title: Consensus statement of the consortium for LESS cholecystectomy.
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. A 5-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.
authors.affiliation: HPB & Foregut Advanced Laparoscopic & Robotic Surgery, Florida Hospital Tampa, 3100 East Fletcher Avenue, Suite 310, Tampa, Florida 33613, USA. sharona.ross@yahoo.com
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
authors.forename: Michael
authors.initials: M
authors.lastname: Albrink
authors.forename: Edward
authors.initials: E
authors.lastname: Choung
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dapri
authors.forename: Scott
authors.initials: S
authors.lastname: Gallagher
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: William
authors.initials: W
authors.lastname: Kelley
authors.forename: Michael
authors.initials: M
authors.lastname: Kia
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Marks
authors.forename: Jose
authors.initials: J
authors.lastname: Martinez
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
authors.forename: Dmitry
authors.initials: D
authors.lastname: Oleynikov
authors.forename: Aurora
authors.initials: A
authors.lastname: Pryor
authors.forename: David
authors.initials: D
authors.lastname: Rattner
authors.forename: Homero
authors.initials: H
authors.lastname: Rivas
authors.forename: Kurt
authors.initials: K
authors.lastname: Roberts
authors.forename: Eugene
authors.initials: E
authors.lastname: Rubach
authors.forename: Steven
authors.initials: S
authors.lastname: Schwaitzberg
authors.forename: Lee
authors.initials: L
authors.lastname: Swanstrom
authors.forename: John
authors.initials: J
authors.lastname: Sweeney
authors.forename: Erik
authors.initials: E
authors.lastname: Wilson
authors.forename: Harry
authors.initials: H
authors.lastname: Zemon
authors.forename: Natan
authors.initials: N
authors.lastname: Zundel
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D006801:Humans