One glove single port cholecystectomy: some tips and tricks

Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of traditional laparoscopy. The aim of this video is to show tips that are useful when performing a cholecystectomy with a single umbilical trocar while respecting the rules of biliary surgery.

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One glove single port cholecystectomy: some tips and tricks

Authors

J Leroy, F Costantino, J Marescaux

Abstract

Single incision laparoscopic surgery (SILS) was developed with the aim of reducing the invasiveness of traditional laparoscopy. The aim of this video is to show tips that are useful when performing a cholecystectomy with a single umbilical trocar while respecting the rules of biliary surgery.

Classification

single port

Keywords

One glove single port cholecystectomy, tips and tricks

Media type

Surgical video

Duration

03'55''

Publication

2010-02

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E-publication

WeBSurg.com, Feb 2010;10(02).
URL: http://www.websurg.com/doi-vd01en2845.htm

One glove single port cholecystectomy: some tips and tricks

1. Introduction 00'08''

The aim of this video is to show tips that are useful when performing a cholecystectomy with a single umbilical trocar while respecting the rules of biliary surgery.

2. Plastic sleeve introduction 00'19''

We introduced a plastic sleeve to retract and protect the borders of an incision that should be 2cm long at most.

3. Introduction of trocars 00'25''

We then introduce various trocars, flexible or rigid, in the finger extremities of the glove, thus allowing to place instruments with diverse shapes.

4. Exposure of Calot\'s triangle 00'34''

We start the dissection with scissors and retract the spleen upwards, exposing in that way the cystic duct first, then the Calot’s triangle. With double-curved instruments, straight instruments such as the hook, clip appliers or scissors with modifiable angles, we can gradually dissect the anatomical structures, starting with the cystic duct and artery, clip them and divide them once we are sure that they are perfectly isolated. We see the cystic artery being clipped here. This technique is advantageous as it allows to perform the same maneuvers as we would do during a conventional laparoscopy through a single incision. To keep a clean operative field, we evacuate the smoke through instruments that are connected to a suction device. We see the roticulator Endo mini-shears being used here: it is very practical as manipulation is made easy through varying working angles, but also because it has a very short tip, thus allowing it to perform like a hook.

5. Curved grasper insertion 02'24''

A double-curved grasper (Karl Storz®) allows to retract while keeping out of the visual field. We use a 10mm optic that can be introduced with 5mm instruments. This is possible through the use of a trocar connected to a glove, a tip that has been described numerous times in the literature. This concept is interesting as a lot of freedom can be obtained in instrument manipulation, along with reduced instrument conflict. Thanks to the shape of the instruments, conflict is further reduced extracorporeally. As a reminder, the operative field is fogless as a suction device was connected to the hollow instruments, along with a spigot at the other end.