Gallbladder Stones
Cholecystectomy
|
|
||||||||||||||||
Minimally Invasive Laparoscopic Cholecystectomy
Minimally Invasive Laparoscopic Cholecystectomy
Thanks to the development of small diameter instruments and to the refinement of laparoscopic techniques, a new minimally invasive technique for laparoscopic cholecystectomy was developed for non inflamed gall bladders to be performed only in lean patients, without a history of previous abdominal surgery.
Technique
Classical laparoscopic approach (French position) is used. Two trocars are needed. The first (1) is a 10 mm trocar introduced trans-umbilically (it harbors a 10 cm 30° angled laparoscope initially).
Initial exploration is performed and feasibility of the technique is estimated. A second (2) 3 mm diameter trocar is placed to the right of the round ligament of the liver, 7 cm distal to the xiphoid appendix. A 3 cm 30° angled pediatric laparoscope is now introduced in (2) and a needler holder in (1). A 2.0 nylon thread on a straight needle is introduced percutaneously in the right upper quadrant, looped around the round ligament and again passed percutaneously and held by a forceps outside the abdomen. This maneuver makes the subhepatic area accessible. By similar technique, a thread is looped around the infundibulum of the gall bladder at the level of the anterior axillary line. The infundibulum is freed by pull to the right and Callot’s triangle is maintained under traction. A 15 cm Verres needle is placed percutaneously right across the gall bladder hilum. Manipulation of the Verres needle allows for liver retraction and / or traction of the peritoneum in Callot’s triangle. Dissection is performed as in regular laparoscopic cholecystectomy and the gall bladder is extracted in (1).
Discussion
- Advantage of this technique is purely esthetical.
- Disadvantages include :
- impaired vision (less illumination possible in 3 mm scope)
- reduced manipulations of target organ possible.
Cadière’s forceps