Consensus statement of the consortium for LESS cholecystectomy

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.

Single‐incision laparoscopic cholecystectomy

“…Surgical societies made attempts to standardize the technique. 3 We strongly recommend that surgeons attend a training course if they are unfamiliar with this approach. In addition, it may be beneficial to have a proctor for the first several cases.…”

Robotic Approach to Cholecystectomy

“…In order to perform this type of surgery, surgeons use end articulating instruments and specialized ports. The most popular commercial ports are the TriPort™ (Olympus) and SILS port™ (Covidien) [12,13]. While the benefits of single-site surgery include cosmesis and are thought to reduce postoperative pain, concerns about the complications and technical aspect of this type of surgery remain a topic of controversy.…”

“…Several large prospective randomized and case-matched cohorts have demonstrated no significant increases in complications, such as port site hernias or pain scores. While the procedure is slightly longer, with an average operative time of roughly 70 minutes compared to 55 minutes for multiport cholecystectomy, patients report greater satisfaction with the cosmetic result [13][14][15][16]. While the overall success and popularity of single-site surgery has been well described, the technical difficulty of the procedure remains a deterrent.…”

A novel locally operated master-slave robot system for single-incision laparoscopic surgery

“…To reduce the number of scars and lessen scar pain, single-incision laparoscopic surgery (SILS), which requires only a single incision, has been developed. This method is more cosmetic than laparoscopic surgery and is called "scarless surgery" since the scar is hidden if the incision is made at an umbilicus (1,2). However, SILS presents technical problems due to its single opening, such as a narrow area, internal and external interference between the instruments, and field-of-view issues.…”