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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

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Front Med    2011, Vol. 5 Issue (3) : 283-287    https://doi.org/10.1007/s11684-011-0151-9
REVIEW
Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?
Hongyi Cui()
Department of Surgery, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester, MA 01605, USA
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Abstract

Single incision laparoscopic surgery (SILS) is a novel minimally invasive surgical technique that is gaining popularity around the world. One of the most commonly performed procedures is single incision laparoscopic cholecystectomy (SILC). Most reported techniques utilize special purpose-made access port and articulating instruments, rendering the procedure costly and difficult to learn. This article provides a stepwise description of SILC technique using all straight instruments without the need for a special port. It aims to shorten the learning curve for surgeons wishing to adopt a safe and cost-effective SILC technique to their practice.
Keywords laparoscopic cholecystectomy      single incision laparoscopic surgery     
Corresponding Author(s): Cui Hongyi,Email:cuih@ummhc.org   
Issue Date: 05 September 2011
 Cite this article:   
Hongyi Cui. Single incision laparoscopic cholecystectomy using the one-incision three-trocar technique with all straight instruments: how I do it?[J]. Front Med, 2011, 5(3): 283-287.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-011-0151-9
https://academic.hep.com.cn/fmd/EN/Y2011/V5/I3/283
Fig.1  The external set-up. Three 5-mm trocars are placed in a triangulated arrangement via a single transumbilical incision. The two working trocars are aimed 45-degree laterally to traverse the rectus muscles. A 50-cm long, 5-mm 30-degree rigid bronchoscope with an L-shaped light cord adaptor is used to yield more external working space. The laparoscopic screen is placed above the patient’s right arm. Both the surgeon and the assistant stand on the left side of the patient.
Fig.2  Gallbladder dissection using a modified dome-down approach. (A) Medial dissection by retracting the gallbladder laterally. (B) Lateral dissection by retracting the gallbladder medially.
Fig.3  (A) A window is created between the gallbladder body and the liver bed prior to retrograde dissection toward the porta hepatis. (B) The skeletonized cystic duct (the cystic artery has been cauterized and transected).
Fig.4  Comparison of skin appearances before and after surgery. (A) Skin appearance before surgery; (B) Wound appearance immediately after skin closure with expected bruises.
Fig.5  Wound appearance at four-week follow-up. Scars are barely visible within the umbilicus.
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