Eijiro Harada, MD, Yuki Suehiro, MD, Naruji Kugimiya, MD, Yoshihiro Takemoto, MD, Atsushi Suga, MD, Kimikazu Hamano, MD. Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Japan
Single-incision laparoscopic cholecystectomy (SILS-C) has been developed as an alternative method to multi-port laparoscopic cholecystectomy. However, SILS-C has some difficulties due to limited triangulation and limited movement of laparoscope and instrument.
Two well-known approaches, which are called the parallel method and the cross method, are used for SILS-C. The merit of the parallel method is that its manipulation has the same feeling as that in multi-port laparoscopic surgery. However, extracorporeal interference occurs by each pair of forceps and the surgeon’s hand. On the other hand, the merit of the cross method is that it has less extracorporeal interference than the parallel method. However, as surgeons sometimes require grasping with the right hand and dissecting with the left hand, this method is more difficult hand-eye coordination than the parallel method. Moreover, this method sometimes needs special instruments such as bending forceps.
We introduce our method to minimize interference in parallel method. LAPPROTECTORTM(Hakko, Japan) is placed on the umbilical wound as a wound protector. EZ access®(Hakko, Japan), which is inserted with three EZ trocars®(Hakko, Japan) in an inverted-triangle formation. Here, we consider the reason for the interference that occurred in the parallel method, dividing it into two scenes (the ventral and dorsal sides of the gallbladder).
On the dorsal side, the surgeon grasps the gallbladder with the left-hand forceps toward the two o’clock direction and dissects with the right-hand forceps or energy devices. Therefore, in an extracorporeal situation, because the distance between the left and right hands widens, no interference occurs.
On the other hand, on the ventral side, the surgeon grasps the gallbladder with the left-hand forceps toward the nine or ten o’clock, and dissects with the right-hand forceps or energy devices. Therefore, on the ventral side, extracorporeal interference occurs because the hand is closing in on to the other hand in the same plane of movement of the forceps. Exposing the critical view of safety, one of the most important parts, is difficult.
Then, EZ access® is rotated clockwise at an angle of 90-degree, and the remaining ports are used for the right hand, left hand, and scope. With this, although the axis directions are close to each other, the movement of the forceps in each plane is different and the interference would be diminished.
We will show the surgical video in detail. This method minimizes interference easily, without requiring special instruments.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94951
Program Number: V030
Presentation Session: HPB Videos
Presentation Type: Video