Single-Incision Laparoscopic Cholecystectomy in a Patient with a Left Ventricular Assist Device

Laparoscopic cholecystectomy (LC) is the standard treatment for benign gallbladder diseases, including acute cholecystitis (AC). However, performing LC in patients with a left ventricular assist device (LVAD) presents specific technical and physiological challenges related to driveline preservation and hemodynamic stability. We report the first case of single-incision laparoscopic cholecystectomy (SILC) via the right lower abdomen in a patient with an LVAD after treatment for biliary tract infection, following prior surgery for strangulated ileus and umbilical wound infection.

A 57-year-old male with dilated cardiomyopathy underwent LVAD implantation and later developed AC and cholangitis, managed with endoscopic retrograde biliary drainage. Three months later, he underwent laparoscopic adhesiolysis for a strangulated ileus via a midline incision, complicated by umbilical wound infection. After recovery, elective LC was planned. Preoperative fluoroscopy identified the driveline's subcutaneous course through the upper midline and right upper abdomen. To avoid the infected area and driveline injury, SILC was performed via the right lower abdomen. Dense midline adhesions were manageable on the right side, and the driveline was clearly preserved. Pneumoperitoneum was maintained at 8 mmHg to minimize hemodynamic disturbance. Heparin was resumed 3 hours postoperatively and warfarin on POD 1. The patient was discharged on POD 7 without complications.

This case demonstrates the feasibility of SILC via the right lower abdomen in an LVAD patient with a complex surgical history. A tailored surgical approach and multidisciplinary perioperative planning were essential for achieving a safe and effective surgery.