized to amputate the uterus from the cervix. Attention was then directed to the vagina where the cervix was dilated to approximately 15mm. A Gynecare MorecellexTM was placed through the dilated cervix and used to systematically morcellate the uterine fundus, weighing approximately 220g. At this point, a Carter-ThomasonTM suture passer was passed through the cervix to close the cervical defect. The gallbladder was extracted through the umbilicus. The umbilical incision was closed with a figure-of-eight absorbable suture, and the skin was approximated.
LESS surgery provides superior cosmesis, as there is no apparent scar, and potentially offers less pain and a quicker return to daily activities. Futhermore, LESS surgery provides equal and satisfactory access to all quadrants of the abdomen and pelvis. Such access allows “bundling” of procedures to safely accommodate patient needs with a superior cosmetic outcome. Furthermore, LESS surgery promotes application of epidural anesthesia, thereby avoiding the costs and adverse effects of general anesthesia.
Session Number: VidTV2 – Video Channel Rotation Day 2
Program Number: V110