BACKGROUND
Laparoscopic cholecystectomy has traditionally been done using four laparoscopic ports. Recently, there has been a strong move towards reduced port cholecystectomy. The mid clavicular 5-mm port used in retraction of the fundus of the gall bladder is often the first that can be omitted.
TECHNIQUE
Following the insertion of the camera (10–11-mm umbilical port), and the two operative ports (5 mm), in the epigastrium and laterally respecting the triangulation for the control of the gallbladder. A Prolene (Ethicon, Johnson & Johnson Intl. St-Stevens-Woluwe, Belgium) 2/0 stitch on a straight needle is passed through the abdominal wall under vision (Fig. 1) and then through the fundus of the gallbladder (Fig. 2) and back again through the abdominal wall and tied on the outside of the abdominal wall for retraction of the gall bladder fundus (Figs 3 and 4). The operation is completed in a routine fashion, and we use a 5-mm camera through the epigastric port to guide the extraction of the gallbladder in the endopouch through the umbilical port after cutting the Prolene stitch to release the gallbladder.
Figure 1.
A straight needle is passed through the abdominal wall under vision.
Figure 2.
Needle is passed through the fundus of the gallbladder.
Figure 3.
Needle is passed back again through the abdominal wall.
Figure 4.
Prolene thread tied on the outside of the abdominal wall.
DISCUSSION
This simple technique allows reduction in the number and size of the used ports during routine laparoscopic cholecystectomies.