Laparoendoscopic single-site cholecystectomy: using a gelport device

Laparoendoscopic single-site (LESS) surgery has emerged as a viable and widely applicable minimally invasive technique. Presented here are the steps necessary to perform LESS cholecystectomy using a readily available gelport device.

To perform LESS cholecystectomy we make a 2 cm incision through the umbilicus until the fascia is identified. The fascia is opened 2 cm and a wound protector is inserted. Through the gelport we insert a 5 mm trocar with a balloon tip for the insufflation and three 5 mm trocars as working ports. Three of the trocars are placed in the lower third in a semilunar configuration before mounting the gelport onto the wound protector. A fourth trocar can then be placed at the superior aspect of the gelport. Intra-abdominal visualization is obtained with an articulating 5 mm laparoscope.

At our institution 19 patients have undergone LESS cholecystectomy out of 20 attempts (5% conversion rate), with the first 15 patients undergoing a single skin incision, multifascial incision approach and the last 5 done using a gelport device and single fascial incision. One patient in the multifascial group required conversion to a dual incision laparoscopic cholecytectomy due to cystic duct bleeding. Overall, procedures averaged 81 minutes (range, 43 to 181 min), the average length of stay was <1 day (range, 0 to 2 d). To date, 1 patient developed a wound infection that responded to oral antibiosis (5% overall complication rate), and no hernias have developed with a mean follow-up of 9 months (range, 3 to 12 mo).

The gelport may allow for the widespread use of this exciting technology even in nonspecialized centers because of the familiarity of minimally invasive surgeons with this device. The elasticity of this device seems to facilitate the use of 4 trocars, thus, replicating the "critical view" of the structures of the triangle of Calot seen in standard multi-incision laparoscopic cholecystectomy.