0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Correspondence |

Transumbilical Laparoscopic Cholecystectomy

Alexander Julianov, MD, PhD; Anatoli Karashmalakov, MD
Arch Surg. 2010;145(4):402. doi:10.1001/archsurg.2010.31.
Text Size: A A A
Published online

Extract

We read with interest the article by Dunning and Kohli1 that described their technique for laparoscopic transumbilical cholecystectomy. We agree with the authors' concept that this intervention usually does not require specially designed laparoscopic equipment; however, we would like to add some comments.

The study objective and results can be obtained with minimal modification of the surgical technique, without excluding patients with stones larger than 5 mm and/or acute cholecystitis. We use a single continuous incision within the umbilical folds, 2 ports placed through that incision—one 10 mm and one 5 mm—and a single 10-mm 30° camera. The main difference in our approach comes from the concept of the retracting suture through the infundibulum of the gallbladder. We transfixed the latter with 2 or 3 stitches in a figure-of-eight fashion, with one end of the suture passed through the abdominal wall at the midline and the other at the anterior axillary line. This allows retracting the gallbladder in a desired lateral direction by maneuvering different ends of the suture, thus greatly facilitating exposure (video). When necessary, more retracting sutures can be passed in a similar way. This technique helps overcoming difficulties in exposure when adhesions or inflammation is present. The use of a flexible-end Maryland dissector facilitates dissection in such cases. In cases of large stones, we cut the fascial bridge between ports to remove the gallbladder and always close the fascia with sutures. No skin incision enlargement was necessary in our experience with 13 similar consecutive operations.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

April 1, 2010
Kyle Dunning, MD
Author Affiliation: Department of Surgery, Easton Hospital, Easton, Pennsylvania.
Arch Surg. 2010;145(4):402-403. doi:10.1001/archsurg.2010.32.
CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Related Multimedia
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();