Technique of double incision laparoscopic cholecystectomy (DILCH) as an alternative to SILS

Abstract

Background. Single incisions laparoscopic surgery (SILS) applied for cholecystectomy can ensure a good cosmetic effect expecting without no visible scarring cosmetic effect after surgical procedures, but needrequires implementation of special ports, as well as articulating and banked instruments to be more comfortable for the surgeon. The aim of this paper is to present three three-ports cholecystectomy through two well hidden incisions – umbilical and suprapubic, – performed by with typical laparoscopic instruments.

Methods. Ten consecutive elective patients with typical, symptomatic cholelithiasis were qualified for DILS cholecystectomy. All acute cases were excluded from intervention. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports, 5 mm and 11 mm, were inserted in the maximum external edges of this incision. The second incision for 11 mm optical trocar for optic was performed in the suprapubic median line, just in the hairy zonewithin the hair line, to hidden conceal himit.

Results. DILCH were performed without any conversions to classical LCH or open cholecystectomy. Each procedure was different according to technical improvement of access and manipulation of instruments manipulations. Time of interventions ranged between from 2 hours for the first patients to 1 hour for the last according to the learning curve. No complications were observed and all patients were discharged as after conventional LCH.

Conclusions. DILCH as a three three-port laparoscopic intervention, performed with typical laparoscopic instruments, is more convenient for the surgeon than single incision LCH. Transfer of the optic from the umbilical port site to hidden the concealed suprapubic hairy region gives thereprovides more space for instruments but didn’t did not spoil theed good cosmetic effect of intervention. This procedure is easy to learn and in case of technical problems we can always apply additional ports like foras in typical LCH.