title: Marionette method for transumbilical single-incision, two-trocar laparoscopic cholecystectomy: a new, simple technique.
abstract: OBJECTIVE
  Single-incision laparoscopic cholecystectomy (SILC) has recently become a topic of interest among types of minimally invasive surgery.
  
  
  METHODS
  We developed a novel "marionette method"technique for performing SILC. Two 5 mm trocars were placed through a 1.5 cm transumbilical incision. In addition, a nylon suture with a laparoscopic sliding knot was used to tighten the fundus of the gallbladder and was thereafter suspended with this nylon suture. The neck of the gallbladder was tightened by means of a loop type retractor, to enable adequate visualization of the triangle of Calot. Dissection was performed as a conventional laparoscopic cholecystectomy using standard straight laparoscopic instruments.
  
  
  RESULTS
  All 20 patients successfully underwent a single-incision, two-trocar laparoscopic cholecystectomy performed using the marionette method. The mean operative time was 119 min. There were no complications.
  
  
  CONCLUSIONS
  The marionette method can provide good tension and an appropriate laparoscopic view with a suitable surgical field for safely performing a dissection at the triangle of Calot during SILC.
authors.affiliation: Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan. tkuroki-gi@umin.ac.jp
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Adachi
authors.forename: Amane
authors.initials: A
authors.lastname: Kitasato
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Okamoto
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D014472:Umbilicus / Q000601:surgery