Simple and effective suspension technique for laparoscopic cholecystectomy

Area of Science:

• Minimally Invasive Surgery
• Surgical Techniques
• Gastrointestinal Surgery

Background:

• The standard American four-port technique for laparoscopic cholecystectomy often omits the lateral retraction port.
• Omitting this port can compromise surgical ergonomics and safety.
• Scarless suspension techniques have emerged as alternatives to the lateral retraction port.

Purpose of the Study:

• To review existing gallbladder fundus suspension techniques.
• To develop an expedient, safe, and cost-effective suspension technique.
• To maintain the ergonomic and observational advantages of the four-port technique without a lateral port.

Main Methods:

• A systematic review of published gallbladder fundus suspension techniques was conducted.
• A novel technique involves a snare loop created by a folded thread passed through a 14-G intravenous cannula.
• Anchorage is secured using a two-haemostat technique; the cannula can be repositioned for enhanced liver retraction.

Main Results:

• The described suspension technique effectively entraps and holds the gallbladder fundus.
• The two-haemostat anchorage method is a novel approach.
• Repositioning the cannula into the thoracic cage provided cephalad retraction and liver rotation without causing pneumothorax, confirmed by chest radiographs.

Conclusions:

• This simple gallbladder suspension technique effectively replicates the ergonomic and exposure benefits of the four-port technique.
• The method is safe and cost-effective for selected patients undergoing laparoscopic cholecystectomy.
• Surgeons should exercise due caution when applying this technique, considering patient selection.