title: "Hook and roll technique" using an articulating hook cautery to provide a critical view during single-incision laparoscopic cholecystectomy.
abstract: We describe a new simple and easy technique called the "Hook and roll technique" (HRT) that uses an articulating hook cautery to provide a critical view during single incision laparoscopic cholecystectomy (SILC). A 2-cm incision is made at the umbilicus to insert three 5-mm trocars or a multichannel port. After dissection of the serosa of the dorsal and ventral sides of the gall bladder, including Calot's triangle, the angled tip of the hook cautery is inserted between the cystic artery and duct with its tip placed dorsally. The tip is then rotated in a clockwise manner to avoid bile duct injury, allowing the connective tissue between them to be hooked, coagulated and cut. This procedure is repeated several times, followed by dissection between the cystic artery and the liver bed to achieve a critical view. From December 2008 to May 2011, 121 patients underwent SILC using HRT in our hospital without any serious complications. This technique is suitable for SILC, as it is consists of simple procedures that can be performed safely and easily, even by left hand in a cross-over approach, and it allows complete dissection of Calot's triangle to achieve a critical view without using any dissector under dangerous in-line viewing.
authors: Department of Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima 721-8511, Japan. ihitoshi@saturn.dti.ne.jp
authors: Hitoshi
authors: H
authors: Idani
authors: Kanyu
authors: K
authors: Nakano
authors: Shinya
authors: S
authors: Asami
authors: Tetsushi
authors: T
authors: Kubota
authors: Satoshi
authors: S
authors: Komoto
authors: Yohei
authors: Y
authors: Kurose
authors: Shinichiro
authors: S
authors: Kubo
authors: Hiroki
authors: H
authors: Nojima
authors: Katsuyoshi
authors: K
authors: Hioki
authors: Hitoshi
authors: H
authors: Kin
authors: Norihisa
authors: N
authors: Takakura
mesh_terms: D001158:Arteries / Q000601:surgery; D002425:Cautery / Q000295:instrumentation*; D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation* / Q000379:methods*; D004210:Dissection / Q000295:instrumentation*; D005704:Gallbladder / Q000601:surgery; D006801:Humans; D011183:Postoperative Complications / Q000523:psychology; D013525:Surgical Instruments; D016896:Treatment Outcome