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Single incision laparoscopic cholecystectomy without special SILS port or roticulating instruments with routine ports and instruments

N Jha, MBBS, MS, FAIS, FIAGES
Epublication WebSurg.com, Mar 2017;17(03). URL: http://websurg.com/doi/vd01en4858

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  • 2017-03-08
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Conventional single incision laparoscopic surgery (SILS) with special ports and instruments has transformed the way people undergo cholecystectomy. However, it requires high costs as compared to routine laparoscopic cholecystectomies. We present another way of performing a SILS cholecystectomy without any special SILS port or any special roticulating laparoscopic instruments. One 10mm port is placed in the lower aspect of the umbilicus at a 6 o’clock position and the gallbladder is assessed for SILS suitability. Another 5mm port is placed at a 3 o’clock position through a separate incision. A mini-laparoscopic grasper (Mini-Lap Technologies) is inserted in the right subcostal region. Remaining operative steps are similar to the ones used for any standard laparoscopic cholecystectomy. Careful and skilful manipulation of the mini-laparoscopic grasper helps in anterior and posterior dissection of Calot’s triangle, while maintaining the triangle of instrumentation (which is not achievable in SILS port techniques). A critical view of safety is also nicely demonstrated before clipping and dividing any structure. For clipping the cystic artery (CA) and the cystic duct (CD), a 5mm scope is used through the 5mm port and a standard clip applicator is inserted through the 10mm port. The gallbladder is extracted through the 10mm port. The 10mm port fascia is closed.