Single Incision Laparoscopic Cholecystectomy by Using a 2 mm Atraumatic Grasper without Trocar
Purpose. We present our experience in single incision laparoscopic cholecystectomy by using a grasper directly without using a trocar in five patients. Methods and Results. The technique involves the use of Karl Storz 27290F grasper in order to perform gallbladder retraction in single port cholecystectomy. The grasper was introduced directly into the skin through abdominal wall without using any trocar and used to mobilize gallbladder whenever needed during surgery without causing any perforation or leakage of the gallbladder. There were no intraoperative and postoperative complications in 5 patients with the advantages of shorter operation time and almost invisible postoperative skin scar formation. Conclusion. We claim that the use of this instrument in SILS surgery might be advantageous than the conventional placement of sutures for the gallbladder mobilization
Single incision laparoscopic surgery (SILS) for cholecystectomy procedure has been introduced as early as 1999 [1] to achieve less pain, less scarring, and less hospitalization period. One of the major difficulties of this procedure seems to be the traction of the gallbladder in order to expose the tissues during operation without additional ports. The use of transabdominal 2–0 nylon sutures attached to Keith needles [2] and the use of a Kirschner wire hook introduced through subcostal area [3] are reported methods used for traction of gallbladder and better exposition of the Calot triangle. However, all these techniques consist puncture of the gallbladder with sharp needles especially if it is distended and carry the risk of bile leakage and contamination afterwards. They also have limited ability to mobilization whenever needed.
Herein, we describe our technique in establishing single port access for cholecystectomy in five patients that involves the use of a 2 mm in diameter grasper, Karl Storz 27290F, that is generally used by urologists for percutaneous nephrolithiasis intervention.
