title: The "invisible cholecystectomy": A transumbilical laparoscopic operation without a scar.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. ma.cuesta@vumc.nl
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: Frits
authors.initials: F
authors.lastname: Berends
authors.forename: Alexander A F A
authors.initials: AA
authors.lastname: Veenhof
mesh_terms: D000328:Adult; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery; D002921:Cicatrix / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay; D008875:Middle Aged; D016896:Treatment Outcome; D014463:Ultrasonography; D014472:Umbilicus / Q000601:surgery