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Four-channel single incision laparoscopic cholecystectomy using a snake retractor: comparison between 3- and 4-channel SILC 4-channel single incision cholecystectomy.

Sung NS, Choi IS, Moon JI, Ra YM, Lee SE, Choi WJ - Ann Surg Treat Res (2014)

Bottom Line: The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709).In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043).There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Single incision laparoscopic cholecystectomy (SILC) is a widely used method of performing cholecystectomy. A common technique used in SILC is a 3-channel method. However, exposure of Calot's triangle is limited in conventional 3-channel SILC. Therefore, we herein report the adequacy and feasibility of 4-channel SILC using a snake retractor.

Methods: Four hundred and fifteen SILC cases were performed between April 2010 and February 2013. We performed 326 SILC cases between April 2010 and September 2012 using the 3-channel method. We introduced a snake retractor for liver traction in October 2012, and 89 cases of 4-channel SILC using snake retractor have been performed since.

Results: Thirty patients (9.2%) in the 3-channel SILC group, and 23 patients (25.8%) in the 4-channel SILC group, were treated with percutaneous transhepatic gallbladder drainage insertion because of acute inflammation of the gallbladder (GB) before operation (P < 0.001). The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709). In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043). There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

Conclusion: Benign diseases of the GB can be operated on using SILC with the 4-channel method using a snake retractor.

No MeSH data available.


Related in: MedlinePlus

Placement of the snake retractor for liver traction.
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Figure 2: Placement of the snake retractor for liver traction.

Mentions: The patients were placed in reverse Trendelenburg position (15-30 degrees) with right side up. A 2.5-cm transumbilical incision was made and the handmade port was inserted. After making pneumoperitoneum, a flexible telescope was inserted through 3rd finger channel and then snake retractor was inserted through 2nd finger below the telescope. The snake retractor was angulated and retracted the liver. The GB was retracted laterally with a grasper which was inserted through 5th finger and the anterior peritoneum surrounding the cystic duct was dissected by left hand using a dissector through 1st finger channel (Fig. 2). After that, the left hand performed cephalic traction of the infundibulum and exposed the posterior peritoneum of the cystic duct, and then the grasper held in the right hand carried out posterior peritoneal dissection. Isolation of the cystic duct and artery using 30-50 degrees angulated dissector held in the left hand was performed. After isolating the cystic duct, both the duct and the artery are clipped using 5-mm Hem-O-Lok clip held in the left hand and the cystic duct and artery were divided using scissors held in the left hand. After the cystic artery and duct were divided, the GB was pulled cephalad using the grasper held in the right hand and then the GB was dissected from the GB bed using the suction-hook bovie held in left hand. After irrigation by the right hand using the suction-hook bovie, the GB was removed through the Alexis wound retractor positioned at the umbilical incision without an endo-bag.


Four-channel single incision laparoscopic cholecystectomy using a snake retractor: comparison between 3- and 4-channel SILC 4-channel single incision cholecystectomy.

Sung NS, Choi IS, Moon JI, Ra YM, Lee SE, Choi WJ - Ann Surg Treat Res (2014)

Placement of the snake retractor for liver traction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127901&req=5

Figure 2: Placement of the snake retractor for liver traction.
Mentions: The patients were placed in reverse Trendelenburg position (15-30 degrees) with right side up. A 2.5-cm transumbilical incision was made and the handmade port was inserted. After making pneumoperitoneum, a flexible telescope was inserted through 3rd finger channel and then snake retractor was inserted through 2nd finger below the telescope. The snake retractor was angulated and retracted the liver. The GB was retracted laterally with a grasper which was inserted through 5th finger and the anterior peritoneum surrounding the cystic duct was dissected by left hand using a dissector through 1st finger channel (Fig. 2). After that, the left hand performed cephalic traction of the infundibulum and exposed the posterior peritoneum of the cystic duct, and then the grasper held in the right hand carried out posterior peritoneal dissection. Isolation of the cystic duct and artery using 30-50 degrees angulated dissector held in the left hand was performed. After isolating the cystic duct, both the duct and the artery are clipped using 5-mm Hem-O-Lok clip held in the left hand and the cystic duct and artery were divided using scissors held in the left hand. After the cystic artery and duct were divided, the GB was pulled cephalad using the grasper held in the right hand and then the GB was dissected from the GB bed using the suction-hook bovie held in left hand. After irrigation by the right hand using the suction-hook bovie, the GB was removed through the Alexis wound retractor positioned at the umbilical incision without an endo-bag.

Bottom Line: The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709).In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043).There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea.

ABSTRACT

Purpose: Single incision laparoscopic cholecystectomy (SILC) is a widely used method of performing cholecystectomy. A common technique used in SILC is a 3-channel method. However, exposure of Calot's triangle is limited in conventional 3-channel SILC. Therefore, we herein report the adequacy and feasibility of 4-channel SILC using a snake retractor.

Methods: Four hundred and fifteen SILC cases were performed between April 2010 and February 2013. We performed 326 SILC cases between April 2010 and September 2012 using the 3-channel method. We introduced a snake retractor for liver traction in October 2012, and 89 cases of 4-channel SILC using snake retractor have been performed since.

Results: Thirty patients (9.2%) in the 3-channel SILC group, and 23 patients (25.8%) in the 4-channel SILC group, were treated with percutaneous transhepatic gallbladder drainage insertion because of acute inflammation of the gallbladder (GB) before operation (P < 0.001). The mean operating time was 53.0 ± 25.8 minutes in the 3-channel SILC group and 51.9 ± 18.6 minutes in the 4-channel SILC group (P = 0.709). In the 3-channel SILC group, mean hospital stay was 3.0 ± 3.3 days whereas it was 2.6 ± 0.9 days in the 4-channel SILC group (P = 0.043). There were a total 9 cases (2.1%) of additional port usages, 6 cases (1.8%) in the 3-channel SILC group and 3 cases (3.4%) in the 4-channel SILC group (P = 0.411), due to cystic artery bleeding and bile leakage from gallbladder bed, but there were no open conversions.

Conclusion: Benign diseases of the GB can be operated on using SILC with the 4-channel method using a snake retractor.

No MeSH data available.


Related in: MedlinePlus