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Chirurgie 1. August 2011

Loop retraction of the gallbladder in single incision laparoscopic cholecystectomy*

BACKGROUND: Single incision laparoscopic surgery (SILS) is a modified laparoscopic technique with only one access through the umbilicus to avoid visible scars. One crucial step of a cholecystectomy is a good insight to the triangle of Calot. We present our technique to retract the gallbladder with a PDS-Endoloop fixed to the fundus and which is passed through the abdominal wall with the Endo CloseTM Trocar Site Closure Device. METHODS: Prospective study. RESULTS: Cholecystectomy was performed in 29 patients with the SILS-technique between 7/2009 and 3/2010. Twenty-four patients were female (82.8%), the median age was 50 years (range, 17–74) and the median body mass index was 25.9 kg/m2 (range, 20.5–34.0). Cholecystitis was present in 13 out of 29 patients (6 acute, 7 chronic), all others (55.2%) had no inflammatory signs. In the majority of the cases (69.0%) the PDS-Endoloop technique was feasible; in 4 cases there was no need for additional retraction with the PDS-Endoloop. In 5 cases the application of the PDS-Endoloop was not possible due to advanced inflammation of the gallbladder. No complications occurred. CONCLUSIONS: This technique is simple, safe and feasible and can be carried out in selected cases of cholecystitis. The main advantage is the prevention of bile leakage.

C. Rabl, J. Hutter, S. Reich-Weinberger, K. Emmanuel, D. Oefner-Velano, European Surgery 4/2011

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