title: A Novel Procedure for Single-Incision Laparoscopic Cholecystectomy-The Teres Hanging Technique Combined with Fundus-First, Dome-Down Separation.
abstract: BACKGROUND
  Generally, single-incision laparoscopic cholecystectomy (SILC) requires the use of articulating devices or additional trocars because of the technical difficulties caused by the lack of ergonomics. We developed a novel procedure comprising mainly two simple ideas, "the teres hanging technique combined with fundus-first, dome-down separation," which mainly uses conventional rigid laparoscopic instruments. In this study, we demonstrated our technique and retrospectively evaluated the clinical outcomes.
  
  
  METHODS
  Three trocars were set through a 2.0-cm transumbilical minilaparotomy that was covered with an EZ Access™ combined with a lap protector. To create an adequate surgical field, the teres ligament was laparoscopically hung up with a suture on a straight needle. The gall bladder was then dissected through the fundus to the neck using rigid laparoscopic instruments without any additional trocars. At our institution, 18 consecutive patients underwent SILC using our technique from January 2014 to August 2015. Each patient had a symptomatic gallbladder (GB) stone or polyp. All operations were performed by surgeons who had never performed SILC until this study.
  
  
  RESULTS
  In all operations, our technique was successfully completed without GB perforation or other intraoperative complications. Additional trocars or open laparotomy were not required. The median operation time was 79 minutes, and blood loss was negligible. No postoperative complications were encountered.
  
  
  CONCLUSIONS
  Our novel procedure is safe and feasible. Even for surgeons who have never performed SILC before, our technique may become a standard for benign GB disease without requiring the use of articulating devices or additional trocars.
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Masazumi
authors.initials: M
authors.lastname: Zaima
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Yuya
authors.initials: Y
authors.lastname: Kida
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Hideki
authors.initials: H
authors.lastname: Harada
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Junichiro
authors.initials: J
authors.lastname: Kawamura
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yamada
authors.affiliation: Department of Surgery, Shiga Medical Center for Adults , Moriyama-city, Japan .
authors.forename: Tekefumi
authors.initials: T
authors.lastname: Yazawa
mesh_terms: D000328:Adult; D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005260:Female; D005705:Gallbladder Diseases / Q000601:surgery; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009339:Needles; D011127:Polyps / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D013525:Surgical Instruments; D013536:Suture Techniques; D016896:Treatment Outcome
keywords: SILS; laparoscopic cholecystectomy; single-incision