Single-incision laparoscopic cholecystectomy: How I do it?

Abstract

Single-incision laparoscopic cholecystectomy (SILC) is a relatively new technique that is being increasingly used by surgeons around the world. Unlike the multi-port cholecystectomy, a standardised technique and detailed description of the operative steps of SILC is lacking in the literature. This article provides a stepwise account of the technique of SILC aimed at surgeons wishing to learn the procedure. A brief review of the current literature on SILC follows.

Keywords: Cholecystectomy; Single-incision laparoscopic surgery; laparoscopy; single-port access surgery.

Figure 1

Long laparoscope (arrow) allows freedom of movement for operative instrument.

Figure 2

Positioning of the patient and the equipment (S = position of the surgeon, A = position of the assistant/camera person).

Figure 3

Two ports (10 and 5 mm) in the umbilical incision.

Figure 4

Cephalad elevation of the gallbladder via a fundal traction suture (arrow). Inset shows the traction suture held with hemostats.

Figure 5

Suspension of the gallbladder with a loop suture on the Hartmann’s pouch. Epigastric = suture entering from the epigastrium. Lateral = suture exiting from lateral abdominal wall.

Figure 6

Critical view showing the window between the cystic duct and artery (A) and between the cystic artery and liver (B).

Figure 7

Cystic artery being clipped with a reusable 5-mm clip applicator.

Figure 8

Cystic duct being ligated using an extracorporeal knot (arrow).

Figure 9

Stones milked out from a partly opened cystic duct.

Figure 10

Everted plastic pouch stays open (A) and facilitates introduction of the gallbladder (B) for easy extraction.

Figure 11

Final appearance of transumbilical incision closed with subcuticular suture.