title: New advantageous tool in single incision laparoscopic cholecystectomy: the needle grasper.
abstract: BACKGROUND
  During single-incision laparoscopic cholecystectomy (SILC), the gallbladder is suspended with stitches, resulting in perforation risk and difficulty in exploration.
  
  
  OBJECTIVE
  We used the needle grasper in SILC to hang and manipulate the gallbladder.
  
  
  METHODS
  Sixty-five patients (43 female, 22 male) who underwent SILC between December 2013 and December 2014 were analyzed retrospectively for patient demographics, duration of operation, laparotomy or conventional laparoscopy necessity, drain use, complications, and hospital stay periods. To place the SILC port (Covidien, Inc.), the needle grasper was inserted at the right upper abdominal quadrant without an incision to hang and manipulate the gall-bladder.
  
  
  RESULTS
  The mean age was 47.9 ±13.068 years; the mean body mass index (BMI) was 26.94 ±3.913 kg/m2. ASA scores were 1, 2, and 3. Two patients with high BMI with additional trocar use were excluded. The operations were completed without any additional trocar in 59 patients. The mean operation time was 89 ±22.41 min. Eighteen patients required a drain; all were discharged after drain removal. One patient needed re-hospitalization and percutaneous drainage and was discharged on the 9thday. Fifty-three patients were discharged on the 1stpost-operative day. Eleven patients with drains were discharged on the 2ndday, and 1 was discharged on the 7thday. The mean hospital stay period was 1.26 ±0.815 days.
  
  
  CONCLUSIONS
  The main difficulty of SILC is to manipulate hand tools because the triangulation principle of laparoscopy use is not possible in SILC. Inserting a needle grasper into the abdominal cavity at the right subcostal area to manipulate the gallbladder helps and does not leave a visible scar.
authors.affiliation: Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Donmez
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Uzman
authors.affiliation: Department of General Surgery, Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.
authors.forename: Sina
authors.initials: S
authors.lastname: Ferahman
authors.affiliation: Department of General Surgery, Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.
authors.forename: Suleyman
authors.initials: S
authors.lastname: Demiryas
authors.affiliation: Department of General Surgery, Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.
authors.forename: Engin
authors.initials: E
authors.lastname: Hatipoglu
authors.affiliation: Department of General Surgery, Medical Faculty, Istanbul University Cerrahpasa, Istanbul, Turkey.
authors.forename: Server Sezgin
authors.initials: SS
authors.lastname: Uludag
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Dogan
authors.initials: D
authors.lastname: Yildirim
keywords: laparoscopic cholecystectomy; needle grasper; single port