title: Clinical evaluation of an internal adjustable retractor in laparoscopic cholecystectomy.
abstract: BACKGROUND
  Reducing the number of abdominal incisions in laparoscopic cholecystectomy introduces ergonomic challenges while establishing the critical view during dissection of the triangle of Calot (TC). This study investigates the use of a novel internal retracting device in performing cholecystectomy with a reduced number of ports.
  
  
  METHODS
  A 3-port laparoscopic cholecystectomy was attempted by 4 surgeons unfamiliar with the novel device. Exposure of the TC was obtained using the internal retractor, which comprises 2 clips, linked by an adjustable thread. One clip is fixed on the gallbladder and the other is fixed to the peritoneum. The endpoint was to evaluate the efficacy and reliability of the device in establishing the critical view of safety.
  
  
  RESULTS
  Thirteen patients with a mean body mass index of 25.29 kg/m(2) (standard deviation = 6.24; range = 17.6-36.7 kg/m(2)) were included in the study. The critical view was obtained in 10 of 13 patients. Application of the device was completed in a median time of 2.25 minutes without injury of the gallbladder or bile leak. Failure occurred in 3 patients, related to wrong manipulation of the device (2 patients), and correct placement of the device but inadequate exposure (1 patient). A conventional 4-port technique was used in these patients. Operators rated their experience with the device as an "easy-to-operate" device with a good safety profile and without any interference with the operative process.
  
  
  CONCLUSIONS
  Throughout the minimization process specific to minimal access surgery, internal retractors will certainly allow for a reduction in the number of trocars used in laparoscopic procedures.
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Parag
authors.initials: P
authors.lastname: Dhumane
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France bernard.dallemagne@ircad.fr.
authors.forename: Bernard
authors.initials: B
authors.lastname: Dallemagne
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Brian
authors.initials: B
authors.lastname: Barry
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Silvana
authors.initials: S
authors.lastname: Perretta
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Joel
authors.initials: J
authors.lastname: Leroy
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Mutter
authors.affiliation: IRCAD-EITS Institute, University Hospital of Strasbourg, Strasbourg, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Marescaux
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000295:instrumentation*; D004867:Equipment Design; D006804:Ergonomics; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013525:Surgical Instruments
keywords: LESS; biomedical engineering; ergonomics and/or human factors study; laparoscopic cholecystectomy