Single-incision Laparoscopic Cholecystectomy: A New Retraction Technique

Abstract

Adequate retraction greatly simplifies laparo-endoscopic single site cholecystectomy. New retraction techniques will enable wider use of this novel minimally invasive approach. Further work is needed to investigate the advantages of this new technique.

Effective method of gallbladder retraction for single‐incision laparoscopic cholecystectomy

“…Generally, SILC requires several specific instruments, such as a grasper, a dissector, a flexible 5‐mm endoscope, and a specialized port for the single incision itself. Moreover, commercially available single ports are usually more expensive than conventional ports, leading to increased medical costs . Our method was $50 cheaper than that using a Mini Loop Retractor (approximately $100 vs $150) .…”

“…However, SILC is still considered a challenging procedure because of the collision of surgical instruments and a limited operative field. Therefore, several instruments have been developed for gallbladder retraction to enable better visualization of Calot's triangle without the use of forceps, including the Mini Loop Retractor (Covidien, Tokyo, Japan) and the Internal Organ Retractor (Aesculap PA, USA), which can adjust retraction strength and direction . However, these devices may lead to increased procedural costs .…”

“…After the cystic artery and duct were cut, the resected gallbladder was directly extracted from the umbilical incision.Discussion: Several methods and devices have been developed to perform single-incision laparoscopic cholecystectomy, including the suturing method, the Mini Loop Retractor II (Covidien), and the EndoGrab (Virtual Ports, Caesarea, Israel). However, considering medical costs and safety, our retraction method seems to be feasible and comparable to existing methods.for gallbladder retraction to enable better visualization of Calot's triangle without the use of forceps, including the Mini Loop Retractor (Covidien, Tokyo, Japan) and the Internal Organ Retractor (Aesculap PA, USA), which can adjust retraction strength and direction (5,6). However, these devices may lead to increased procedural costs (4).…”

“…for gallbladder retraction to enable better visualization of Calot's triangle without the use of forceps, including the Mini Loop Retractor (Covidien, Tokyo, Japan) and the Internal Organ Retractor (Aesculap PA, USA), which can adjust retraction strength and direction (5,6). However, these devices may lead to increased procedural costs (4).…”

New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper.

“…Actually, recently, similar retraction tools have been reported to facilitate operations. Some authors used a needle grasper with a 3 mm trocar, and some authors used EndoClose and a 2-mm atraumatic grasper without the use of a trocar [ 7 , 10 , 11 ].…”