Consensus statement of the consortium for LESS cholecystectomy

Sharona Ross, Alexander Rosemurgy, Michael Albrink, Edward Choung, Giovanni Dapri, Scott Gallagher, Jonathan Hernandez, Santiago Horgan, William Kelley, Michael Kia, Jeffrey Marks, Jose M Martinez, Yoav Mintz, Dmitry Oleynikov, Aurora Pryor, David Rattner, Homero Rivas, Kurt Roberts, Eugene Rubach, Steven Schwaitzberg & 5 others Lee Swanstrom, John Sweeney, Erik Wilson, Harry Zemon, Natan Zundel

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

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.A5-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.

Original languageEnglish
Pages (from-to)2711-2716
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number10
DOIs
StatePublished - Oct 1 2012

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Cholecystectomy
Surgical Instruments
Umbilicus
Bupivacaine
Gallbladder
Laparoscopes
Bariatrics
Cystic Duct
Laparoscopic Cholecystectomy
Intraoperative Complications
Pituitary Gland
Postoperative Pain
General Anesthesia
Cicatrix
Arteries
Safety
Liver
Surgeons

Keywords

  • Cholecystectomy
  • Laparoendoscopic single site
  • LESS

ASJC Scopus subject areas

  • Surgery

Cite this

Ross, S., Rosemurgy, A., Albrink, M., Choung, E., Dapri, G., Gallagher, S., ... Zundel, N. (2012). Consensus statement of the consortium for LESS cholecystectomy. Surgical Endoscopy and Other Interventional Techniques, 26(10), 2711-2716. https://doi.org/10.1007/s00464-012-2478-y

Consensus statement of the consortium for LESS cholecystectomy. / Ross, Sharona; Rosemurgy, Alexander; Albrink, Michael; Choung, Edward; Dapri, Giovanni; Gallagher, Scott; Hernandez, Jonathan; Horgan, Santiago; Kelley, William; Kia, Michael; Marks, Jeffrey; Martinez, Jose M; Mintz, Yoav; Oleynikov, Dmitry; Pryor, Aurora; Rattner, David; Rivas, Homero; Roberts, Kurt; Rubach, Eugene; Schwaitzberg, Steven; Swanstrom, Lee; Sweeney, John; Wilson, Erik; Zemon, Harry; Zundel, Natan.

In: Surgical Endoscopy and Other Interventional Techniques, Vol. 26, No. 10, 01.10.2012, p. 2711-2716.

Research output: Contribution to journalArticle

Ross, S, Rosemurgy, A, Albrink, M, Choung, E, Dapri, G, Gallagher, S, Hernandez, J, Horgan, S, Kelley, W, Kia, M, Marks, J, Martinez, JM, Mintz, Y, Oleynikov, D, Pryor, A, Rattner, D, Rivas, H, Roberts, K, Rubach, E, Schwaitzberg, S, Swanstrom, L, Sweeney, J, Wilson, E, Zemon, H & Zundel, N 2012, 'Consensus statement of the consortium for LESS cholecystectomy', Surgical Endoscopy and Other Interventional Techniques, vol. 26, no. 10, pp. 2711-2716. https://doi.org/10.1007/s00464-012-2478-y
Ross, Sharona ; Rosemurgy, Alexander ; Albrink, Michael ; Choung, Edward ; Dapri, Giovanni ; Gallagher, Scott ; Hernandez, Jonathan ; Horgan, Santiago ; Kelley, William ; Kia, Michael ; Marks, Jeffrey ; Martinez, Jose M ; Mintz, Yoav ; Oleynikov, Dmitry ; Pryor, Aurora ; Rattner, David ; Rivas, Homero ; Roberts, Kurt ; Rubach, Eugene ; Schwaitzberg, Steven ; Swanstrom, Lee ; Sweeney, John ; Wilson, Erik ; Zemon, Harry ; Zundel, Natan. / Consensus statement of the consortium for LESS cholecystectomy. In: Surgical Endoscopy and Other Interventional Techniques. 2012 ; Vol. 26, No. 10. pp. 2711-2716.
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