Many surgeons attempting Laparo-Endoscopic Single Site (LESS) cholecystectomy have found the operation difficult, which is inconsistent with our experience. This article is an attempt to promote a standardized approach that we feel surgeons with laparoscopic skills can perform safely and efficiently. This is a four-trocar approach consistent with the four incisions utilized in conventional laparoscopic cholecystectomy. After administration of general anesthesia, marcaine is injected at the umbilicus and a 12-mm vertical incision is made through the already existing anatomical scar of the umbilicus. A single four-trocar port is inserted. A 5-mm deflectable-tip laparoscope is placed through the trocar at the 8 o’clock position, a bariatric length rigid grasper is inserted through the trocar at the 4 o’clock position (to grasp the fundus), and a rigid bent grasper is placed through the 10-mm port (to grasp the infundibulum). This arrangement of the instruments promotes minimal internal and external instrument clashing with simultaneous optimization of the operative view. This orientation allows retraction of the gallbladder in a cephalad and lateral direction, development of a window between the gallbladder and the liver which promotes the “critical view” of the cystic duct and artery, and provides triangulation with excellent visualization of the operative field. The operation is concluded with diaphragmatic irrigation of marcaine solution to minimize postoperative pain. Standardization of LESS cholecystectomy will speed adoption, reduce intraoperative complications, and improve the efficiency and safety of the approach.
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Sharona Ross, MD, is a consultant for Covidien and Olympus. Alex Rosemurgy, MD, is a consultant for Covidien and Olympus. Santiago Horgan, MD, is a stockholder for USGI, Apollo, Valentx, Virtual Ports, and Eon Surgical. Dr. Horgan is also a speaker for Ethicon Endo-Surgery, Stryker, Intuitive, Olympus, and Gore. William Kelley, MD, has been a speaker for Covidien and is on the scientific advisory board for TransEnterics with some stock options. Michael Kia, MD, is a consultant for Olympus, Ethicon, and Cardinal. Jeffrey Marks, MD, is a consultant for Covidien, Olympus, and Gore. Dr. Marks is also on the advisory council for Apollo Endosurgery. Jose Martinez, MD, has received honoraria from Boston Scientific, Olympus, and Lifecell. Yoav Mintz, MD, is a consultant and receives consulting fees from Virtual Ports, EasyLap, EasyNotes, Eon Surgical, Silenseed, MST, and Lumenis. Dr. Mintz also received an educational grant from Ethicon Endo-Surgery and Storz Endoscopy. Dr. Aurora Pryor, MD, is a consultant with Olympus and Gore, in addition to being a speaker for Covidien. Dr. Pryor also has ownership interest with Transenterix and Barosense. David Rattner, MD, is a consultant with Olympus and is on the scientific advisory board with Transenterix. Homero Rivas, MD, has been a lecturer for Covidien. Kurt Roberts, MD, is a consultant for and receives consulting fees from Olympus. Dr. Roberts also have ownership interest with NovaTract. Eugene Rubach, MD, is a consultant for and holds a research grant with Johnson & Johnson, a research grant with Covidien, and is a speaker with Gore. Steven Schwaitzberg, MD, is a consultant with Endocore, Olympus, Stryker, Surgiquest, Neatstitch, Combridge Endo, and Acuity Bio. Erik Wilson, MD, has taught at, proctored at, and consulted with Ethicon Endo, Intuitive Surgical, Gore, and Olympus. Harry Zemon, MD, is a consultant with Olympus, and Nathan Zundel, MD, is a consultant with Olympus, Covidien, Apollo, and Ethicon. In addition, Dr. Zundel is a speaker for Ethicon and CibeMed. Michael Albrink, MD, Edward Choung, MD, Giovanni Dapri, MD, Scott Gallagher, MD, Jonathan Hernandez, MD, Dmitry Oleynikov, MD, Lee Swanstrom, MD, and John Sweeney, MD, have no conflicts of interest or financial ties to disclose.
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Ross, S., Rosemurgy, A., Albrink, M. et al. Consensus statement of the consortium for LESS cholecystectomy. Surg Endosc 26, 2711–2716 (2012). https://doi.org/10.1007/s00464-012-2478-y
- Laparoendoscopic single site