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Different techniques for gallbladder fundus retraction in single port cholecystectomy

Authors

Abstract

One of the main drawbacks of single port cholecystectomy, which cripples the surgeon is the gallbladder fundus retraction. Here, we demonstrate the different cost-effective methods we employ for fundus retraction in single port cholecystectomy.

Classification

single port, contribution

Keywords

Gallbladder fundus retraction, single port cholecystectomy

Media type

Duration

05'06''

Publication

2011-12

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E-publication

WeBSurg.com, Dec 2011;11(12).
URL: http://www.websurg.com/doi-vd01en3454.htm

Different techniques for gallbladder fundus retraction in single port cholecystectomy

1. Introduction 00'07''

One of the main drawbacks of single port cholecystectomy is the retraction of the fundus of the gallbladder. There are many techniques and tricks of doing retraction of the gallbladder fundus. The use of suture, Endograb, mini-loop retractor, magnets, K-wire has been documented. Some of the techniques we employ to retract the gallbladder are demonstrated in this video.

2. Pin retractor 00'30''

A pin with a hook on both ends is introduced into the peritoneal cavity through a 10mm cylindrical tube through the E.K. glove port in the umbilicus. With the help of a needle holder, one end of the hook is fixed to the peritoneum above the liver and the other end to the fundus of the gallbladder. A long thread is attached to the pin to prevent it from getting lost in the peritoneal cavity. Adequate retraction is achieved but the pin frequently gets dislodged, which needs repeated fixing.

3. Spinal needle as retractor 01'14''

An 18 gauge spinal needle is passed into the peritoneal cavity in the right subcostal region. The content of the gallbladder is first aspirated out. With the help of a needle holder, the spinal needle is then curved into a hook. We then hook the wall of the gallbladder and if we are careful, and with experience we can hook only the serosa and the wall of the gallbladder without puncturing the lumen of the gallbladder. The needle is then pulled from outside and fixed with a hemostat. Sufficient retraction is achieved in this manner. This method is not suitable in acute cholecystitis when the gallbladder wall is edematous and friable and in patients whose gallbladder lies high above the costal margin. This shows the external view of the abdomen with the E.K. glove port in the umbilicus and the spinal needle held with a hemostat.

4. 2.3mm Alligator grasper as retractor 02'20''

Sometimes, we also use the 2.3mm Alligator grasper introduced through the right hypochondrium. It is a useful instrument especially in dense adhesions around the fundus of the gallbladder. The disadvantage is the additional financial burden to the patients and needs a small nick in the skin.

5. Thread as retractor 02'52''

A tuft or bun is made with the end of a No. 1 silk or Ethicon suture with a straight needle as demonstrated in the video. The straight needle is then curved with the help of two needle-holding forceps. It is then introduced into the abdomen through the E.K. glove port. The needle is now passed through the fundus of the gallbladder. Care is being taken to pass the needle through the serosa without puncturing the lumen. The needle is then passed through the peritoneum below the diaphragm. The needle is then brought out through the right subcostal region. When the thread is pulled from outside, we get a good retraction of the gallbladder for safe cholecystectomy.

6. Suture passer as retractor 04'41''

The suture passer is also sometimes used to hold the fundus of the gallbladder for retraction. It is passed through the right hypochondrium after making a small nick with a surgical blade. This is the external view showing the suture passer through the right hypochondrium.

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