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Consensus statement of the consortium for LESS cholecystectomy
- Source :
- Surgical Endoscopy. 26:2711-2716
- Publication Year :
- 2012
- Publisher :
- Springer Science and Business Media LLC, 2012.
-
Abstract
- Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o'clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o'clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the "critical view" of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.
- Subjects :
- medicine.medical_specialty
business.industry
General surgery
Gallbladder
Postoperative pain
medicine.medical_treatment
Surgery
medicine.anatomical_structure
Cholecystectomy, Laparoscopic
Single site
medicine
Humans
Vertical incision
Cystic duct
Cholecystectomy
Simultaneous optimization
business
Laparoscopic cholecystectomy
Subjects
Details
- ISSN :
- 14322218 and 09302794
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Surgical Endoscopy
- Accession number :
- edsair.doi.dedup.....d4b56659adbdb21b63fe9d8aba28dbf6