Single-incision Laparoscopic Cholecystectomy: A New Retraction Technique

Background : Laparo-endoscopic single site cholecystectomy receives great interest from the surgical community. It has potential for reducing postoperative pain, length of hospital stay and improving cosmesis. Minimally invasive surgeons have been forced to develop techniques for providing adequate retraction of the gallbladder. Herein, we describe a new retraction technique to improve the dissection of Calot’s triangle.

Surgical technique : Twelve patients underwent laparo-endoscopic single site laparoscopic cholecystectomy using this retraction technique. An intra-umbilical skin incision was made by pulling out the umbilicus. A SILS® port was placed through an open approach. We inserted a 10-mm 30^o camera through the SILS® port without using any trocar. One suture was knotted in the middle of the gallbladder. Gallbladder retraction was achieved by the use of an EndoClose® needle that was inserted into abdominal cavity at the subcostal border. The floppy knot was held by the notched end of the EndoClose^® needle. This device provided retraction of the gallbladder in every direction.

Conclusions : Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.