TY - JOUR
T1 - Consensus statement of the consortium for LESS cholecystectomy
AU - Ross, Sharona
AU - Rosemurgy, Alexander
AU - Albrink, Michael
AU - Choung, Edward
AU - Dapri, Giovanni
AU - Gallagher, Scott
AU - Hernandez, Jonathan
AU - Horgan, Santiago
AU - Kelley, William
AU - Kia, Michael
AU - Marks, Jeffrey
AU - Martinez, Jose
AU - Mintz, Yoav
AU - Oleynikov, Dmitry
AU - Pryor, Aurora
AU - Rattner, David
AU - Rivas, Homero
AU - Roberts, Kurt
AU - Rubach, Eugene
AU - Schwaitzberg, Steven
AU - Swanstrom, Lee
AU - Sweeney, John
AU - Wilson, Erik
AU - Zemon, Harry
AU - Zundel, Natan
PY - 2012/10
Y1 - 2012/10
N2 - 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.A5-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.
AB - 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.A5-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.
KW - Cholecystectomy
KW - LESS
KW - Laparoendoscopic single site
UR - http://www.scopus.com/inward/record.url?scp=84871603080&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84871603080&partnerID=8YFLogxK
U2 - 10.1007/s00464-012-2478-y
DO - 10.1007/s00464-012-2478-y
M3 - Article
C2 - 22936433
AN - SCOPUS:84871603080
SN - 0930-2794
VL - 26
SP - 2711
EP - 2716
JO - Surgical endoscopy
JF - Surgical endoscopy
IS - 10
ER -