Ann Surg Treat Res.  2018 Jun;94(6):291-297. 10.4174/astr.2018.94.6.291.

Single-incision laparoscopic cholecystectomy using instrumental alignment in robotic single-site cholecystectomy

Affiliations
  • 1Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea. feel415@cha.ac.kr

Abstract

PURPOSE
There is no standardized single-incision laparoscopic cholecystectomy (SILC) technique in contrast to robot single-site cholecystectomy (RSSC). We tried to implement the array of instruments used in RSSC to SILC.
METHODS
A series of 108 consecutive patients underwent SILC between September 2014 and July 2017 by 2 surgeons. The indication was benign disease of the gallbladder. The perioperative outcomes were reviewed. We used the 4-channel Glove port and conventional laparoscopic instruments.
RESULTS
The study subjects consisted of 29 males and 79 females, and the mean age was 44.4 years (range, 16-70 years). Mean body mass index was 24.1 kg/m2. The mean working time was 25.0 ± 10.7 minutes and total operation time was 44.4 ± 12.4 minutes. There were 7 cases of conversion (additional 1 port in 4 patients, additional 2 ports in 2, and conventional 4 port technique in 1). Bile spillage from the gallbladder during the procedure occurred in 17 (15.7%). There were no postoperative complications. Postoperative hospital stay was 2.0 ± 0.6 days.
CONCLUSION
The alignment of the instruments in a RSSC was successfully implemented into a SILC, so that an equally effective operation was possible.

Keyword

Cholecystectomy; Laparoscopy; Minimally invasive surgical procedures; Robotics

MeSH Terms

Bile
Body Mass Index
Cholecystectomy*
Cholecystectomy, Laparoscopic*
Female
Gallbladder
Humans
Laparoscopy
Length of Stay
Male
Minimally Invasive Surgical Procedures
Postoperative Complications
Robotics
Surgeons

Figure

  • Fig. 1 Setting of the Glove port. The blue channel for the laparoscopic camera was placed toward the gallbladder (arrow). The 2 channels for the working instruments and the camera channel were arranged in a triangle, and the remaining channel for gallbladder traction was located on the left side of the patient.

  • Fig. 2 Alignment of the instruments in robot single-site cholecystectomy. The instrumental arrangement consists of a retraction grasper, a robotic camera, and 2 working instruments from the top. The left lower figure shows the instrument sequence within skin incision. R, assistant retractor; C, camera; w1 and 2, working instruments.

  • Fig. 3 External view of alignment of the instruments. (A) The laparoscopic grasper was inserted for upward retraction of the gallbladder through the lateral channel (channel ①) and was fixed to the operative drape using a towel clip (arrow). (B) The two working channels (channels ② and ③) were located on the left and right sides of the laparoscope. The traction of the gallbladder was made with the right hand of the operator, and the main work was performed with the left hand. ⓐ, assistant's hand; OR, operator's right hand; OL, operator's left hand.

  • Fig. 4 Internal view of alignment of the intruments. (A) From top to bottom, retraction grasper, laparoscopic camera, coagulator, and working grasper. The laparoscopic camera was introduced first. Laparoscopic retraction grasper (®) was inserted for upward retraction of the gallbladder. At this time, the laparoscope was moved to the bottom of the grasper. Another laparoscopic working grasper entered below the laparoscope and the laparoscopic hook coagulator entered between the working grasper and the laparoscope. (B) Full exposure of the anterior Calot's triangle. (C) In order to dissect the posterior aspect of Calot's triangle, the 2 working instruments that were crossed could be exchanged up and down (arrows: direction of movement). (D) Full exposure of the posterior Calot's triagle. OR, operator's right hand (working grasper); OL, operator's left hand (laparoscopic coagulator).


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