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New curved and reusable instruments for single access laparoscopic cholecystectomy

Authors

G Dapri, L Casali, J Himpens, GB Cadière

Abstract

This video demonstrates a laparoscopic single incision cholecystectomy using new curved and reusable instruments: a grasper with double curves and a hook with a single curve. A reusable 10mm trocar is inserted.

Classification

single port, contribution

Keywords

New curved reusable instruments, single access laparoscopic cholecystectomy

Media type

Duration

06'31''

Publication

2010-02

Popular

Favorites

Audio

Subtitles

E-publication

WeBSurg.com, Feb 2010;10(02).
URL: http://www.websurg.com/doi-vd01en2868.htm

New curved and reusable instruments for single access laparoscopic cholecystectomy

1. Introduction 00'20''

For laparoscopic cholecystectomy through a single incision, the incision is made in the umbilical fold. As soon as the peritoneum is entered, a purse-string of large monofilament absorbable suture (PDS 1) is placed.

2. Trocar and instruments placement 00'43''

A reusable 10mm trocar is inserted and the abdomen is insufflated. The procedure will be done using specific instruments: a grasper with double curves and a hook with a single curve. The instruments are placed as follows: the grasper is placed just outside the purse-string; it is inserted at a 45 degree angle and then manipulated until well inside the abdomen. The hook is placed also without a trocar but within the purse-string. And the double curves will help maintaining excellent ergonomics throughout the procedure. One can appreciate the double curve of the grasping forceps and again its insertion at a 45 degree angle. The instrument is advanced until the straight part remains outside. The same goes for the hook, but again the hook is inserted within or inside the purse-string.

3. Calot\'s triangle exposure and incision 01'56''

The gallbladder is snapped as per routine at the level of the infundibulum and the triangle of Calot is exposed. The peritoneum is incised thanks to the specific hook and the usual landmarks are used. The lymph node of Calot is visible. The gallbladder is lifted cephalad and the incision in the peritoneum is carried out from medial to lateral on the posterior or dorsal aspect of the gallbladder. Subsequently, the superior leaflet of the peritoneum overlying the gallbladder is incised and again the classic principles of laparoscopy of traction and counter-traction are perfectly observed here. The lymph node is now dissected free and the cystic duct is discovered. The instruments are, as you can tell, placed at a 90 degree angle again for perfect ergonomic conditions.

4. Cystic duct clipping and division 03'35''

Once the cystic duct has been identified and skeletonized, a straight clip applier is introduced again without trocar and a specific safety hook clip is placed. After placement of a second clip, the cystic duct is ready for transection. In order to do so, another specific curved instrument, namely the scissors is introduced through the same incision and the cystic duct is severed. The scissors saw again a single curve and insertion is performed just like the other tools at a 45 degree angle with the skin. Dissection is then carried out as usually by pulling the gallbladder laterally and by severing the attachments with the liver bed. It is very convenient to switch tools and make them cross just like in a regular laparoscopy. Monopolar hook cautery is used for this purpose. The surgeon is standing straight again observing the rules of laparoscopy with its two working tools at a 90 degree angle, the scope being at the bisector of both. Meticulous hemostasis is performed as usually and the fundus of the gallbladder is now reached.

5. Specimen extraction 06'07''

In order to retrieve the gallbladder, an inexpensive plastic bag is inserted and the gallbladder once placed inside the bag is pulled to the outside and removed.

6. Final incision 06'28''

The final incision appears to be 16mm.

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