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Marionette method for transumbilical single-incision, two-trocar laparoscopic cholecystectomy: a new, simple
Tamotsu Kuroki1, Tomohiko Adachi, Amane Kitasato
1Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan. tkuroki-gi@umin.ac.jp
Background/Aims:
Single-incision laparoscopic cholecystectomy (SILC) has recently become a topic of interest among types of minimally invasive surgery.
Methodology:
We developed a novel "marionette method"technique for performing SILC. Two 5 mm trocars were placed through a 1.5 cm transumbilical incision. In addition, a nylon suture with a laparoscopic sliding knot was used to tighten the fundus of the gallbladder and was thereafter suspended with this nylon suture. The neck of the gallbladder was tightened by means of a loop type retractor, to enable adequate visualization of the triangle of Calot. Dissection was performed as a conventional laparoscopic cholecystectomy using standard straight laparoscopic instruments.
Results:
All 20 patients successfully underwent a single-incision, two-trocar laparoscopic cholecystectomy performed using the marionette method. The mean operative time was 119 min. There were no complications.
Conclusions:
The marionette method can provide good tension and an appropriate laparoscopic view with a suitable surgical field for safely performing a dissection at the triangle of Calot during SILC.