title: Microlaparoscopic cholecystectomy with an unorthodox scope position.
abstract: OBJECTIVE
  We report our initial experiences with microlaparoscopic cholecystectomy (MLCE) in children using a 2.4-mm mini-scope placed to the right of the umbilicus. The umbilicus was used as the working trocar for large-diameter instruments.
  
  
  METHODS
  The mini-scope was inserted 2-3 cm to the right to the umbilicus and slightly above the umbilical line. A miniport for the 2-mm grasper was inserted laterally through the right abdominal wall, and a 5-mm working trocar was inserted infra-umbilically. The three-angle principle of laparoscopic instrumentation remained, as the trocar positions were merely shifted to the right side of the abdominal wall. With the patient in the supine position, the surgeon stood on the left side of the patient, facing the monitor.
  
  
  RESULTS
  MLCE was successfully performed in 12 children (average age: 15 years, average body weight: 46.4 kg). In two cases, the optic trocar was repositioned one cm laterally, because the initial trocar position was too close to the umbilicus and was colliding with the 5-mm instruments. The view at the cystohepatic triangle was sufficient. There were no specific complications due to the rearranged trocar positions or the use of a mini-scope. It was possible to displace the scope out of the umbilical area without compromising the superior cosmesis allowed by using only miniports.
  
  
  CONCLUSIONS
  Based on our early experiences, MLCE is safe and feasible. This technique helps reduce the access trauma and operative time while allowing for superior cosmesis.
authors.affiliation: Department of Pediatric Surgery, University Medical Centre, Mainz, Germany. salmai.turial@unimedizin-mainz.de
authors.forename: Salmai
authors.initials: S
authors.lastname: Turial
authors.forename: Veronika
authors.initials: V
authors.lastname: Engel
authors.forename: Felix
authors.initials: F
authors.lastname: Schier
mesh_terms: D000293:Adolescent; D002648:Child; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation / Q000379:methods*; D041761:Cholecystolithiasis / Q000601:surgery; D003549:Cystic Duct / Q000473:pathology / Q000601:surgery; D004867:Equipment Design; D005260:Female; D005355:Fibrosis; D006801:Humans; D020706:Laparoscopes; D008297:Male; D010865:Pilot Projects; D011677:Punctures / Q000379:methods*; D014472:Umbilicus; D055815:Young Adult