Single-incision laparoscopic cholecystectomy using hands-free retraction system, flexible port and pre-bending forceps

Nobumi Tagaya, PhD, Yawara Kubota, MD, Nana Makino, MD, Asami Suzuki, MD, Kosuke Hirano, MD, Kazuyuki Saito, MD, Takashi Okuyama, PhD, Shinichiro Koketsu, PhD, Emiko Takeshita, PhD, Hidemaro Yoshiba, PhD, Yoshitake Sugamata, PhD, Shinichi Sameshima, PhD, Masatoshi Oya, PhD

Department of Surgery, Dokkyo Medical University Koshigaya Hospital

Introduction: The introduction of new devices is mandatory in the progression of laparoscopic surgery. At this time, we used the several new devices consisting of Endo-Grab, MIT port and Pre-bending instruments for the purpose of the elimination of port or instruments, the reduction of clashing between the instruments and laparoscope. We report the experience with those instruments during single-incision laparoscopic cholecystectomy (SILC).

Patients and methods: We performed SILC in 70 patients from October 2011. They were 29 males and 41 females with a mean age of 55 years (range: 33-86 years). Their diagnoses were 64 gallbladder stones and 6 polyps. Initially, we made a 2.5-cm skin incision at umbilicus and the incision was applied a wound retractor and surgical glove. We used three ports technique. After retracting the gallbladder upward using an Endo-Grab, the cystic duct and artery were divided and identified using pre-bending forceps through the MIT port and laparoscopic coagulating shears (LCS). The cystic artery was dissected by LCS and the cystic duct was also dissected by shears after clipping. The gallbladder was freed from the liver bed using LCS. The specimen was retrieved from the umbilical wound.

Results: All procedures were completed without any intraoperative complications. There were no additional ports during SILC. The mean operation time was 72 min (range: 34-144 min). Endo-Grab eliminated the retraction of the gallbladder by grasping forceps. The MIT port and pre-bending forceps reduced the clashing between the instruments and laparoscope at the intra- and extra-peritoneal cavities. We have to be careful to injure the viscera by the hook locating at the both sides of Endo-Grab.

Conclusion: Endo-Grab, MIT port and Pre-bending forceps were very useful in the performance of SILC with the elimination of additional instruments and the reduction of clashing between the instruments and laparoscope.

Session: Poster Presentation

Program Number: P380

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