Laparoscopic one trocar cholecystectomy: Gelport® technique

Single port access cholecystectomy is a new laparoscopic procedure using only one transumbilically placed port. This video shows a procedure performed using a Gelport® through a 2.5cm incision. This Gelport® is usually used to perform hand-assisted surgery. In this case, the incision used to introduce the hand was closed by a single suture and 3 ports are inserted in the gel. These 3 ports allow to insert a 5mm 30 degree optic and straight or angulated instruments into the abdomen.

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Laparoscopic   one   trocar   cholecystectomy:   Gelport®   technique

Authors
D Mutter, J Marescaux
Abstract
Single port access cholecystectomy is a new laparoscopic procedure using only one transumbilically placed port. This video shows a procedure performed using a Gelport® through a 2.5cm incision. This Gelport® is usually used to perform hand-assisted surgery. In this case, the incision used to introduce the hand was closed by a single suture and 3 ports are inserted in the gel. These 3 ports allow to insert a 5mm 30 degree optic and straight or angulated instruments into the abdomen.
Catégorie
new techniques
Mots-clés
Laparoscopic one trocar cholecystectomy, Gelport® technique
Type de vidéo
Durée
06'41''
Publication
2009-07
Popularité
Favoris
Favorites Media
Audio
en fr
Sous-titres
en
E-publication
WeBSurg.com, Jul 2009;9(07).
URL: http://www.websurg.com/doi-vd01en2630.htm

Laparoscopic   one   trocar   cholecystectomy:   Gelport®   technique

2. Calot\'s triangle exposure and dissection 01'28''
Exposure of the Calot’s triangle appears to be very difficult due to the left liver that comes in front of the scope. Due to the lack of force instruments, another solution must be found in order to have a very good and safe exposure of the Calot’s triangle. In fact, the complete identification of the cystic duct and cystic artery is not feasible. We decide to introduce a stitch around the round ligament to perform a suspension of the round ligament. This is done using a stitch with a 5cm straight needle introduced, controlled and passed around the round ligament, and then extracted at the same place. This stitch will allow, without any significant scars to the patient, to retract cephalad and to the left the right ligament and the liver. This will allow a good exposure of the Calot’s triangle without requiring any further instruments. With this technique, we can complete a single port cholecystectomy without any other suspension device and without any traction on the gallbladder. The use of only one port makes the control of bleeding difficult. That is why the dissection is very progressive, and whenever there is a little bleed, monopolar or here bipolar cautery are used to control this bleeding. This has to be done very slowly and very progressively as the 5mm optic with a 30 degree angle offers a worse view than the standard 10mm straight optic. The performance of the cholecystectomy and the dissection of the Calot’s triangle have to follow the same rules in one trocar surgery as in the standard surgery with 3 or 4 ports. This implies a very good dissection of the Calot’s triangle. As we don’t routinely perform an intraoperative cholangiography, this will not be performed with this technique. The patient has no clinical history of common bile duct stones. The cystic duct is very well identified and dissected over a length of 2cm in order to place two clips distally and one clip proximally. The artery is dissected during the same maneuver and the clips are applied simultaneously. As the dissection is performed very far away from the common bile duct, there is no risk of common bile duct injury. In fact, the cystic duct and cystic artery are very well identified.