Please wait a minute...
Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

Postal Subscription Code 80-967

2018 Impact Factor: 1.847

Front Med    2011, Vol. 5 Issue (3) : 283-287     DOI: 10.1007/s11684-011-0151-9
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
Download: PDF(199 KB)   HTML
Export: BibTeX | EndNote | Reference Manager | ProCite | RefWorks

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 Authors: Cui Hongyi,   
Issue Date: 05 September 2011
URL:     OR
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.
1 Romanelli JR, Earle DB. Single-port laparoscopic surgery: an overview. Surg Endosc 2009; 23(7): 1419–1427
doi: 10.1007/s00464-009-0463-x pmid:19347400
2 Hernandez JM, Morton CA, Ross S, Albrink M, Rosemurgy AS. Laparoendoscopic single site cholecystectomy: the first 100 patients. Am Surg 2009; 75(8): 681–685, discussion 685-686
3 Ponsky TA. Single port laparoscopic cholecystectomy in adults and children: tools and techniques. J Am Coll Surg 2009; 209(5): e1–e6
doi: 10.1016/j.jamcollsurg.2009.07.025 pmid:19854392
4 Podolsky ER, Rottman SJ, Poblete H, King SA, Curcillo PG. Single port access (SPA) cholecystectomy: a completely transumbilical approach. J Laparoendosc Adv Surg Tech A 2009; 19(2): 219–222
doi: 10.1089/lap.2008.0275 pmid:19260790
5 Mahmud S, Masaud M, Canna K, Nassar AHM. Fundus-first laparoscopic cholecystectomy: a safe means of reducing the conversion rate. Surg Endosc 2002; 16(4): 581–584
doi: 10.1007/s00464-001-9094-6 pmid:11972192
6 Tuveri M, Calò PG, Medas F, Tuveri A, Nicolosi A. Limits and advantages of fundus-first laparoscopic cholecystectomy: lessons learned. J Laparoendosc Adv Surg Tech A 2008; 18(1): 69–75
doi: 10.1089/lap.2006.0194 pmid:18266578
7 Cui H, Kelly JJ, Litwin DEM. Single incision laparoscopic cholecystectomy using a modified dome-down approach with conventional laparoscopic instruments. Surg Endosc ) in press)
[1] Vinay K. Kapoor. Bile duct injury repair — earlier is not better[J]. Front. Med., 2015, 9(4): 508-511.
Full text