The “invisible cholecystectomy”: A transumbilical laparoscopic operation without a scar

• Published in: Surgical endoscopy Vol. 22; no. 5; pp. 1211 - 1213
• Main Authors: Cuesta, Miguel A., Berends, Frits, Veenhof, Alexander A. F. A.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.05.2008; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Bile; Biological and medical sciences; Body mass index; Cholecystectomy; Cholecystectomy, Laparoscopic - adverse effects; Cholecystectomy, Laparoscopic - methods; Cholelithiasis - diagnostic imaging; Cholelithiasis - surgery; Cicatrix - etiology; Cicatrix - prevention & control; Digestive system. Abdomen; Endoscopy; Female; Gallbladder; Gallbladder diseases; Gallstones; Gastroenterology; General aspects; Gynecology; Hepatology; Humans; Intraoperative Period; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Length of Stay; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Patients; Proctology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Treatment Outcome; Ultrasonic imaging; Ultrasonography; Umbilicus - surgery; Vagina; Wire; Netherlands; Laparoscopic cholecystectomy; Minimally invasive; Scarless cholecystectomy; Cholecystectomy; Medicine; Endoscopic surgery; Treatment; Scar; Gallbladder; Laparoscopy; Endoscopy
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-007-9588-y

Background Looking to further reduce the operative trauma of laparoscopic cholecystectomy, we developed, in patients with no history of cholecystitis and a normal BMI, a scarless operation through the umbilicus. The operative technique, along with the results of the first 10 patients operated in this way, are fully described. Methods 10 female patients underwent transumbilical scarless laparoscopic cholecystectomy. Through the umbilicus, two trocars of 5 mm were introduced parallel to another with a bridge of fascia between them (one for the 5-mm laparoscope and the other for the grasper). With the help of one 1-mm Kirschner wire, introduced at the subcostal line and bent with a special designed device, the gallbladder was pulled up and the triangle of Callot was dissected free, clipped, cut, and the gallbladder was subsequently resected. Finally the gallbladder was taken out through the umbilicus and the umbilicus reconstructed. Results 10 female patients, mean age 36 years (range: 31–49), mean body mass index (BMI) 23 (range: 20–26), after one attack (six patients) or a second attack (four patients) and cholelithiasis confirmed by ultrasonography with no suspicion of inflammation were included in this preliminary study. Mean operative time was 70 minutes (range: 65–85) with no conversions; hospital stay was less than 24 hours with no complications. Conclusion Looking to reduce operative trauma and improve the cosmetic result following laparoscopic cholecystectomy, a transumbilical operative technique has been developed. Results of the operative procedure in a selected group of patients are encouraging with no signs of inflammation and normal BMI. The umbilicus can be developed as a natural port for performing various operative procedures with the help of the traction produced by thin Kirschner wires.