Utility of Hybrid SILS with Minute Diameter Forceps in Cholecystectomy

Jun Hanaoka, MD, Mitsuo Shimada, MD PhD FACS, Tohru Utsunomiya, MD PhD, Satoru Imura, MD, Yuji Morine, MD, Tetsuya Ikemoto, MD, Hiroki Mori, MD, Syuichi Iwahashi, MD, Yu Saito, MD. The University of Tokushima

(introduction)
The technique of cholecystectomy using single-incisional laparoscopic surgery (SILS-chole) is not united between each facilities though it is spreading rapidly. As for it, various advantages are reported as the wound is excellent in the small size and beauty, and the pain is slight, etc. The device that was able to be peeled off is displayed from the experience of SILS-chole in this department to making to the fixed form.

(methods and procedures)
The adjustment of the adjustment by present is a benign illness including the cholelithiasis, and advanced obesity and the example of the inflammation remaining syndrome have been excluded. The incision of 2.5cm is put and cut open the abdomen to the umbilical region. SILS port is inserted. The interference with forceps can be suppressed by putting the angle enough by using 5mm flexible scope. The holding and the elevation of the gallbladder bottom insert 2mm forceps directly with no port (Hybrid SILS). As a result of using the forceps, it freely has the gallbladder and it is possible to change it. The forceps operation adopts the Combined method. The neck and bottom of gall bladder is grasped by using the roticulator forceps at the one side of the hand, and dissected the cystic duct and removed from the liver by using the LCS and electric cautery by the other side of the hand. At last, The gallbladder is removed from the umbilical region.

(results)
SILS-chole has been introduced in this department since February, 2010. And they have performed already 12cases. Lap-C case (n=12) who had enforced it to a simultaneous period and the patient background and the operation factor were compared. The difference was not admitted in the age, sex, the physique, and the disease, etc. , and the difference was not admitted in hospital stay after the operation and the amount of blood loss and operation time.

(conclusion)
A safe, prompt operation similar to past Lap-C is possible, and it will be possible to become a gallbladder holding with the standard art type of the gallbladder removal by making Hybrid SILS a fixed form with 2mm forceps in the future.