Single Incision Laparoscopic Cholecystectomy

Introduction: Single incision laparoscopic surgery (SILS) has been proposed as a minimally invasive technique with proposed advantages of smaller external scars and reduced pain. Furthermore, usage of the flexible endoscope for SILS in lieu of the standard laparoscope provides distinct visualization advantages. This video illustrates a single incision cholecystectomy performed through a single incision placed through the umbilicus.
Methods: A 39 year old female with chronic symptomatic cholelithiasis was enrolled under IRB protocol to undergo SILS. She has previously undergone a laparoscopic tubal ligation. A single incision was made using the previous umbilical incision, and the abdomen entered in an open fashion. The flexible endoscope was placed directly through the fascial incision, with two 5 mm ports on either side. Adhesions to the gallbladder were taken down with the harmonic scalpel. Dissection proceeded using an articulating grasper and retraction to identify the cystic duct and artery. The duct and artery were serially clipped and divided. The cystic duct was additionally secured with a loop ligature. The gallbladder was cauterized from the liver bed using the articulating hook cautery and extracted through the wound.
Results: The final incision was at the base of the umbilicus, and was 7mm in length. Operative time was 58 minutes, with minimal blood loss recorded. The patient was discharged home on the day of procedure, and did not develop any postoperative complications.
Conclusions: Single incision cholecystectomy can be performed safely through one incision in the umbilicus, optimizing cosmesis. Substitution of the flexible endoscope for the standard laparoscope allows many greater degrees of visualization in SILS. This allows clear identification of biliary ductal anatomy to allow cholecystectomy to proceed safely. Placing the endoscope directly through the incision decreases the profile of ports through the incision and increases maneuverability.

Session: Podium Video Presentation

Program Number: V031

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