Completely Intracorporeal Retraction of the Gallbladder for Laparoendoscopic Single Site (LESS) Surgery

Abstract

Laparoendoscopic single site surgery (LESS) cholecystectomy requires a creative solution to retract the gallbladder. Transabdominal suture retraction is a commonly used technique to achieve adequate exposure of the critical structures within Calot's triangle. To avoid the multiple punctures of the gallbladder and abdominal wall required by such suture retraction, we developed a novel internal retractor specifically for use during LESS cholecystectomy. This retractor consists of a laparoscopic bulldog clamp fitted with a small metal hook, and was successfully used in a recent case of LESS cholecystectomy.

Single-incision Laparoscopic Cholecystectomy Versus Laparoscopic Cholecystectomy

“…Other solutions, such as retractors, can be used to retract the gallbladder. 15,16 Another issue is that the roticulator devices must be used appositely; otherwise, the operation cannot be completed as the surgeon desires.…”

Single-incision Robotic Cholecystectomy: Initial Experience and Results

“…In SILC, several methods of gallbladder retracting-including sutures, clips, and magnets-have been described. 19,20 In this study, however, none of the previous methods have been proven to be necessary. The retractor grasper was inserted via the accessary channel of the reverse port, moved under the rigid scope, advanced along the same axis, and entered into the surgical field.…”

Two-Port Laparoscopic Cholecystectomy: 18 Patients Human Experience Using the Dynamic Laparoscopic NovaTract Retractor

“…Several minimally invasive retraction methods such as transabdominal stay sutures, transabdominal endoloop, Magnetic Anchoring and Guidance System (MAGS), EndograbÔ, VERSA LifterÔ, and modified laparoscopic bulldog clamp have been used in clinical practice. [13][14][15][16][17][18] The transabdominal stay sutures are placed through the fundus and infundibulum of the gallbladder using straight Keith needles and then transabdominally externalized to allow continuous extracorporeal adjustments and manipulations. This retraction method only leaves negligible puncture marks where the needles are passed through the skin.…”