Other Minimal Access Surgical Procedures
Two Port Cholecystectomy
Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease. The operation is routinely performed using four or three ports of entry into the abdomen. At Laparoscopy Hospital we frequently perform cholecystectomy by a two-port method using a modified extracorporeal knot. With this technique, we can give traction over the gallbladder in any direction for proper exposure. This new innovative two-port method of gallbladder removal can be used only for simple uncomplicated cholelithiasis cases by an experienced surgeon, but it has a definite advantage over conventional three or four-port cholecystectomy in two-port cholecystectomy fundus is retracted by the help of strategically passed suture. Once the proper exposure of the cystic pedicle is achieved Maryland is used for dissection.
Port position for two-port cholecystectomy
Fundus is retracted up with the help of needle and thread passed through intercostals space under vision
Another Vicryl is applied over Hartsman pouch to provide anterolateral traction. Any leak from the gallbladder is irrigated and sucked nicely with the help of suction irrigation instrument
Dissection of the cystic pedicle is performed by Maryland
An extracorporeal knot can be applied for a cystic duct without any problem after a nice dissection of the cystic pedicle. The knot which is tied over the cystic pedicle is used to pull the neck of the gallbladder up and with the help of hook GB is separated from the liver. Patients undergoing cholecystectomy by the two-port method had a better resumption of diet and less postoperative pain. Two-port cholecystectomy is technically feasible and may further improve the surgical outcomes in terms of postoperative pain and better cosmetic value. The two-port cholecystectomy should be performed by an experienced laparoscopic surgeon because skilled choreographic hand movement is very important in this surgery. Bimanual skill and correct interpretation of anatomy is a must before proceeding for this technique. We do not recommend two-port cholecystectomy as a routine procedure.
Clip or extracorporeal Meltzer knot is applied over cystic artery and duct
The extracorporeal knot of the cystic duct is used to pull the neck up and to expose bed of the gallbladder
Any leak should be sucked and gallbladder is separated with the help of hook
Ending of the Operation
The instruments and ports are removed. The telescope should be removed leaving the gas valve of umbilical port open to let out all the gas. At the time of removing the umbilical port, the telescope should be again inserted and umbilical port should be removed over the telescope to prevent any entrapment of omentum. The wound is then closed with suture. Vicryl should be used for rectus and unabsorbable intradermal or stapler for the skin. A single suture is used to close the umbilicus and upper midline fascial opening. Many laparoscopic surgeons routinely leave this fascial defect without ill effect. Some surgeon likes to inject local anesthetic agent over the port site to avoid postoperative pain. Sterile dressing over the wound should be applied.
